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FOR CITY VALIDATION[ <br />Received by: <br />Date:, <br /> <br />MARION COUNTY BIJILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-fi147 8:00am - 4:30pm <br />FAX: 5g~-7948 <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all .qections, I through $ <br /> <br />1. LOCATION OF INSTALLATION' <br /> <br />PERIVlITS ARE NON-TRANSFERABLE AND ~XPIRE IF WORK IS NOT ] <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 1~ SUSPENDED FOR 1/0 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br /> FOR OWNER INSTALLATIONS <br />Pmporty Owe. cc ~lease <br /> <br />Mailing <br /> <br />City/Sml~lZjp <br /> <br />Owner's Signature: <br />Agent's Sisnatut~: <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 />I specifications with this application. <br /> MC 1541 <br /> REV 8/96 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEB SCHEDULE (Complete and ~nt~r total in A 1 below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL <br /> USE OP STRUCTURE: <br /> NEW O ALTERATION m ADDITION m P..~.,OCATION~ <br /> GAS /2 or ELECTRIC ~ <br /> No. X Feo = /him <br />BASE FEE $10.00 <br /> <br />FORCED AIR ~URNACE <br />up ~o lO0,O00 BTU / $ 6.00 <br />over 100,000 BTU $ <br /> <br />Floor Fta-aac¢ $ 6.00 <br />Suspended Heator $ 6.00 <br />Wall Heater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 -- <br /> <br />HEAT PUMp <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />AIR CONDITIONER <br />undgr ,3 Ton $ 6.30 <br />3 Ton and up $11,00 <br /> <br />EvaporativeCooler $ 4.50 <br />Commercial Exhaust System $ 4.50 <br />Conuncrcial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 <br /> <br />ADDITIONAl, APpLIANCRS <br />Gas Water H*atcr $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeq~ $ 7,50 -- <br />Other $ 7.50 <br /> <br /> PIPING SYgTEM <br /> IA outlets (per outlet) <br /> a~d ~sp oatl~ts (pot ~t~t) <br /> <br />O~ER (as ~quimd by B~l~ O~eial) <br /> <br />DWELLINO P~ L~EL ~ of ~la <br /> <br />$ 2,00 <br />$ .~0 <br /> <br />$ 3.00 <br /> <br />5. F~E8 <br /> A 1. Enter total of fees from S<. #4 <br /> A.~ Add 5% surch~rg~ (.05 x Al) <br /> <br />Subtotal <br /> <br />g. Emir 25% of line A1 for Plan Review <br /> (Al + .25), if required <br />C. Invcstigalion F, ce 0frequkod) <br />D. Reinsp~¢tion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br /> <br />