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MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Le~cas~er Dr. NE- Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 585-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CROSS STREET/ <br /> DIRECTIONS <br /> <br />pERMITS AP.E 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 />2B. FOR OWNER INSTALLATIONS <br /> <br />Proper~ Owner (please print) <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 /> 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 />NEW {~ ALTERATION [] ADDmON~'--RELOCATiON [] REPLACE <br /> <br />BASE FEE ASSESSED ON ALL APPLICATIONS <br /> <br />FURNACE OTY <br />FORCED AIR UP TO [00,~00 BTU <br /> <br />$10.00 <br /> <br />x $6.00 <br />x $7.~0 <br /> <br />x $6.00 <br />x $7.50 <br /> <br />x $6.oo <br />x $7.00 <br />x $7.50 <br />x $7.50 <br />x $7.50 <br />x $7.50 <br /> <br />x $.50 = $ <br /> <br />x $6.00 =$ <br />x $6.00 = $ <br />x $6.00 = $ __ <br /> <br />x $6.50 = $ <br /> <br />x $6.50 =$ <br />x $1L00 $ <br />x $4.50 = $ <br /> <br />x $4.50 = $ <br />x $4,50 =$ <br />x $4.50 = $ <br />x 53.00 ~ $ -- <br />x $3.00 = $ -- <br /> <br />x $3.00 = $ -- <br /> <br />x $7.50 = $__ <br />x $3.~0 = $ -- <br />x $30.00 = $ <br /> <br />#of Labels. N/C <br /> <br />5. FEES <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25). ff requir~ <br />C. Investigation Fee (if required) <br /> <br />Recaipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ /goo <br />S . ED <br />$ l,~.qo <br /> <br />MC 15-41 7/97 <br /> <br /> <br />