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,. MARION COUNTY t~.~ ~l,~ - -.~-~ <br /> ~ ~.~., .~ ......... I BUILDING INSPECTION DIVISION PE~IT NO: ~ ~ ~ <br /> Ir~ uti v~m~l l~m] 3150 L~caster Dr. ~ - Suite C r <br /> R~eived By: ~ Salem, Oregon 97305-1398 Da~:~ ~ <br />Date: ~ ~ ~ Im~ion Li~ 373-4427 <br />I I Orate: pho~ ~am- 4:~om Issued by: ~ ~ <br /> <br />I MECHANICAL PERMIT APPLICATION I -Y 4. ~E SCHEDULE (Complete and enter tot~ in Al ~low) <br /> Please complete all Sections, 1 through 5 ~PR 2 ~ 1 ~sm~ ~ co~.c~ ~ vs~:_ ~ <br />I [ t~ ~ ~TE~ ~ ~DiTION D ~ATION D ~PLACE~ <br /> ~RION C01 N~ ~AS ~ ELECT~C ~ ~ <br /> <br />TAX ACCOUNT NO. <br /> <br />JOB ADDRESS <br /> <br />PROPERI~f OWNER <br /> <br />OWNER' S <br />PHONE # <br /> <br />CROSS STREET/ <br />DIRECTIONS <br /> <br />PERMITS 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 /> MechanicalContractor ~ .~.. /~']~W~ ~ <br /> <br />PHONE <br /> <br />CONTRACTOR' S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <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 />FURNACE OTY <br />FORCED AIR UP TO 100.0O0 BTU x S6.00 = $ __ <br />FORCED AIR OVER 100.000BTU x $7.00 =$ __ <br /> <br />FLOOR FURNACE x $6.00 = $ <br />DUCTS (ALTERATION/EXTENSION) x $7.50 = $ -- <br />GAS INSTALLATIONS <br />GAS FURNACE (up to I~0,~00BTU) x $6.00 =$ <br />GAS FURNACE (over 100.000 BTU) x 57.00 = $ __ <br />GAS FIREPLACE/INSERT x S7.50 ~ $ <br />GAS WATER HEATER x S7.50 = $ <br />GAS LOG LIGHTER x S7.50 -- $ <br />GAS BARBEQUE x S7.50 = $ __ <br />GAS PIPING <br />Each outlet up to 4 outlets x $2.00 = $ __ <br />Each additional outlet over 4 outlets x $.50 = $ <br />HEATERS <br />SUSPENDED HEATER x $6.00 -- $ __ <br />WALL HEATER x $6.00 = $ __ <br />FLOOR MOUNTED x $6.00 = $ <br />HEAT PUMP <br />UNDER 3 TON x $6.50 <br />3 TONANDMORE ~ x $11.00 <br /> <br />AIR CONIUTIONER <br />UNDER 3 TON x $6.50 = $ __ <br />3 TON AND MORE x $11.00 $__ <br />EVAPORATIVE COOLER x $4.50 = $ __ <br />EXHAUST / FANS / VENTS <br />COML. EXHAUST SYSTEM x $4.50 = $ __ <br />COME HOOD & EXHAUST x $4.50 = $ <br />DOMESTICP~MqGEHOOD x $4.50 =$__ <br />DOMESTIC EXHAUST FANS x $3.00 = $ __ <br />DOMESTIC DRYER VENTS x $3.00 = $ <br />APPLIANCE VENTS <br />not included in an appliance pemdt x $3.00 = $ __ <br /> <br />ADDITIONAL APPLIANCES <br />WOODSTOVE / FIREPLACE x $7.50 <br />IFIRE DAMPER x $3.00 <br />COMLJlNDUSTRIAL INCINERATOR __ x $30,00 = $ <br />OTHER (as required by the Building Official) <br />DWELLING PERMIT LABELS g of Lahe]s <br />(For New Single Family l~.veRing s Only) <br /> <br />$10.00 <br /> <br />5. FEES <br /> Al. Enter to,at of fees from Sec. <br /> A2. Add 5% surcharge (~05 x Al) <br /> <br />B. Enter 25% of line A1 for Ham Review <br /> (Al + .25). if required <br />C. Investigation Fee (if required) <br />D, Reinspection Fee ($25.00) <br /> <br />Receipt No, <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />8 aa <br />$ I. <br /> <br />$ <br />$ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />