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FOR CITY VALIDATION] <br />Received by:_ <br />Date:~ J <br /> <br />MARION COUNTY BUILDING INSPECTIOI~-/~ (~I~ I'~ ~'~ ~ <br />COMMUNITY DEVELOPMENT CENTER pl::N~ ~:~_~/.~/~ ~ } ~ <br /> 285 Church St NE. Room 132 "m~' ~ <br /> Salem, OR 97301 ~ IJ ~. '3 <br /> D at oT'. ~ ~~C~ <br /> 24 Hr In~ectina Line: 5SS-7904 Issued by'MARION COUNTY <br /> ogrme: $88-5147 8:OOa.m.-4:3Op.m. <br /> F~C(: 5SS-~)4S ~'[~ILD-'-~T~ iNSP--'~'~-~'ON <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />PERMr~ ARE NON-TRAHSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor'a Board Reg, No. <br />Con~¢tor'~ _si~~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Prop4m'y Owner (ple~s~pdtg) <br />Mailing Address ] Phone <br />City/Slate/Zip <br /> <br />Own~r'a Signature: <br /> <br />Agent's Signaturo: <br /> <br /> 3. PLANRBVIBW $t/CTION <br />IMarion County does not require a plan review. <br /> We will provide plan review se~vi~e if you complete <br /> Section SB and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-41 <br /> <br />4. FEB SCHEDULE (Complat~ and enter total in Al below) <br /> <br /> RESIDENTIAL I~ COMMI~RCIAL I-'l <br /> U~£ OF STRUCTURE: <br /> NEW [3 ALTERATION I~ ADDITION I~ RELOCATION <br /> <br /> GAS ~] or ELECTRIC ~ <br /> No.X Fee ~ <br />BA~E FEE <br /> <br />FORCED ALR FURNACE <br />~ ~ 1~0 B~ $ 6.00 <br />~er 1~,~0 ~ ~ $ 7.00 <br /> <br />Sus~d Hendr $ 6.~ <br />~r Mo~d H~t~ $ 6.~ <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 -- <br />$ Ton and up $11.00 -- <br /> <br />/tlR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 ~ <br /> <br />EvaporativeCool~r $ 4.50 -- <br />Domestic R ~ $4.50 ~ <br /> <br />Furn~¢o Du¢~ (Alte~ttion/~xlan~ion) ~ $ 7.50 <br /> <br /> O~ Barbeque $ 7.50 -- <br /> I-4outl¢la (p~routn*t) ~ $ 2.00 ~L~ <br /> <br />OTH]~R (ss r~ndred by Ruil~g Of~e#t0 <br /> <br />DWELLING PERMIT LABEL <br /> <br />Al, Enter total of fees from Sec. <br /> <br /> Subtotal <br /> $---- <br /> <br />B. Enter 2555 of line Al for Plan Reviow <br />(Al + ,25), if required <br />C. lnveatigntion Fee (if required) $.__ <br />D. Reinspection Fee ($25.00) $.__ <br /> <br /> TOTALAMOt rrD <br />Receipt No, <br /> <br /> <br />