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FOR CITY VALIDATION <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT ~: <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 /> I <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Property Owner (.~ ~T' ~ <br /> <br />Cross StreetJDirectiom: <br /> <br />PER/rUTS 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 />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2,B. FOR OWNER INSTALLATIONS <br />Property Owner (ple~seprir~) <br />Mailing Address Phone <br />City/StatetZJp <br />Owner's Signature: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FBB SCHEDULB (Complete and en~ total in A1 below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL <br /> USE OF STRUCTURE: <br /> NEW ~2 ALTERATION O ADDITION 12 RELOCATION <br /> GAS ~ or ELECTRIC O <br /> No. X <br />BASE FEE $10.~0 <br /> <br />FORCED AIR FURNACE <br />up to 100,00O BTU $ 6.00 <br />over 100,000 BTU $ 7.00 -- <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 -- <br />Wall nester $ 6.00 -- <br />HoorMounted Heater $ 6.00 -- <br /> <br />HEAT pUMP <br />muder 3 Ton $ 6.50 <br />3 Ton and up $11.00 -- <br /> <br />AIR CON/)[TIOI'~R <br />under 3 Ton $ 6.50 -- <br />3 Ton and up $11 .iX) <br /> <br />EvaporativcCooler $ 4.50 -- <br />Commercial Exhaust System $ 4.50 <br />Commercial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 -- <br />Domestic Exhaust Fans <br />and Dryer Vents $ 3.00 -- <br />Fit* Damper $ 3.00 -- <br />Wood Stove/Firepla~ $ 7.50 -- <br />Furnace Ducts (AIt~rstion/Extcoaion) $ 7.50 -- <br />Conunercial / lndus~al Incinerator $30.00 -- <br /> <br />GAS PIPINg} SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vealt~ not included in <br />an appliance permit <br /> <br />OTHER (as required by Buil&'qg OB~cial) <br /> <br />DWELLING PERMIT LABEL # of LabEls <br /> <br />$ 2.00 <br />$ 50 <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />3. PLANRBVIBW SBCTION <br /> <br />Marion County does not require a plan review. <br />We will pwvide plan review service if you complete <br />Section SB and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />REV 8/96 <br /> <br />5. FF~,S <br /> A 1. Ent*r total of f~s fwm Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (A 1 + .25), if required <br />C. Investigalion Fe~ (if required) <br />D. Reimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br /> <br />