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FOR CITY V~ALIDA.T~I~_N { <br />R~ceived by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />COMMUNITY DEVELOPMENT CENTE <br />285 Church St NE- Room 132 <br />Salem, OR 97301 <br /> Dato: <br /> MARION COUNTY <br />24 Hr Inspection Line: 588-7904 <br />Of F~ 588-5147 8:00ann.-4:30p.m. <br />FAX: 588-7948 <br /> <br /> 4. F~E SCHF~UL~ (Compl6te and ©nt~r tokai in Al be[ow) <br /> <br /> RESIDENTIAL <br /> USE OF STRUCTtmE: <br /> f <br /> <br /> NEW O ALTERATION"A~ ADDITION <br /> GAS El or ELECTRIC~'~ <br /> No. X F~o ~* Sum <br /> <br />PERMITS ARE NON-TRAHSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED '6qTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTP. ACTOR INSTALLATION ONLY <br /> <br />Mailing Address ~ ~). <br /> <br />Contractor's License No. <br /> <br />I ,ob.o. 9939 <br /> <br />Contractor's Board Reg. No. <br /> <br />liB, FOR OY~qER INSTALLATIONS <br /> <br />Prolgay Owner (ple, seprint) ~'~ <br /> <br />City/Stete/Zip ~O,l~$Ulk~ ~ e~ Ot'~'2~5 <br />Owne?aSignature: %~__ ~ <br /> <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU ~ $6.00 ~d~.OO <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 -- <br />Suspended Heater $ 6,00 -- <br />Wall Heater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 -- <br /> <br />HEAT pLrMp <br /> under 3 Ton <br /> 3Tonand up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Conunercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$4.50 __ <br />$4.50 -- <br />$4.50 -- <br />$4.5O __ <br /> <br />$ 3.00 <br />$ 3.00 <br />$7.5O <br />$ 7.5O <br />$50.00 __ <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbequ¢ <br /> Other <br /> <br />$ 7.50 -- <br />$ 7.5o __ <br />$ 7.5o __ <br />$7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> IA outlets (per outlet) <br /> 4 and up outlets (p~r outle0 <br /> <br />Appliance Vents not in¢lnded in <br />~ appliance permit <br /> <br />OTHER (as required by Buil~ag Ol~eial) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$ 2.00 __ <br />$ .50 -- <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan 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 1541 <br /> <br />5. FEES <br />A 1. Enter lotal of fees from S~c.//4 $ ~.o'O <br />A2. Add 5% aurebarg~ (.05 x Al) $ <br /> Subtotal $ <br /> <br /> B. ~ter25~ of lineAl for PI~ Review <br /> (Al + .25), if ~i~d $ <br /> C. l~estigation ~ (if~qM~) ~/ ~ ~ ~ <br /> <br /> _ TOT S <br /> Receipt No. <br /> <br /> <br />