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FOR GITY USE'ONLY <br />Received By: Date: <br />Zoning By: CityL <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> COMMIYNITY DEVELOPMEN~ CENTER <br /> 3150 Lancaster Dr. NE- Suite C, Salem, Oregon 97305 <br /> }~8:00 am - 4:30 <br /> 24 hr. lnspectio~[~l~ FAX 588-7948 <br /> <br />[ ] ~ [~P~SIDEWTIAL (]COMMERCIAL <br />MECHANICAL PERMIT APPLICATION I 0~'~ - , 1~9~IEw '{)Q ADDmON <br /> Please complete all Seetions, lthrough$ ] w--- ( )RELOCATION [ )REPLACEMENT <br />1. LOCATION OF INSTAL]L~TION [¥[ARION <br /> Foc~ed Air over 100.~00 BTU <br /> <br /> Ducts (Atlna-a0ons/Extcnsion 1 <br /> ~ .~ .Gas lastallarion <br /> <br /> Paroel Owner_- ~ ~ .__~-~: f.. _ 4 /.,~ . .~ Gas Fumac~ (up to 100.000 BTU) <br /> Gas Furnace (over 100.000 BTU) <br /> <br />  .~ Gas Log Lighrer <br /> Gas Piping <br /> Each outlet up to 4 outlets <br /> Each addtlio~l outlet over 4 outlets <br /> <br /> IS NOT STARTED FFITltIN 180 DA YS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DA <br /> <br />2A. CONTRACYOR INFORMATION <br />DOING THE WORK <br /> <br />Con or's Signa : <br /> <br />ProlgtW Owner: (please prtnu <br /> <br />City: State: Z~p <br />Phone: Fax: <br /> <br />I am the PROPERTY OWNER and own. reside in. or will reside in the <br />completed structure and will be my own general contractor. I understand <br />that I m dSt regtster as a construcnon contractor ff the structure is sold or <br />offered for sale before or upon completion. Ill hire subcontractors. ! wdl <br />hire onl9 subcontractors registered with the Construction Contractors Board. <br />Ill change my mind and do hire a general contractor who is registered with <br />the Construction Contractors Board. I will immediately notify Marion County <br />of the name of the contractor. <br /> <br /> "1 <br />Marion County does ncr require a plan revie,a We will provide plan review ~ <br />service if you complete Section 5B and submit two (2) sets of plae~ and <br />specifications with this apphcatmn. <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />Und~ 3 Ton <br />3 Ton and More <br /> <br />Air Conditioner <br />Uede~ 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />Exhaust / ~ans / Vents <br />Coral Exhaust System <br />Coml Hood & E~thaust <br />Domesfc Range Hood (includes ducts) <br /> <br />woo ove Pt Fm,0 <br />Fi~ Dampo- <br /> <br />Onefr~ Family Dwelling Fee Square Feet: <br />Dwelling Permit Labels <br />(For New Dwellings Only) <br />Oth~ (as requited by the Building Official) <br /> <br />GAS ( ) ELECTRIC <br />ALTERATION <br /> <br /> x $12.00 = $ <br /> x $15.00 = $ <br /> x $12.00 = $ <br /> x $15.00 = $ <br /> <br />x $12.00 = <br /> x $15.00 <br /> x $15.00 <br /> x $15.00 <br /> x $15.00 <br /> x $15.00 <br /> <br />x $ 4.00 = $ <br />x $ 1.00 = $ <br /> <br />x $12.00 = $ <br />x $t2.00 = $ <br />x $12.00 = $ <br /> <br />x $12.00- $ <br />x $22.00 = $ <br /> <br />x 1;15.00 = $ <br />x $22.00 = $ <br />x $9.00= $ <br /> <br />x $ 9.00 <br />x g 9.00= $ <br />x $ 9.00 <br />x $6.00= $ <br />x $ 6.00 <br /> <br />x $ 6.00 = $ <br /> <br /> 6.00- $ <br />$60.00- $ <br /> <br /> x $ .04- $ <br /># of Labels ~ $ N/C <br /> <br /> FEES <br />BASE FEE Assessed on ~ /LPPLICA TIONS: <br />Al. EnterTotal Fees from Section #4 <br />A2 Add State Surcharge (.05% x Al) <br /> SUBTOTAL: <br />B. Enter .30% of line A1 fo~ Plan Review <br />C. Investigation Fee~ ifr~quired <br />D. Reinslx~tion Fee ($50.00) <br />E. Additional Plan Review, $62.50/hour, ( minimum one half hour) <br />F~ lnspectio~ for which no fee is specifically indicated, $62.50/hr~ <br /> (minimum one hour) <br />G. Inspection Outside Normal Business Hou~ $62.50/hr~ <br /> (minimum ~ houma) <br />McH Seismic Fee (01% x A1~1541 Rev 9/98 TOTAL AMOUNT DUE <br /> <br /> <br />