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i*0R CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Saiem, 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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br /> JOB ADDRESS <br /> <br />CITY <br /> <br />PROPERTY OWNER <br /> <br />OWNER'S <br />PHONE # <br /> <br />CROSS STREET/ <br />DIRECTIONS <br /> <br /> PROJECT DESCRIPTION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED W1THIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mechanical Contractor <br />Mailing Address City <br /> <br />PHONE ~, ,~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Properly 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 />MC 15-41 7/97 <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />RESIDENTIAL ~ COMMERCIAL ~ USE: <br />NEW ~ ALTERATION [~ ADDmON ~ RELOCATION ~ REPLACE O <br /> GAS f'l ELECTRIC ~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />FURNACE OTY <br />FORCED AIR UP TO 100~000 BTU x $6.00 <br />FORCED MR OVER 100,000 BTU x $7.00 <br /> <br />FLOOR FURNACE x $6.00 <br />DUCTS (ALTERATION/EXTENSION) x $7.50 <br /> <br />GAS FURNACE (up m IlI0,0S0BTU)~/ '2 x $6.00 <br />GAg FURNACE (over ICO,~0 BTU) x $7.00 <br />GAS ~IREPLACE/INSERT x $7.50 <br />GAS WATER HEATER d' / x $7.50 <br />GAS LOG LIGhtER x $7.50 <br />GAS BARBEQUE x $7.50 <br /> <br />Each outlet up to 4 outlets x $2.00 <br />Each additionaloutlet over4 outlets ~ ~l~ x $.50 <br />HEATERS <br />SUSPENDED HEATER x $6.~0 <br />WALL H~ATER x $6.00 <br />FLOOR MOUNTED x $6.00 <br />HEAT PUMP <br />UNDER 3 TON x $6.50 <br />3 TON AND MORE x $11.00 <br />AIR CONDITIONER <br /> <br />3 TON AND MORE x $1L00 <br />EVAPORATIVE COOLER x $4.50 <br /> <br />COML. EXHAUST gYSTEM x $4.50 <br />DOMESTIC RANGE HOOD x $4.50 = $ <br /> <br />5. FEES <br /> 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 required <br />C. Investigation Fee (if requi~ed) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt NO. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />