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FOR CITY VALIDATION] <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER PI/RMI~d''NO <br /> 255 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> Date: <br /> <br />24 Hr Inspection Lin< 588-7904 <br />Oil's.e: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSI~ATION <br /> <br /> -TA <br /> g7 <br /> <br />PERM[TS AR.~ NON-TRAHSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED V, qTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />Co~tractor's License No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Pwp~rty Owner (pleasep.~) <br /> Mailing Address Phone <br /> City/State/Zip <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan <br /> 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 l$~11 <br /> <br /> Issued by: <br /> <br /> ?f,.. <br />4. FEE SCHRDULE (Completa and enter total in Al below) <br /> <br /> P SlDE i* gl COMMERCI* <br /> USE OF STRUCTURE: <br /> NEW El ALTERATION ~i~ ADDITION D RELOCATION <br /> GAS El or ELECTRIC ~ <br /> No. X Feo = 8mn <br />BASE FEE $10.00 <br /> <br />FORCED AIR F URNAC~ <br />up to 100,000 BTU ] $ 6.00 <br />ovor 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wal~ Heater $ 6.00 -- <br />FloorMoun~dH~atcr $ 6.00 -- <br /> <br />HEAT PLR~P <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR COI~}iTIOI~R <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCoolcr <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 6.50 -- <br />$11.00 -- <br /> <br />$430 __ <br />$4.50 -- <br />$4.50 -- <br />$4.50 -- <br /> <br />$ 3.00 __ <br />$ 3.00 -- <br />$ 7.50 -- <br />$ 7.50 -- <br />~0.00 -- <br /> <br />$ 7.50 -- <br />$ 7.50 -- <br />$7.50 -- <br />$7.5O __ <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (p=r outlet) <br /> 4 and up oudets (lgr outlet) <br /> <br />Appliance Vents not in¢ludad in <br />an appliance permit <br /> <br />OTHER (as required by Building Ol~ciaI) <br /> <br />DWELLING pERIVlIT LABEL # of Labels <br /> <br />$ 2.00 -- <br />$ 30 -- <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. ~4 <br />A2. Add 5 % surcharge (.05 x A 1) <br /> Subtotal <br /> <br /> B, Enter 25% of line A 1 for Plan R~vi~w <br /> (Al + .25), if r~quired <br /> C, Investigation Fe~ (if required) <br /> D. Remspection Fee ($25.00) <br /> <br /> TOTAL AMOUHT DUE <br /> Receipt No. <br /> <br />$ I/.~ <br />$.__ <br /> <br />$___ <br />$___ <br /> <br /> <br />