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FOR CITY VALIDATION [ <br />Receive~ by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE ' Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am-4:30pm <br />FAX: 588-7948 <br /> <br />PERMIT NO: <br />r).to: II -97 <br /> <br />Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />,ob^dr=, t 0 7 T/4 <br /> <br />PETE <br /> <br />Cross StreeUDireedons: <br /> <br />.lob Descr~tion: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND ~XPIRE IF WORK IS NOT <br /> STARTle} WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR nqSTALLATION ONLY <br /> <br />Contra¢~or~ HE- -TDO( col <br /> <br />Conlrnclor', License No. <br /> <br /> 2B. FOR OWHER I~STALLATIONS <br /> I~olgr~ Owner (ple~s~ <br /> Mailing Addr~a Phone <br /> City/State/Zip <br /> Owner's Signature: <br /> Agent's Signnture: <br /> <br />~. PLANREVIEW SECTION <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 1541 <br /> <br />4. ~q~E SCHEDULE (Complete and enter totalinA1 below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL [2] <br /> USE OF STRUCTURE: <br /> NEW I~ ALTERATION ]i~ ADDITION I~ RELOCATION [] <br /> GAS ~ or ELECTRIC 2~- <br /> NO. X Fee ~ Sum <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 />Floor Fuma~ $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall Heater $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Water Heater <br /> Ga~ Log Lighter <br /> G~ Barbeque <br /> Other <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per oudet) <br /> 4 and up outlets (,per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Buil~tlg Ol~cia0 <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$11.00 <br /> <br />$ 6.50 __ <br />$11.00 <br /> <br />$4.50 <br />$4.50 <br />$4.50 -- <br />$4.5O -- <br /> <br />$ 3.00 -- <br />$ 3.00 <br />$ 7.50 <br />$ 7.50 <br />$30.00 <br /> <br />$ 7.50 <br />$7.5o <br />$ 7.5o __ <br />$ 7.5o <br /> <br />$ 2.00 <br />$ 50 <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec. g4 <br /> A2. Add 5% surcharge (.05 x Al) ,Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25). if r~quir*d <br /> C. Investigation Fee (if raqui~ed) <br /> D. Reinspection Fee ($25.00) <br /> <br /> YOTAL ~ougr mm <br /> Receipt No. <br /> <br /> <br />