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IF. OR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone ~88-5147 8:00am - 4:30pm <br />FAX S88-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PROPERTY OWNER <br /> <br /> OWNER'S <br /> PHONE # <br /> <br /> CROSS STKEET/ <br /> DIRECTIONS <br /> <br />PROJECT DESCRIPTION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S 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 />Property Owner (please prinO <br /> <br />Mailing Address <br /> <br />City, State, Zip <br /> <br /> Owner's Signature <br /> <br /> Agent's Signature <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 15-41 7/97 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al I~low) <br />RESIDENTIAL [~ COMMERCIAL [~ USE: <br /> <br /> NEW I'[ ALTERATION O ADDITION f*l RELOCATION <br /> GAS {~ ELECTRIC f"[ <br /> <br />FORCED AIR OVER 100,000 BTU x $%00 = $ <br /> <br />HEAT PUMP <br /> <br />COML. <br /> <br />5. FEES Al. Enter total &fees from See. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of lin~ Al for Plan Review <br /> (Al + .25), if requlr~l <br />C. Investigation Fee (if requlred) <br />D. R¢inspection Fee ($25.00) <br /> <br />R~ceipt No. <br /> <br />SubtoM <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />