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FOR CITY USE ONLY <br />Received By:. Date: <br />Zoning By: City:__ i <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete aII Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DE]~ELOPMENT CENTER <br />3150 La.0gi,,~!'~'~ite C, Salem, Oregon 97305 ~ ~ <br /> <br /> N~ t} : ': ' ~&KESIDENTIAL ( ) COMMERCIAL ( ) GAS ( ) ELECTPdC <br /> "" ~ ~ · 3-NEW ~ ADDITION ( ) ALTERATION <br /> <br /> ~A.~i~ G0~i{T~ ~RELOCATION /("~REPLACEIvlENT QTY <br /> <br /> porc~t Air upto 100.000 BTU <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br />Fax: <br /> <br />Prepe~y Owner: (please pnno <br />Mailing Address: <br /> <br />City: State: Zip: <br />Phone: Fax: <br /> <br /> I am the PROPERTY 0 WNER and o~n, reside in, or will reside in the <br /> completed structure and will be my own general contractor. I understand <br /> <br /> offered for sale before or upon completion. If[ hire subcontractors. I will <br /> lf l change my mind and do hire a general contractor who is regtstered with <br /> the 'Construction Contractors Boar~ I will immediately notify Marion County <br />Iof the name of the contractor: <br /> <br /> Owner's Signature: <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plum review. We will provide plan rcview <br />sc~icc if you complete Section 5 B and submit two (2) sets of plans and <br /> <br />4. FEE SCHEDULE (complete and eater total in All <br /> <br />Forced Air over 100,000 BTU <br />Floor Furnace <br />Ducts (AOerationa/E~e~on] <br /> <br />Gas Installatioa_ <br />Gas Furmaee (up to 100,000 BTU) <br />Gas Furnace (ove~ 100,000 BTU) <br />Gas Fireplace / Insert <br /> <br />Gas Log Lighter <br />Gas Barbeqne <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 />n $15.00 = $ <br />x $15.00 ~ $ <br /> <br />Gas Piping <br />Each outlet up to 4 c~tlets <br />Each additional outlet over 4 ou0et~ <br /> <br />x$ 4.00=$ <br /> <br />Suspended H~ater <br />Wall Heater <br />FIo~ Mourned Heater <br /> <br />x $12.00 = $ <br />x $12.00 = $ <br />x $12.00 = $ <br /> <br /> x $12.00 = $_ <br />_ x $22.00 = $ <br /> <br />Air Conditioner <br />Under 3 Ton <br />3 Ton and More <br />Evapcnative Ccolcr <br /> <br />Exhaust / Fans t Vents <br />Coral Exhaust System <br /> <br /> x $15.00 = $ <br /> x S22.00 = $ <br /> x $ 9.00 = $ <br /> <br /> x $9.00 = $ <br /> x $ 9.00 = $ <br /> x $ 9.00= $ <br /> x $6.00= $ <br /> x $ 6.00 = $. <br /> <br /> x $15.00 = $~_,~ <br /> x $ 6.00 = $ <br /> x $60.00 = $ <br /> <br /> x $ .04 = $_ <br /># of Labels _ ~ $ ]~/C <br /> <br /> $ <br /> <br />5. FEES <br />~ ~d S~te S~c~gc (.05% x Al ) S~TOT~ $$~'~ <br />D. Re~ti~ F~ ($50.~) ~ <br /> <br /> (mm~um ~ ~uO $ ~ <br /> <br /> (~imum ~o ~u~] $ ~ <br /> H. Se~mie F~ (.01%x Al} $- ~ <br /> <br /> <br />