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I'FOI~ CITY VALIDATION <br /> <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-S147 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, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CROSS STREET/ <br /> DIRECTIONS ~ <br /> <br /> I - <br /> <br />PERMITS ARE NON-TRANSFERABLE 33qD 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 />Mechanical Contractor <br />Mailing Address City <br /> <br />PHONE ~ ~ <br />FAX ~ ~ <br />CONTRACTORS BOARD <br />REGISTRATION NO, <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. <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 />RESIDENTIAL ~ COMMERCIAL ~ USE: <br />NEW I~ ALTERATION {~ ADDmON {~ RELOCATION {~ REPLACE <br /> OAS {~ ELECTRIC {~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />FORCEDAiRUPTO 100,0~OBTU x $6.00 =$ <br />FORCED AIR OVER 100,000 BTU x $7.00 = $ -- <br /> <br />FLOOR FURNACE x $6,00 = $ <br />DUCTS (ALTERATION/EXTENSION) x $7.50 -- $ __ <br />GAS INSTALLATIONS <br />GAS FURNACE (up to 1~0.0~0 BTU) x $6.00 = $ -- <br />GAS FURNACE (over 100,000 BTU) x $7.00 = $ <br />GASFIREPLA~SERT x $7.50 =$__ <br />GAS WATER HEATER x $7.50 -- $ -- <br />GAS LOG LIGHTER x $7.50 -- $ <br />OAS BARBEQUE x $7.50 = $ -- <br />GAS PIPING <br /> <br />COML./INDUSTRIAL INCINERATOR <br /> <br />OT}t--ER (aa required by the Building Official) <br /> <br />x $7.50 = $ -- <br />x $3.~0 =$ <br />x $30.00 = $ -- <br /> <br /># of Labels <br /> <br />5. FEES <br /> <br />B. Enter 25% of line A 1 for Pl~a Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reinspeetion Fee ($25.00) <br /> <br />Re~i~ No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />