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Salem, OH 07301 I Ae 3 0 <br /> MARION COUNTY <br /> 24 Hr lnspt~t'km Lin~: <br />om~ sss-st4v s:oo,.raF~..!s~kq~i INSPLSO~I~bY: <br /> <br />MECHANICAL PERMIT APPLICATION [ <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />AR~ NON-TRAHSFERAEI~ AND KKPIRE IF WORK tS NOT <br /> STARTED WFH-UH 180 DAYS OF ISSUANCE OR IF <br /> WORK I5 SUSPEIqDED FOP. 180 DAYS, <br /> <br />2A. COI~'YKACTOR RqSTALLATION OHLY <br /> <br />Mailing Address <br />Contraotor's Board Reg, No, ] Job No. <br /> <br />2,B. FOR OV, rNER INSTALLATIONS <br /> <br />Propmy Owner (ple~seprim) <br />Mail[us Address Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />4. FEB 8CHI~DLI-LE (Complete and enter total in Al below) <br /> <br /> RESIDENTIAL ~i~ COMMERCIAL {~ <br /> USE OF STRUCTURE: .. ~ ~ <br /> NEW ~ ALTERATION ~1 ADDITION C3 RELOCATION <br /> GAS D or ELECTRIC D <br /> No. X Fee = Sum <br />BASE FEE $10.00 <br /> <br />PORCED AiR FURNACE <br />up to 100,000 BTU $ 6.00 <br />ov~ 1~0,000 BTU $ 7.00 <br /> <br />Freer Ftux~ce $ 6.00 <br />S~sl~nded Heater $ 6.00 <br />Heater $ 6.00 <br />Floor Mountad Heater $ 6.00 <br /> <br />HEAT PUMP <br /> undar 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> un0~r 3 Ton <br /> 3 Ton andup <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Dom~stin Exhaust Fins <br /> and Dryer Veta~ <br />Fir~ Damper <br />Wood Stove/Fireplace <br />Furnace Duets (A Itecation/E~ension) <br />Commercial I Industrial Incinerator <br /> <br />$ 6.50 -- <br />$11.00 <br /> <br />$ 6,50 <br />$11.00 . . <br /> <br />$4,50 <br />$ 4.5o __ <br />$ 4.50 -- <br />$ 4.50 <br /> <br />$ 3.00 <br />$3.00 <br />S?.S0 <br />$7.50 <br />$30.00 <br /> <br />$ 7.50 <br />$7.50 <br />$7.5O -- <br />$ 7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 1M outlets (per outlet) <br /> 4 and up oudet~ (l~r cutlet) <br /> <br />Appliance Vent~ not incl~ed M <br /> <br />~HER (as ~quiced by B~l~ O~ciaO~ <br />DWELL~G PE~ L~EL ff of ~ <br /> <br />$ 2.00 <br />$ 30 <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br /> 3. PLANRBVIBW SECTION <br />IMarion Coun~ does not require a plan review. <br /> We will pwvide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />Rev. 12/94 <br /> <br />5. FEES <br />Al. Enter total of foes from S~. #4 $ ~.~____ <br />A2. Add 5% aur~harge (,05 x A l) <br />. ~ Subtotal $ <br />B. ~t~r ~5% of lineAl for P~ R~w <br />(Al + .25), if required $. <br />C. ~v~figafion F~ (ifrequ~d) <br />D. R¢impecfion Fez ($25.~) <br /> <br /> <br />