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R CITY VALIDATION <br /> <br /> ivcd By: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancasinr 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 />P~RM~T NO~ <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PROPERTY OWNER <br /> <br />IPERM1TS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />PropeRy Owner (please p6nt) <br />Mailing Address <br /> <br />City, State, Zip <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 ^DD ON n oc^ om n <br /> GAS ~ ELECTRIC ~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS <br /> <br />FORCED AIR UP TO 10O.000 BTU <br />FORCED AIR OVER 100,000 BTU <br /> <br />FLOOR FUILNACE <br />DUCTS (ALTERATION/EXTENSION) <br /> <br />GAS FURNACE (up to 100,CO0 BTU) <br /> <br />GAS FURNACE (over 100,000 BTU) <br />GAS FFREPLACEdNSERT <br />GAS WATER HEATER <br />GAS LOG LIGHTER <br /> <br />GAS BARBEQUE <br /> <br />GAS PIPING <br /> <br />HEPL^CE ~ <br /> <br /> $10.00 <br />~-- x$6.00 =$~ <br /> x $7.~) = $ __ <br /> <br /> x $6.CO <br /> x $7.50 = $ <br /> <br />x $6.00 = $ <br />x $7.00 = $ -- <br />x $7.50 = $ __ <br />x $7.50 = $ -- <br />x $7.50 = $ -- <br />x $7.50 -- $ __ <br /> <br />x $1L00 $_ <br /> <br />x $630 = $__ <br />x Stl.00 $- <br />x $4.50 = $ -- <br /> <br />x $4.50 =$__ <br />x $4.50 = $ -- <br />x $4.50 = $ __ <br />x $3.00 =$__ <br />x $3.00 =$__ <br /> <br />x $3.00 = $ __ <br /> <br />x $7.50 = $ -- <br />x S3.00 = $ <br />x $30.00 -- $ <br /> <br /># of Labels. N/C <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subto~l <br /> <br />B. Enter 25% of ]ine A l for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Rehqspecdon Fee (S25.00) <br /> TOTAL AMOUNT DUE <br />Receipt No.__ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />