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FOR CITY VALIDATION Received by: Date: MARION COUNTY ' BUILDING INSPECTION DIVISION 3150 LANCASTER DR NE - SUITE C SALEM OREGON 97305-1398 24 hr. Inspe~lon Line 373-4427 Office: Phone 588-$147 8:00am - 4:30pm FAX: 58~-7945 I MECHANICAL PERMIT APPLICATION [ Please complete all ~ections, I through 5 I 1. LOCATION OF INSTALLATION % ~ ~ NON-~S~LE ~ ~ ~ WO~ IS NOT STAR~ ~N l~ DAYS OF ISSU~ OR W I WO~ ~ SUS~ FOR 1~ DAYS. 2A. CONTRACTOR INSTALLATION ONLY 2B. FOR OWNER INSTALLATIONS Mailing Add~ ~ty~p 3. PL~BW S~TION Madon Coun~ does not r~uim a p~ review. We will provide pl~ review se~ice if you compl~e S~fion 5B and submit ~o (2) sero of pla~ and I s~cificafions wi~ ~is application. PERMIT NO: Date: Issued by: 4. FEE SCHEDULE (Comple~ and emer tolal in A l be~w) ~SID~I~ O COMMERC~ ~ u~ oF ~u~: ~~ ~~ N~ ~ ~TION ~ ~D~ON ~ ~ATION ~ GAS ~ or ~E~'I'KfC ~ N~ X Pm = ~ B~E FEE $1~ FORCED AIR FURNACE upto 100,000nTU $ 6.00 __ over 100,000 BTU $ 7.00 Floor Fumnce $ 6.00 Sasl~ Heater J $ 6.00 Wall Hea~er $ 6,00 __ F/oor Mounted H~r $ 6.00 HEAT PUMP under 3 Ton $ 630 -- 3 Ton and up $11.00 -- AIR CONDITIONER unde~ 3 Ton $ 6.~0 -- 3 Ton and up $11.00 -- Evapora~iveCool~r $ 4,50 -- Commercial Exhaust System $ 4.50 -- Commercial Hood ~nd Exhaust $ 4.50 -- Dom~i¢ Range Hood $ 4.50 -- Dome~tio Exhaust Fans ~d Dryer Vents $ 3.00 -- Fir~ Damper $ 3.00 -- Wood StovdPireplaee $ 7.50 -- Furnace Due~ (AIteration/Extemion) $ 7.50 -- Commemi~l / lndm~isl Incinerator $30.00 -- Log Lighter $ 7.50 Bad~equ~ $ 7.50 -- OIher $ 7.50 -- GA5 PIP[NO SY~'EM 14 outlels (per outlet) I $ 2.00 4 and up outlets (per cutlet) $ 30__ 5. FEES Al, Enter totalof fees from Sec,//4 A2~ Add 5% surcharge 605 x Al) B. Enter25% ofliaeAl forPlanRevicw (Al + .25), if required $.__ C. Investigation Fee (if requited) %__ D. Reinspec tion Fee ($25.00) $.__ TOTAL AMOUNT DUE $.__ Receip~ No.