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FOR CITY USE ONLY Received By: Date: Zoning By: City: Receipt #: Amount: $ MECHANICAL PERMIT APPLICATION I Please complete all Sections, I through $ I 1. LOCATION OF INSTALLATION Tax Lot: ~)~ City: Parcel Owner: pER~IITS ARE NON-TRANSIIERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER I "SF.I US ON THE WEt 3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 WWW.O~EiiJB$/HeBiiiID 8:00am - 4:30pm (503)588-5147 Inspection Line (503) 373-4427 FAX (503) 588-7948 Web page acmess - use lower casa letters 4. FEE SCHEDULE (complete and eater total in Al) iA. ~?ONTRACTOR INFORMATION -- PLEAS~ INDICATI~ ~ ~1~O IS DOING THE WORK (' ~2~ ~ ~}~ ~ Contractor: Mailing Address: City: State: Zip: Fax: Contractors Board Registration No.: Contractor's Signature: 2B. FOR OWNER INSTALLATION prope~y Owner: (please print) Mailing Address: City: State: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. 1 understand that I must register as a construction COhO'actor if the structure is sold or offered for sale before or upon completion. If l hire subcontractors, 1 will hire only subcontractors registered with the Construction Contractors Board. lfl change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately notify Marion County of the Owner's Signature: Agent's Signature: 3. PLAN REVIEW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and subm/t t~o (2) ~ets of p mas and spec ficafions w th th s app icat on. MC 154I Rev 11/99 RESIDENTIAL ( ) COMMERCIAL ( ) GAS ( ) ELECTRIC NEW ( ) ADDITION ( ) ALTERATION RELOCATION ( ) REPLACEMENT OTY Furnace (includes ducts / vents) Forced Air up to 100,000 BTU -- x $18.00 = $ -- Forced Air over 100,000 BTU -- x $22.00 = $ -- Floor Furnace -- x $18.00 = $ -- Ducts (Alterations/Extension) -- x $16.00 = $ -- GasFumace(uptol00,000BTU) -- x $18.~0=$__ Gas Furnace (over 100,000 BTU) -- x $22.00 = $ -- Gas Fireplace / Insert -- x $I6.00- $ -- Gas Water Heater -- x $16.00 = $ -- Gas Log Lighter -- x $16.00 = $ -- Gas Barbeque -- x $16.00 = $__ Gas Piping Each outlet up to 4 outlets -- x $6.00 = $ -- Each additional oudet over 4 outlets -- x $2.00=$__ Heaters Suspended Heater -- x $18.00=$__ 5. FEES BABE FEE Assessed on ALL APP£1CATION$: For issuing each supplemental permit Al. Enter total &fees from Sec. g4 A2. Add Slate Surcharge (.07 x Al '- Base Fee) $ -- x $8.00 = $ $ $ SUBTOTAL $ $ $ 30.00 B. Enter .30 x line A I for Plan Review C. Investigation Fee (if required) (same as Al) D. Rehnspection Fee ($50.00) $ E. Additional Plan Review ($62.50far, mininmm one-half hour) S.__ nspection for which no fee is specifically indicated, - O (,62.50/hr, minimum one hour)~ '~"'~1~ &~ $~ G. Inspection Outside Normal Business lto-ff?~, fN I' ~ ($62.50/1~, minimum two hours) ~-AS'~ O~V $. H. Seismic Fee <.01x Al)) ~ (~]_Og~)"~ *. TOTAL AMOUNT DUE Checks received for the payment of fees, and returned by the bank for insufficiem fimds, or any other reason, shall be assessed a $25.00 "returaed cheek" charge.