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I oR O qL¥I <br />Received by: <br />Date: <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Poem 132 <br /> Salem, Oregon 97301 <br /> <br />Phone 5Sg-5147 8:00 a.m. ~ 4:30 p,m. <br />Code-A-Phone: 558-7904 <br />lAX: 588-7948 <br /> <br />SITE #: Permit No. <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Directions <br /> <br />PERMITS ARE NON.TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STAR.TED WITHIN 180 DAYS OF ISSUANCE <br />OR. IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />Cootrag!or ~-~A~' ~ <br /> <br />Pmpert}' Owner [ Phone <br /> <br />Cootraotofs IJcense No. <br /> <br />Contractors$ignature: ~fM0~.~(L ,t~~]~, <br /> <br />lB. FOR OWNER INSTALLATIONS <br />Ptop*Wd Own¢[ <br />Mailing Address Phone <br />Cit¥/S~aedZip <br /> <br />The installation is being made on property I own which is not intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />RESIDENTIAL [] COMMERCIAL <br /> <br />USE OF STRUCII/RE: <br /> <br />NEW[~ ALTERATION[] ADDITION[~] RELOCATION[] <br /> <br /> GAS [] ne ELECTRIC [] <br /> NO. X FEE - SUM <br />BASE YEE $10.00 <br /> <br />Forced Air Furnace [ $ 6.00 <br />100,000 BTU or l~s <br />Over 100,000 BTU -- $ 7.50 <br /> <br />Floor Furnace __ $ 6.00 <br />Suspended Heater I $ 6.00 <br />Wall lteater __ $ 6.00 <br />Ploor Mounted Unit Heater __ $ 6.00 <br /> <br />Heat Pump [] / Air Conditioner [] <br />Up to 3 Ton ~ $ 6.00 <br />3 Torito 15 Ton $11.00 __ <br />Evaporative Cooler $ 4.50 <br />Exhaust System, Commercial ~ $ 4.50 <br />Hood and Exhaust, Commercial __ $ 4.50 <br /> <br />Domestic Range Hood __ $ 4.50 <br />Domestic Exhaust Fans <br />and Dryer Vents __ $ 3.00 <br />Fire Damper $ 3.00 <br />Wood Stove __ $ 7.50 <br />Furnace Ducts (Alteration, F. xtension) __ $4.50 <br /> <br />Commercial or Industrial Incinerator __ $30.00 __ <br /> <br />Gas Water Hea~r (relocalion <br />or replacement) __ $ 7.50 <br />Gas Connection : , ~ <br />-per outlet, up to 4 ~ $ 2.00 <br />--over 4, $8.00 plus ea. <br />additional $ .50 <br /> <br />For the Installation, Relocation <br /> or R. eplacement of ea. Apptiaace <br /> Vent not included in aa <br /> Appliance permit. <br /> <br />O~her (as requffed by Bmlding Official) <br /> <br />__ $ 3.00 <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />Rev. 8/94 <br /> <br />5. FEES <br /> Al. F~ter total of Fe~ frcm Sec. gA <br /> A2. Add $%surdmrge (.05 xAl) <br /> <br /> Subto~l <br /> <br /> B. <br /> (Al x .25) if requlmd ~ <br /> Eme~ 25% of llnc Al f <br /> <br /> <br />