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FOR CITY VALIDATION <br />Received by: <br />Dat~: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-~427 <br />Office: Phone S88-S147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all ,~ections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Phone# <br /> <br />PI~IVliT5 ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br />STARTED WITHIN 180 DAYS OF ISSUANC~ OR IF <br /> WORK IS SUSPILNDED FOR 180 DAYS. <br /> <br />CONTRACTOR ,INSTALLATION ONLY <br /> <br />Mailing Address <br />Contractor's Liceme No. <br />Contractor's Board Reg. No. Job No. <br /> <br />21]. FOR OWNifll IHSTALLATION$ <br /> <br />Agent's Signature: ~ J <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. ]~l~ ~CI=I~UL]~ (Complete and enter ~ <br /> <br /> RESIDE~I~ ~ COMMERC~ <br /> U~ OF ~RU~: <br /> ~ ~ AL~TION ~ ~DffION ~ ~OCATION <br /> GAS ~ or ~IC ~ <br /> No, X F~ ~ Sum <br />B~E FEE $10,W <br /> <br />FORCED AIR FURHACE <br />up to l00,000 BTU $ 6.00 -- <br />ovor 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall Hcnter $ 6.00 -- <br />Floor Mcunt~d Heater $ 6.00 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR COI~mOI~R <br /> under 3 Ton <br /> 3Toned ~ <br /> <br />~cs~c R~ge H~ <br /> <br />$ 6.50 <br />SILO0 -- <br /> <br />$ 6.50 -- <br />SILO0 -- <br /> <br />$4.50 -- <br />$4.5O -- <br />$4.50 <br />$4.50 <br /> <br />$ ~.oo <br />$7.50 -- <br />$7.50 -- <br />SZ0.00 <br /> <br />ADDITIONAL APPLIANCES <br /> Gm Water Heater <br /> Gas Log ~ghter <br /> Gna Barbequ¢ <br /> Other <br /> <br />$ 7.50 <br />$ 7.50 -- <br />$7.50 <br />$7.50 __ <br /> <br />GAS PIPINO SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per ouOe0 <br /> <br />Appliance Vents not included in <br /> <br />$ 2.~0 -- <br />$ 30 __ <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />3. PLANREVIBW SECTION <br /> <br />5. FEllS <br /> Al. Emer total of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete E. Enter 25% of line Al for Plan Review <br /> (Al + .25), if roquircd $ -- <br />Section 5B and submit two (2) sets of plans and c. Investigation Fee (if required) <br />specifications with this application. D. Reinsp~¢tion F~ ($25.00) <br /> , _~OTAL AMOUNT DUll $. <br />MC 15-41 Receipt No. ,/ ' <br /> <br /> <br />