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FOR CITY VALIDATION <br />R~c~ivvxl by:. <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF IN'STALLATION <br /> <br />P]~,M1TS AR~ NON-'rP~VSFI{{L~BLE 3aND ~PIR~ IF WORK IS NOT <br /> SrAR'rI~L~ ~ 1~) DAYS OF ISSUANCE OR [F <br /> WORK IS SUSPI~IDHD [:OR 180 DAYS. <br /> <br />Date: <br /> <br />I gA. COI~TRACTOR INb'rALIdiTION ONLY <br /> <br />M~iling Add~ess <br /> <br />Contractor's f~ NO. <br /> <br />24 Hr Inspection Line: 588-7904 <br />Off'w.~ 58~-5147 8:00 ann. - 4:30 p.m. J~U~ by.* <br />FAX: 588-?948 <br /> <br /> 4. ~1~ ~CHBDUL~ (Complete and enler Iotel in Al b~low) <br /> <br /> RESIDENTIAL J~',~ COMMERCIAL f-I <br /> USE OF STRUCTURE: f/"O <br /> NEW ~q ALTERATION ,~DDITIoN <br /> /~l~ff~S ~' or ELECTRIC <br /> g~,, N~ X Pc* = Sum <br /> FEE $1o. o0 <br /> <br /> I~)RCI~D AIR FURNACE <br /> uplo 100,000 BTU $ 6.00 -- <br /> over 100,000 BTU $ 7.00 <br /> Floor Furnace .ff-.L) $ 6.00 <br /> Susl~ridcd Hester ~ $ 6.00 <br /> Wall H~ater $ 6.00 <br /> Floor Mounted H~r $ 6.00 <br /> <br /> HEAT pUMP <br /> I un&r 3 Ton $ 6.50 <br /> 3 Ton add up $11~) <br /> AIR CONDITIONER <br /> under 3 Ton $ 6.$0 <br /> 3 Ton and up $11.00 <br /> <br /> EvaporaliveCeoler $ 4.50 <br /> ~ia[ Exhsusi System $ 4.50 <br /> Commercial Hood and lLv. hauzt $ 4.50 <br /> Domestic Range Hood $ 4.50 <br /> Domca6c F~&ausi Fans <br /> and D~r V~te $ 3.00 <br /> Fire Damper $ 3.(i0 <br /> Wood S IovedFi~plae~ $ 7.50 <br /> Furnace D~ete (AIterat in~Exi~alsion) $ 7.50 <br /> Commereinl ! lndus~ial l~¢inerator $30,00 <br /> <br /> ADOITIONAL APPLIANCES <br /> Oas Water Healer $ 7.50 -- <br /> Gaa Log Lighter $ 7.50 <br /> (]mm Bnrbex]u~ $ 7.~0 <br /> Other $ 7.50 -- <br /> OAS PIPINO SYSTEM 1 1 I ! <br /> 1-4 outkt~ (p~roml~) $ ZOO <br /> 4andupomlels(l~routlet) $ .50 -- <br /> <br /> Appliance Venl~ not included in <br /> m appliance permit <br /> OTHER (as se. quirodby B~ildir~ O~¢iaO ],~ ~ -- <br /> DWBLLINO PERMIT LABEl. #of <br /> <br /> 3. PLANRBVIBW SBCTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review ~rvice if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />~ 1541 <br />l~v, 12/°/4 <br /> <br />5. FBES <br />Al. rmter totelof fee~ from See./~ $ <br />A2. Add 5% surcharge (.05 x Al) $ <br /> <br /> B. Eater 25% of line A 1 for Plan R~view <br /> (Al + .25), ifrequ~ed $ <br /> C. Investigation F~e (if required) <br /> D. Reinspection F~e ($25.00) <br /> <br /> TOTAL AMOIJNT DUE $ <br /> Receipt No. <br /> <br /> <br />