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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr, NE - Suite C <br /> Salem, O~egon 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 />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br /> JOB ADDRESS <br /> <br />CITY <br /> <br />PROPERTY OWNER <br /> <br />OWNER' S <br />PHONE # <br /> <br />CROSS STREET/ <br />DIRECTIONS <br /> <br /> PROJECT DESCRIPTION <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 /> <br /> Mechanical Contractor <br /> <br />Mailing Address City <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (ptease 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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and entex total in A1 below) <br />RESIDENTIAL ['l COMMERCIAL ~ USE:_ <br />NEW [] ALTERATION f'l ADDITION [] RI~OCATION [] REPLACE [] <br /> GAS [] ELECTKIC ~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />OTY <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 /> <br />x $6.00 = $ __ <br />x $6.00 = S __ <br />x $6.00 = $ __ <br /> <br />x $6.50 = $ __ <br />x $11.00 $_ <br /> <br />x $6.50 = $ <br />x Stl.00 $ <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 $3.00 =$__ <br /> <br />x $7.50 = $ -- <br />x $3.00 = $ -- <br />x $30.00 = $ __ <br /> <br />g of Labels. <br /> <br />FURNACE <br />FORCED AIR UP TO 100,000 BTU <br />FORCED AIR OVER t00,000 BTU <br /> <br />FLOOR FURNACE <br />DUCTS (AL'I~RATIONffiXTENSION) <br /> <br />GAS INSTALLATIONS <br />GAS FUP--NACE (up to 100,000 BTU) <br />GAS FURNACE (over 100,000 BTU) <br />GAS FIREPLACE/INSERT <br />GAS WATER HEATER <br />GAS LOG LIGI-1TER <br />OAS BARBEQUE <br /> <br />GAS PIPING <br /> Each outlet up to 4 outlets <br /> Each additional outlet over 4 outlets <br /> <br />SUSPENDED HEATER <br />WALL HEATER <br />FLOOR MOUNTED <br /> <br />UNDER 3 TON <br />3 TON AND MORE <br /> <br />AIR CONDITIONER <br />UNDER 3 TON <br /> 3 TON AND MORE <br /> EVAFORATIVE COOLER <br /> <br /> COME EXHAUST SYSTEM <br /> COML. HOOD & EXHAUST <br /> DOMESTIC RANGE HOOD <br /> DOMESTIC EXHAUST FANS <br /> DOMESTIC DRYER VENTS <br /> APPLIANCE VENTS <br /> no~ included in an applia~c~ permit <br /> <br /> WOODSTOVE / FIREPLACE <br /> FIRE DAMPER <br /> COMLJlNDUSTRIAL INCINERATOR <br /> <br /> OTHER (as required by the Building Official) <br /> <br /> (For New Single Family Dwellings Only) <br /> <br />5. FEES Al, Enter total of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Ente~ 25% of line A1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (it required) <br /> <br />D. Reinspeeqon Fee ($25.00) <br /> <br />Receipt No..__ <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$. <br />$ <br />$ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />