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FOR <br /> CITY VALIDATION <br />Received by: <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER ~_._~" <br />285 Church St ~ · Room 132 PERMH' NO: <br /> <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 /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Property <br /> <br />Cross StreeYDirections: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />~) COlqTRACTOR~ I~STALLA, T~ION..O]~ Y ~)t 5Ogl ~ <br /> <br /> Mailing Addr~s <br /> <br /> Pcopelty Owner (please print) <br /> Mailing Addve$~ Phone <br /> City/State/Zip <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br /> 3. PLAN RFIVIBW SECTION <br /> <br /> Marion County does not require a plan review. <br />I We will provide plan review service if you complete <br />I Section 5B and submit two (2) sets of plans and <br />I specifications with this application. <br /> MC 1541 <br /> REV 8/96 <br /> <br />Date: ~ <br />Issued by~ <br /> <br />4. FBE SCHEDULE (Complete ~1 ~ater total in Al below) <br /> <br /> RESIDElCFIAL [~[ '~2OMMERCIAL <br /> USE OF STRUCTURE: ,~ <br /> NEW Q ALTERATION El ADDITION ~' RELOCATION El <br /> <br /> GAS El or ELECTRIC ~l ~ <br /> No. X Fee <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br />overUP to 100,000100'000 BTU -/T-- $ 6.00 <br />BTU ~ $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br /> <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton ~ $ 6.50 <br />3 Ton and up ~,~ $11.00 <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Tonand up $11.00 <br /> <br />EvaporativeCooler $ 4.50 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 <br /> <br />OAS PIPING SYSTEM '~-~ <br />1-4 outlets (perouOet) ~ $ 2.00 <br />4 and up outlets (p~r outlet) $ .50 <br /> <br />Appliance Vents not included in <br />an appliance permit $ 3.00 <br /> <br />OTHER (as required by Buile~ng Or, ciaO <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />5. FF~S <br /> Al. Enter to~alof fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> ~ubtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigation Fee (if required) <br /> <br /> Receipt No. <br /> <br /> <br />