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FOR CITY VALIDATION <br />Received by:, <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> PERMff NO: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />24 Hr Inet'mn Linc: 588-7904 <br />Offke: 588-514.7 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />AR~ NON -~t~aNSi~,ABLE AND ~XPIRE IF WORK IS NOT <br /> STARTED wrrHIH 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLylON ONLY <br /> <br />Co,~,,~',~ng. No..~ ~ ] ~No. <br /> '~ ~ ~ .- <br /> <br />2B. FOR OWHI~R INSTALLATIONS <br />l~op~ Owner ~/e~ prir~) <br /> <br />Mailing Address Phone <br />City/State/Zip <br />Owner's Signature: <br />A~nt's Signnture: <br /> <br />4. F~lq SCH]~I~UL]~ (Complete andent~tolal h~Al b~low) <br /> <br /> R~DE~I~ ~ CO~ERCI~ ~ <br /> U~ OF ~U~: <br /> N~ ~ AL~TION ~ ~DffION ~ ~AT[ON ~ <br /> GAS ~ or~E~lC ~ <br /> No. X F~ ~ 8urn <br />B~E F~ $1~ <br /> <br />FORCED AIR FURNACE <br />up to lOO,OOO BTU I $ 6.00 -- <br />over 100,000 BTU $ 7.00 <br /> <br />FloorFumace $ 6.00 -- <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 -- <br />Floor M~nt~d H~r I $ 6.00. <br /> <br />H~AT PUMP <br />under3Ton $ 6~50 -- <br />3 Ton andup SILO0 <br /> <br />AIR COHDITIOH~R <br />under 3 Ton $ 6.50 -- <br />3 Ton and up ~ $11.00, <br /> <br />Evaporativ~Cooler $ 4.50 -- <br />Commercial F.4chaust Systom $ 4.~0 -- <br />Commercial Hood and Exhaust $ 4.~0 -- <br />Domestic Range Hood $ 4.~0 <br />Domestic Exhnu~ Fans <br />and Dry~ Ven~ $ 3.00 <br />l:h~ Damper $ 3.00 -- <br />Wood S~ow/Firopl~0e $ 7.~0 -- <br />Furnace Do¢ts (Alt~ration/Ext~.~ion) $ 7.~0 -- <br />Con,hernial ! lndu~liai Incinerator $30.00 <br /> <br />Gas Log Lighter $ 7.50 <br />~ Bm~quo $ 7.50 <br />Oth=r $ 7.50 <br /> <br />GAS PIPING 8YfffEM <br /> 1~[ outlets (per outlot) <br /> 4 and up outlets (per <br /> <br />Appliance Vents ~ ~cl~ in <br />~ appliance pe~it <br /> <br />~HER (as ~ui~d by ~1~ O~c~l) <br /> <br />D~INO ~ff L~ ~of ~h <br /> <br />$ 2.00 <br />$ .5O <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />3. PLANREVIBW SI~CTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-41 <br />t~ov. 12/P4 <br /> <br />5. FEES <br /> A 1. Emir to~al of f~es fi~m See. fi4 <br /> A2. Add 5% ~hargo (.05 x A 1) <br /> <br />Subtotal <br /> <br />B. Eater 25% of line A1 for Plan Review <br /> (Al + .25), if requi~d <br />C. Investigation Fee (if required) <br />D. R~in~pect~n Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />R~¢oipt No. <br /> <br /> <br />