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FOR CITY VALIDATION <br />R~iv~d by:~ <br />Date: <br /> <br />285 Church St NE · Room 132 ,/ <br />Salem, OR 97301 <br /> Da~e: <br /> <br /> 24 hr. Illspectlofl Line 373~27 <br />Office: Phone ~88~147 8:OOnm - 4:~pm <br />FAX: 588-7948 <br /> <br /> I <br />MECHANICAL PERMIT APPLICATION ] <br />Please complete all Sections, I through 5 <br /> I <br /> <br /> LOCATION OF INSTALLATION <br /> <br />Cross Strcet/Directiom: <br /> <br />/ob Descr~tion: <br /> <br />PF_,RMIT~ ARE NON-TRANSFERABLE AND EXHRE IF WORK IS NOT I <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPF2qDED POR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Marling Address <br />Contractor's License No. <br />Con~ra¢lor's Board Reg, No. /ob No. <br /> <br />Issued by: <br /> <br />4. FilIt SCHEDULE (Compl~t~ andent~ totalin Al below) <br /> <br /> R.EUSF~OE4~T~RD~cNTITui~! COMMI~RCIAL ~] <br /> NE~ ALTERATION O ADDITION 0 RELOCATI~''~ <br />G,~ I~- or ELECTRIC ~ No. X P~ ~'~Sum~ <br />BASE FEE ~.~ <br />I~RCED AIR FURNACE <br /> <br /> up to 100,000 BTU $ 6.00 <br /> over I(~C,,000 BTU $ 7.~0 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heatcr $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3Tonand up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton ~nd up <br /> <br />EvaporativeCooler <br />Commercial Exhaust Sy~m <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 4.50 <br />$ 4.~0 <br />$4.5O , <br />$4.50 , <br /> <br />$ 3.00 <br />$ &00 , <br />$7.~o ~ <br />$7.50 '-~-~' <br /> <br />O. Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Oher $ 7.50 <br /> <br />OAS PIP[NO SYSTEM <br /> 1-4 outlets (per omle0 <br /> 4 and up ootlets~(per outlet) <br /> <br />2.00 <br /> .5O <br /> <br />$3.~0 <br /> <br />FOR OWNJRR INSTALLATIONS <br /> <br /> ~. PLANREVII~W SECTION <br /> <br /> Marion County does not require a plan review. <br />We will provide pian 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 />REV 8/96 <br /> <br />Al. Enter tolal off~ from Sec. <br /> Add 5% su~harge (.05 x A 1) ~-~..b~bt- ~ $ . <br />B. Enter 25% of line A 1 for Plan Review <br />(Al + .25), if requital <br />C. Investigation Fee (if r~quired) $ <br />D. Rdr~I~tioa Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE $ <br />Receipt No. <br /> <br /> <br />