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IFOR 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, Oregon 97305-1398 <br /> <br />~ 24 HR Inspection Line 373.4427 <br /> Office: phone 588-S147 8:00am - 4:30pm <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete afl Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> T ACCO NO. 1 roi 71 -t-- <br /> ,OB non.ss <br /> <br />PEKMITS 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 />j. at ' {998 <br /> NTY <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mechaincal C°ntract°r ]dfi/O~l ~ <br />PHONE <br />CO~RS <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (please pHn0 <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 />FAX S88-7948 BUILDING I! <br /> <br /> 4. FEE SCHE ~DU/LE (Complete and enter total in Al below) <br /> REsmENTIAL ~ COMMERC,L~fL {~ USE:__ - <br /> NEW [~ ALTERATION [~ ADomo~.~RELOCATION fl RM'tACE <br /> OAS ~ ~LECrmc ~ <br /> <br />BASE FEE ASSESSED ON ALL APPLICATIONS <br />~ OTV <br />FORCED AIR UP TO 100,000 BTU <br />FORCED AIR OVER 100,000 BTU <br /> <br />FLOOR FOILNACE <br />DUCTS (ALTERATION/EXTENSION) <br /> <br />GAS FURNACE (up to 100,000 BTU) <br />GAS FURNACE (over 1001000 BTU) <br />GAS FIREPLACE/INSERT <br />GAS WATER HEATER <br />OAS LOG LIGHTER <br /> <br />GAS BARBEQUE <br /> <br />GAS PIPING <br /> Each outlet up to 4 outlets <br /> Each additional outlet over 4 outlets <br /> <br />SUSPENDED HEATER <br /> <br />WALL HEATER <br />FLOOR MOUNTED <br /> <br />UNDER 3 TON <br />3 TON AND MORE <br /> <br />UNDER 3 TON <br />3 TON AND MORE <br /> <br />$10.00 <br /> <br />x $6.00 = $ -- <br /> <br />x $6.00 =$____ <br />x $7.50 <br /> <br />$6,00 =$___ <br />$7.0O = $ __ <br />$7.50 = $ -- <br />$7.50 = $ -- <br />$7.50 =$__ <br />$750 =$__ <br /> <br />x $50 $ <br /> <br />x $6.50 = $ -- <br /> <br />x $6.50 = $ -- <br />x $4.50 =$__ <br /> <br />$4.50 =$__ <br />$4.50 =$____ <br />$4.50 =$__ <br />$3.00 = $ __ <br />$3.00 = $ __ <br /> <br />x $3.00 $ <br /> <br /> x $3.00 $ <br />x $30.00 $ <br /> <br />5. FEES AL E~ter total of fees from Sea. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if requked <br />C. Investigation Fee (ff required) <br />D. Reinspec0on Fee ($25.00) <br /> TOTAL AMOUNT DUE <br />Receipt No.__ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />