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FOR CITY VALIDATION[ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER pl:RMiT NO: <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Off'~ 588-5147 8:O0a.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 />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWH~R INSTALLATIONS <br /> <br />Prope~y Owner ~pleaseprint) <br />Mailing Addr~s lVaonc <br />CRy~tatclZip <br />Owner's Signature: <br />Agent's Sisn~ure: <br /> <br />D=~ <br /> <br />Issued by: <br /> <br />4. ~q~]~ SCI'~3DUL]~ (Complete and ente~ toLal ~ A1 be~w) <br /> <br /> RE~DB~I~ ~ CO~BRCI~ ~ <br /> U~ OF ~UC~: <br /> ~W ~ ~TION ~ ~DfflON ~ATION ~ <br /> GAS ~ ~IC ~ <br /> No. X F~ ~ Sum <br />B~E FEE $10~ <br /> <br />FORORD AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />FloorFumaco $ 6.00 -- <br />Suspended Hea~or $ 6~00 __ <br />WaU Heater $ 6.C0 -- <br />Floor Moun~.d Heater $ 6.00 -- <br /> <br />HEAT PUblP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR COIq~iTIOI~R. <br /> u~der 3 Ton <br /> 3 Ton and up <br /> <br />s <br />$tl.00 <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$4.5O <br />$4.~0 -- <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 -- <br />$ 3.00 -- <br />$7.~0 -- <br />$7.5O <br /> <br />O~ <br />Other <br /> <br />$ 7.~0 -- <br />$ 7,~0 <br />$ 7.~0 -- <br />$7.5O <br /> <br />OAS PIPIHO 8YS'I~M lA outlets (per oudct) <br /> 4 and up outlem (per omle~) <br /> <br />Appliauce Ven~ not included in <br />mm applinnce permit <br /> <br />OTHER (as eaqui~d by B~il~ Ot~ial) <br /> <br />DWELLINO PERMIT LABEL # of Labels <br /> <br />$ 2.00 -- <br />$ ,50 -- <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br /> 3. PLAN RBVIBW SECTION <br />IMarion 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 />M~ 15-41 <br /> <br />5. FBES <br /> A I. Ent~ total of fe~ f~om Sec. ~4 <br /> A2. Add 5% surch~e (.G5 x Al) <br /> <br />Subtotal <br /> <br />$ <br />$ <br /> <br />B, Enter 25% of line Al for Plan Rgvicw <br />(Al + .25), if required $ <br />C. Investigation Fee (ifr~quingl) $ <br />D. Reinspe~tion Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $ / ~o~Y <br />Rcccip~ No. <br /> <br /> <br />