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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br /> Salem, OR97301 rr D ! k~! <br /> Dato: <br /> 24 hr. Inspection Line 373-4427 MARION COUNTY <br />omce: PhoneS88-5147 S:00am - .:3op~UiLD1NOSiN~j3~O' <br /> FAX: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF I~['ALLATION <br /> <br />Pro~rty Owner hoIm <br /> <br />Job Description: <br /> <br />PERMIT8 APE 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. CONTRACTOR INSrALLATION ONLY <br /> <br /> liB. FOR OWNBR INSTALLATIONS <br /> Prop~eq' Owner (please pri~t) <br /> Mailing Addreas Phone <br /> City/Statet~p <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br />3. PLAN RBVIBW SBCTION <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) set~ of plans and <br />specifications with this application. <br /> <br />MC 1541 <br />REV 8/96 <br /> <br />4. FIlE SCHEDULE (Complete and ente~lotalin A1 below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL <br /> USE OF STRUCTURE: <br /> NEW ~2 ALTERATION r~ ADDITION [3 RELOCATION <br /> GAS C] or ELECTRIC C] <br /> No. X F~o = 8urn <br />BASE FEE $10,00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 -- <br />over 100,000 BTU $ 7.00 <br /> <br />Nloor Furnace $ 6.00 <br />Suspended Heater $ 6.00 -- <br />Wall Healer $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT POMp <br />· eder 3 Ton _ ~. <br />3 Ton and up <br /> <br />AIR CONDITIONER <br />under3Ton $ 6.50 -- <br />3 Ton and up $11 .~ m <br /> <br />EvaporativeCooler $ 4.50 -- <br />Commercial Exhaust System $ 4.50 -- <br />Commercial Hood and Exhatmt $ 4.50 <br />Domestic Range Hood $ 4.50 __ <br />Domestic Exhaust Fans <br />and Dryer Vents $ 3.00 __ <br />Fire Damper $ 3.00 -- <br />Wood Stove/Fireplace $ 7.50 -- <br />Furnace Duets (Altexatic~/Ext~nsion) $ 7.50 __ <br /> <br /> 6.50 <br />$11.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gas Log Lighter $ 7.50 -- <br />Gas Barb~qu~ $ 7.50 -- <br />Other $ 7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Bulldog Ol~eial) <br /> <br />DWELLING PERMIT LABEL # of Lxh~ls <br /> <br />$ 2.00 <br />$ .50 <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />5. Fr~S <br /> Al. Enter total of fees from S~c. #4 <br /> A2. Add 555 aurcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. ~ler 25% of line A1 for P~ <br /> (Al + .25), if ~quired <br /> C. Investigation ~ (if~qMred) <br /> D. Remspeefion F~ ($25.~) <br /> <br /> Reeeipl <br /> <br /> <br />