Laserfiche WebLink
FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Ott'tee: 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 /> JOB DmS <br /> <br /> CROSS S~ET/ <br /> D~C~ONS <br /> <br />pERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED XVITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR. 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <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 Signatu~ <br /> <br /> Agent's Signatm-c <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 />4. FEE SCHEDULE (Complete and enter total in A1 below) <br />RESIDENTIAL {~ COMMERCIAL {~ USE: <br />N~W {~ ALTERATION [~ ADDITION I~ RELOCATION ~ REPLACE <br /> GAS {~ ELECTRIC ~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />FURNACE <br />FORCED AIR UP TO t00,{~0 <br />FORCED AIR OVER I00.000 BTU x $7l00 <br /> <br />FLOOR FURNACE x $6.00 = $ -- <br />DUCTS (ALTERATION,EXTENSION) x $7.50 = $ -- <br />GAS INSTALLATIONS <br />GAS FURNACE (up t~ 100,000 BTU) x $6.00 = $ -- <br />GAS FURNACE (over I00,{X}0 BTU) x $7.00 = $ -- <br />GAS F/REPLACE/INSERT x $7.50 -- $ <br />GAS WATER HEATER x $7.50 = $ <br />GAS LOG LIGHTER x $7.50 = $ __ <br />GAS BARBEQUE x $7.50 = $ _- <br />GAS PIPING <br />Each outlet up [o 4 outlets x $2.00 = $ __ <br />Each additional outlet over 4 ou0ets x $.50 = $ <br /> <br />REATEpa~ <br />S~dSPENDED~ATER x g6.OO = $ <br />WALL HEATER x $6.00 = $ <br />FLOOR MOUNTED x $6.00 <br /> <br />UIqDER 3 TON x $6.50 = $ <br />3 TON ANDMORE x $11.00 $ __ <br /> <br />AIR CONDITIONER <br />UNDER3TON ~ x $6.50 =$ <br />3 TON AND MORE x $ l <br />EVAPORATIVE COOLER x $4.50 = $ <br />EXHAUST I FANS / VENTS <br />COML. EXHAUST SYSTEM x $4.50 =$_ <br />COME HOOD & EXHAUST X $4.50 = $ __ <br />DOMESTIC RANGE HOOD x <br />DOMESTIC EXHAUST FANS x $3.00 = $ __ <br />DOMESTIC DRYER VENTS x $3,00 -- $ <br />APPLIANCE VENTS <br />not included in an appliance penmt x $3.00 = $ __ <br />ADDITIONAL APPLIANCES <br />WOODSTOVE/FIREPLACE x $7.50 = $ <br />FIRE DAMPER x $3.0~ <br />COMLdINDUSTRIALINCINERATOR __ X $30.00 =$ <br />OTHER (as required by the Building Official) <br />~ g of Labels <br />(For New Siagle Family I~vMlings Only) <br /> <br />N/C <br /> <br />5. FEES <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. ReMspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 1541 7/97 <br /> <br /> <br />