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FOR CITY VALIDATIONI <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 />Of~'lCe.' phone 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br />RESIDENTIAL ~ COMMERCIAL [~ USE: <br />NEW [] ALTERATION ~ ADDITION [~ R~LOCATION ["l REPLACE [] <br /> <br />l i~ OTY <br />FORCED AIR UP TO 100,000 BTU <br />· FORCED AIR OVER 100,000 BTU <br /> <br /> cross snm~r/ <br /> DI~CTIONSt~ ',~/~/ ~.~'~0 , ~t'~ ] I GAS WATER HEATEa <br /> PROIECT DESCRIPTION ~ ~AS BARBEQOE <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY FLOOR MOUN~ <br /> <br />Mechanical Contractor <br />Mailing Address City <br /> <br />PHONE ~. ~ <br />FAX ~ ~ <br />CONTRACTORS BOARD <br />REGISTRATION NO. <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> Propeny Owner (please print) ~ I ~ O $~ L. ~ ~t <br /> <br /> oas ~ gLgc'n~c [] <br /> <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />Agent's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />not included in an applianco permit <br /> <br />DWELLING PERMIT LABEL.{; <br /> (For New Single Family Dwellings On/y) <br /> <br />5. FEES <br /> <br />B. Enter 25% of line A l for Plan Review <br /> (Al + .25), if required <br />C. In~ esllgafion Fee (if required) <br />D, Reinspection Fee ($25.110) <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />Receipt No._ <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 S7.50 = $ __ <br />x $7.50 = $ __ <br /> <br />x $2.00 = $ __ <br />x $.50 = $ __ <br /> <br />x $6.0O = $ __ <br />x $6.00 = $ __ <br />x S6.00 = $ <br /> <br />x $6.50 =$ <br />x $11.00 $ <br /> <br />x $6.50 =$ <br />x $11.00 $- <br />x $4.50 = $ <br /> <br />x $4.50 =$__ <br />x $4.50 =$ <br />x $4.50 =$__ <br />x $3.00 = $ -- <br />x $3.1)0 --$__ <br /> <br />x $3.00 = $ <br /> <br />x $7.50 <br />x $3.00 <br />x $30.00 <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 />MC 15-41 7/97 <br /> <br /> <br />