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FO~CITY VALIDATION <br />Received By: <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 />Please complete all Sections, I through 5 I <br /> <br />MECHANICAL PERMIT APPLICATION <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PROPER~ OWNER <br /> <br />CROSS STREET/ <br />DIRECTIONS <br /> <br />PROJECT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT / <br /> STARTED WlTHRq 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Mechanical Contractor <br /> <br />Mailing Address City <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> Property Owner (please print)~ <br /> Mailing Address ~-3 ~ ~0~-.~' 'f <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 />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br />RESIDENTIAL [~] COMMERCIAL [~ USEr <br />roes ~1 ALTERA~ON 13 ^DDrg.0N I'1 R~oCaT~oN Cl <br /> GAS ~ ELECTRIC 13 <br />BASE FEE ASSESS]E1) ON ALL APPLICATIONS <br /> <br />Ii~JRNACE <br />FORCED AIR UP TO 100,000 BTU <br />FORCED AIR OVER 100,000 BTU <br />FLOOR FURNACE <br />DUCTS (ALTERATION/EXTENSION) __ <br />G$S INSTALLATIONS <br />GAS FURNACE (up to 100,000 BTU) <br />GAS FURNACE (over 100,0OO BTU) <br />GAS FIREPLACE/INSERT <br />GAS WATER HEATER <br />GAS LOG LIGHTER <br />GAS BARBEQUE <br />GAS PIPING <br />Each outlet up m 4 outlets <br /> <br />U~T PUMP <br /> <br />COML./INDUSTEIAL iNCINERATOR <br /> <br />OTHER (as required by the Building Official) <br /> <br /> (For New Single Family Dwellings Only) <br /> <br /> REPLACE <br /> <br />OTY <br /> <br /> x S6.00 = $ <br /> x $7.00 = $ -- <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 $50 =$ __ <br /> <br />x $6.00 = $ <br />x $6.110 --$__ <br /> <br />x $6.50 = $ <br /> <br />x $6.50 =$ <br /> <br />x $4.50 : $ -- <br /> <br />x $4.50 = $ -- <br />x S4.5O = $ __ <br />x $4.50 = $ -- <br />x $3.00 = $ __ <br />x $3.~0 = $ -- <br /> <br />x $3.00 = $ __ <br /> <br />x $7.5o = $ __ <br />x $3.00 : $ __ <br />x $30.00 =$__ <br /> <br /># of Labels N/C <br /> <br />5. FEES <br /> <br />Al. Enter total of fees from Sec. #4 <br />A2. Add 5% sutchaxge (.05 x Al) <br /> <br />Subtotal <br /> <br /> B. Enter 25% of line A1 for Phm Review <br /> (Al + .25), if required <br />~ee (if required) <br /> D. Reinspecfion Fee ($25.00) <br /> TOTAL AMOUNT DUE <br /> Receipt No.__ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />