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FOR 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 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WYIHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br />PHO~ <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 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 />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 ~ ADDmON ~ RELOCATION ~ P-~PLACE [~ <br /> ~AS D ~zEcrmc ID <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br /> FURNACE OTY <br /> FORCED AIR UP TO IO0,OOOBTU x $6.OO =$ <br /> FORCED AIR OVER t00,000BTU x $7.00 =$ <br /> FLOOR FURNACE x $6.~0 = $ -- <br /> DUCTS (ALTERATION/EXTENSION) __ x $7.50 = $ -- <br /> GAg INSTALLATIONS <br /> GAS FURNACE (up to t00,OO0 BTU) x $6.00 = $ __ <br /> GAS FURNACE (over 100,000 BTU) x $7,OO = $ __ <br /> GAS F]REPLACEaNSERT x $7.50 = $ <br /> GAS WATER HEATER x $7.50 = $ -- <br /> GAS LOG LIGHTER x $7.50 = $ <br /> GAS EARBEQUE -- x $7.50 = $__ <br /> <br /> GAS PIPING <br /> Each outlet up to 4 outlets x $2.00 =$__ <br /> Each additional out]et over 4 outlets x $.50 -- $ -- <br /> HEATERS <br /> SUSPENDED HEATER x $6.OO = $ <br /> WALL HEATER x $6,OO = $ -- <br /> FLOOR MOUNTED x $6.OO = $ __ <br /> <br /> HEAT PUM~ <br /> UNDER 3 TON ~ x $6.50 = $ -- <br /> 3 TON AND MORE x $11.00 $__ <br /> <br />AIR CONDITIONER <br />UNDER 3 TON ~ x $6.50 = $ <br />3 TON AND MORE x $1LOO $ <br />EVAIK)RATIVE COOLER x $430 = $ -- <br />EXHAUST / FANS / VENTS <br />COML. EXHAUST SYSTEM x $4.50 = $ <br />COML. HOOD & EXHAUST x $4.50 = $ <br />DOMESTIC RANGE HOOD x $4.50 = $ <br />DOMESTIC EXHAUST FANS x $3.00 = $ <br />DOMESTIC DRYER VENTS x $3.OO = $ <br />APPLIANCE VENTS <br />not included in an appliance permit x $3.00 = $ <br />ADDITIONAL APPLIA NcF~S <br />WOODSTOVE/HREPLACE x $7.50 =$__ <br />FIREDAMPER x $3.OO =$ <br />COML.flNDUSTRIAL INCINERATOR -- x $30.00 = $ -- <br /> <br />OTHER (as requited by the Building Official) <br />DV(ELLING PERMIT LABELS # of Labels <br />(For New Single Family Dwellings Only) <br /> <br />5. FEES Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Al + .25), if requLred <br />C. investigaEon Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-41 7/97 <br /> <br /> <br />