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IFOR 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 588-5147 8:00am - 4:30pm <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 />1. LOCATION OF INSTALLATION <br /> <br /> CROSS <br /> D~C~ONS <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> p.oNE I 1ot: 1-1 II II-- <br /> <br /> CONTRACTOR'S SIGNATURE ~ <br /> <br />2B. FOR OWNER INSTALLAT] <br /> <br /> Property Owner (p/ease print) <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 />4. FEE SCHEDULE (Complete and enter total in A1 below) <br />RESIDENTIAL ~ COMMERCIAL [~ USE: <br />NEW {~ ALTERATION ~ ADDITION ~ RELOCATION ~l REPLACE <br /> GAS ~ ELECTRIC {~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />FURNACE OTY <br />FORCEDAIRUPTO t00,~00BT0 x $6,00 =$ <br />FORCED AIR OVER 100,000 BTU x $7,00 = $ <br /> <br />FLOOR FURNACE x $6.00 = $ __ <br />DUCTS (ALTERATION/EXTENSION) x $7.50 = $ <br />GAS INSTALLATIONS <br />GAS FIdRNACE/up to 1~0,~00 BTU) x $6.00 = $ __ <br />GAS FURNACE/ove~ 100,~00 BTU) x $7.00 = $ __ <br />GAS FIREPLACE/INSERT x $7.50 = $ <br />GAS WATER HEATER x $7.50 = $ <br />GAS LOG LIGHTER x $7.50 = $ __ <br />GAS BARBEQUE x $7.50 = $ __ <br />GAS FIFING <br />Each outlet up to 4 outlets x $2.C~ = $ <br />Each additional outlet over 4 outlets x $.50 = $ __ <br /> <br />HEATERS <br />SUSPENDED HEATER x $6.00 = $ <br />WALL HEATER x $6.00 = $ __ <br />FLOOR MOUNTED x $6.00 = $ <br />HEAT PUMP <br />UNDER 3 TON x $6.50 = $ <br />3 TON AND MORE x $1L00 $ <br /> <br />5. FEES <br />Al. Enter total of fees fram Sec. g4 $ <br />A2. Add 5% su~harge (.05 x Al) $ <br /> Subtotal $ <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-41 7/97 <br /> <br /> <br />