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FOR 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 8:0Barn - 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 />~TAX ACCOUNT NO. <br /> CROSS STREET/ <br /> ,\ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please pdnO <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 Al below) <br />RESIDENTIAL ~-COMMERCIAL [~ USE: <br />NEW [] ALTERATION ~ ADDmON [] RELOCATION ~ REPLACE <br /> <br /> GAS ~ ELECTRIC <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />FURNACE OTY <br />FORCED AIR UP TO 100,(~0 BTU x $6.00 = $ <br />FORCED AIR OVER 100,0~0 BTU x $7.C0 = $ <br /> <br />FLOOR ~URNACE x $6.00 = $ <br />DUCTS (ALTEIL~TION/EXTENSION) x $7.50 = $ -- <br />GAS INSTALLATIONS <br />GAS FURNACE (up to 100,000BTU) x $6.CO =$ __ <br />GAS FURNACE (over IC4),000 BTU) x $7.00 = $ __ <br />GAS FIREPLACEONSERT x $7.50 -- $ <br />GAS WATER HEATER x $7.50 <br />GAS LOG LIGHTER x $7.50 = $ -- <br />GAS BARBEQUE x $7.50 = $ <br /> <br />GAS PIPING <br />Each outlet up to 4 outlets ~ x $2.C~ <br />Each additional outlet over 4 oude~ x $.50 = $ __ <br /> <br />HEATERS <br />SUSPENDED HEATER x $6.C0 = $ <br />WALL HEATER x $6.00 = $ __ <br /> <br />5. FEES Al. Ellter total of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), ffrequired <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt NO. <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br />$ ~,~,~o <br /> <br />MC 15-41 7/97 <br /> <br /> <br />