Laserfiche WebLink
Received By: <br />Date: <br /> <br />FOR CITY VALIDATION <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 3734427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete afl Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> cry <br /> <br /> PROJ~T DE?C~?N LP <br /> <br /> v~xs A~ ~o~-~s~ ~ sx~ ~v wo~z rs ~oz <br /> ST~ <br /> WORK IS SUSPE~ED ~R 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />c5 r 93 /,3 <br /> <br />2B. FOR OWNER <br /> <br />Property Owner (please print) <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 />MC 15-41 7/97 <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> I <br />4. FEE SCHEDULE (Complete and enter total in Al below) I <br /> I <br />RESIDENTIAL [~ COMMERCIAL [~ USE: <br />NEW ~ ALTERATION ~l ADDmON [--[ RELOCATION ['~ REPLP/~"~NI <br /> GAS [] ELECTPdC [~ <br />BASE EEE ASSESSED ON ALL APPLICATIONS <br /> <br /> FUP~NACE OTY <br /> FORCED AIR UP TO 100,O00 BTU <br /> FORCED AIR OVER 100,CO0 BTU <br /> <br />FLOOR FURNACE <br />DUCTS (ALTERATION/EXTENSION) __ <br /> <br />GAS FURNACE (up to 100,000 BTU) <br />GAS FURNACE lover 100,0~0 BTU) <br />GAS FIREPLACETINSERT <br />GAS WATER HEATER <br />GAS LOG LIGHTER <br />GAS BARBEQUE <br /> <br /> GAS PIPING / <br /> Each outlet up to 4 oat]ets <br /> <br /> Each additional oudet over 4 oudets <br /> <br />SUSPENDED HEATER <br />WALL HEATER <br />FLOOR MOUNTED <br /> <br />HEAT PUMP <br />UNDER 3 TON <br />3 TON AND MORE <br /> <br />AIR CONDITIONER <br />UNDER 3 TON <br />3 TON AND MORE <br />EVAPORATIVE COOLER <br /> <br />EXHAUST I FANS I VENTS <br />COML. EXHAUST SYSTEM <br />COML. HOOD & EXHAUST <br />DOMESTIC RANGE HOOD <br />DOMESTIC EXHAUST FANS <br />DOMESTIC DRYER VENTS <br />APPLIANCE VENTS <br /> not included in an appliance per/mt <br /> <br />COML./INDUSTRIAL INCINERATOR <br /> <br />OTHER (as required by the Building Official) <br /> <br />DWELLING PERMIT LAREI.q <br /> (For New Single Family Dwellings Only) <br /> <br />x $6.00 = $ <br />x $7.00 = $ <br /> <br />x $6.00 = $ <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 $2.00 <br /> x $.50 <br /> <br />x $6.00 = $ <br />x $6.~0 = $ <br />x $6.00 = $ <br /> <br />x $6.50 = $ -- <br /> <br />x $6.50 <br /> <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 $7.50 <br /> x $3.00 = $ <br />x $30.00 =$__ <br /> <br />g of Labels <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. g4 <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if ~equirud <br /> C. Investigation Fee (if requked) <br /> D. Reinspeudon Fee ($25.00) <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br /> <br />