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FOR (~ITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> $150 Lancaster 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 588-7948 <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> D~ONS <br /> <br /> PERM1TS 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 /> -7'7t - '7 b P-'7 <br />CONTRACTORS BOARD <br />REGISTRATION NO- 4t~ ? <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> C ty, State, Zip <br /> <br />Owner's Signature <br />Agent's Signature <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br />RESIDENTIAL ~ COMMERCIAL [~ USE: <br />NEW ~ ALTERATION ~ ADDITION ~ RELOCATION {~ REPLACE <br /> GAS ~ ELECTRIC {~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br /> $ <br />=$ <br /> <br />FURNACE <br />FORCED AIR UP TO Iff),000BTU x $6.00 =$ <br />FORCED AIR OVER 100,000BTU x $7.00 =$ <br /> <br />~LOOR FURNACE x $6.00 = $ <br />DUCTS (ALTERATiON/EXTENSION) x $7.50 -- $ <br />GAS INSTALLATIONS <br />GAS FURNACE (up to 100,000BTU) x $6.00 =$ <br />GAS FURNACE (over 100,000 BTU) x $7.00 = $ <br />GAS FIREPLACE/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 to 4 outIets x $2.00 <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 />5. FEES <br /> Al. Enter total of fees from Sec. g4 <br /> 3,2. Add 5% surcharge (.05 x A 1 ) <br /> <br />B. Enter 25% of ]ine A1 for Plan Review <br /> (Al + .25), if re quL, ed <br />C. Investigation Fee (if required) <br />D. Reinspecfion Fee ($25.00) <br /> <br />Receipt No. __ <br /> <br />TOTAL AMOUNTDUE <br /> <br />$~ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />