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FOR CITY VALIDATION] <br />Received by: <br />Date: <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />31§0 LANCASTER DR NE - SUITE C <br />SALEM OREGON 9730§-1398 <br /> <br />24 Hr Inspection Line: 588-7904 <br />OIT~e~ 588-5147 $:00a.m. - 4:30p.m. <br />FAX: 588:7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />PERMITS ARE NON-TRANSFERABLE AHD EXPIRE IF WORK IS NOT <br /> ~TARTED WITHIN ! 80 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR LNsTALLATION ONLY <br /> <br />Conlrnctor's Lleense No. <br /> <br />Cen~'aelor's Board Reg. No. 7~=.~4 JobNo. ,~ <br /> FOR OWHBR INSTALLATIONS <br /> <br />l'mi~rly Owner (plesseprir~) <br /> <br />Cit ylSts{efZip <br /> <br />:3. PLANRBVIBW SBCTION <br /> <br /> Marion County does not require a plau review. <br />We will provide plan review sewice if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications wi~ ~i, application. <br /> <br />A~ I.~I <br /> <br />4. FBI] SCHEDULE (Comp{ere and enter Iota{ in A I below) <br /> <br /> RESI DENTIAL-~ COMMERCIAL ~] <br /> USE OF STRUCTURE: <br /> HEW ~1 ALTERATIOH'~ ADDITION CI RELOCATION D <br /> GAS'~ or ELECTRIC C] <br /> No. X Fe~ = Sum <br /> <br />FORCED AIR FURNACE <br />u~ to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6,00 <br />Suspended Ilester $ 6.00 <br />Wall lien{er ~--- $ 6.00 <br />Floor Mounted Ileater $ 6.00 <br /> <br />IIEAT PD~4P <br />trader 3 Ton $ 6.50 <br />3 Ten and up $ I 1.00 <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $ I 1.00 <br /> <br />Eva~oral{veCcoler $ 4.50 <br />Commercial Exhatlst S ynlella $ 4, 50 <br />Commercial Itood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 <br /> <br /> md D~er Vents $ 3,00 <br />Fire Damper $ 3.00 <br /> <br />ADDITIONAL APPLIANCE5 <br />Oas Water tleater $ 7.50 <br />O~ Log Lighter $ 7.50 __ <br />Oas Barbeque $ 7.50 -- <br />Other S 7.50 <br /> <br />OAS PIPINO 8YSFEM <br /> I~1 outlets (per outlet) <br /> 4 sad op outlels (per outlet) <br /> <br />$ 2.00 <br />$ .50 <br /> <br />$ 3.09 <br /> <br />N/C <br /> <br />5. FEE5 <br /> A I. Enter Iota{ of fees from Sec. If4 <br /> A2, Add $% surcharge (,05 x Al) <br /> <br />B, F~tcr 25% of line A 1 for Plan Review <br /> (Al + ,25), if required <br />C. Investigation Fee (if required) <br />D. Rein~pection Fee ($25.00) <br /> <br /> TOTAL MdOUHT DUE <br />Receipt No. <br /> <br /> <br />