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FOR CITY VALIDATION <br />R~ooived by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION {~'"'~ ~(.O~ <br /> 285 Church St NE. Room 132 PERMII NO: q(~ - . / <br /> <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> Salem, OR 97301 <br /> <br /> 24 hr, Inspection Line 373-4427 <br /> Office: Phone 588.5147 8:OOam - 4:30pm <br /> FAX: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete etl 8actions, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />~._,,~[ ~~_~.~ ~~~/~~Cootractor's Signature. <br />2B. FOR OWNER <br /> <br />Pmpe~ Own~i- (please prino <br /> <br /> I <br />Mailiog <br /> Address [ Phone <br />City/State/Zip <br /> <br />Owtter's Signature: <br /> <br />Agent's Si~: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. ~]~ ~CH]I~DULE (Complete and ~ ~1 ~ Al below) <br /> ~81DE~I~_ COMMERCI~ ~ <br /> U~ OF ~RUCT~: <br /> NEW ~ AL~TION ~ ~DfflON~OCATION ~ <br /> GAS ~ or ELEC~IC ~ <br /> ~. X F~ = Sum <br />B~E FEE $10.~ <br /> <br /> FORCED AIR FURNACE <br /> apio 100,000 BTU ,, $ 6.00 <br /> over 100,000 BTU $ 7.00 -- <br /> <br />~FIoor Furnace $ 6.00 <br />Suspended Healer $ 6.00 <br />Wall Heater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 <br />3Ton and up $iL00 <br /> <br />A1R CoNDmOI~R <br />und~r 3 Toa $ 6.50 <br />3 Ton and up $11.00 <br /> <br />EvaporativeCoolcr $ 4.50 <br />Commercial Exhaust S~tem $ 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 />Fire Damper $ 3.00 <br />Wood Stove/Fireplace $ 7.50 <br />Furnace Duets (Alteration/Extension) $ 7.50 <br />Commemial / Indualrial Incinerator $~0.00 <br /> <br />ADDITIONAL APPLIANCES <br />Oas Water Heater $ 7.50 -- <br /> Gas Log Lighter · $ 7.50 <br /> Oas Barb~q~ $ 7.50 -- <br /> Other $ 7,50 <br /> <br />GAS PIPING Sy$'I~M <br /> r~ <br /> 1-4 outlots (per outlet) ~ <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliame permit $ 3.00 -- <br /> <br />OTHER Os required by ~uil~tl~ Ol~ciaO <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$ 2.00 ,~ ~ <br />$ 30 t <br /> <br />N/C <br /> <br /> 3. PLAN RBVIBW SECTION <br />IMarion 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 /> REV 8/96 <br /> <br />5. FI~S <br /> Al. Enter total of fee~ from S~. gt4 <br /> A2. Add $% surchar~ (.OS x A l ) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), ifraquirod <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br />Receipt No. <br /> <br /> <br />