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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By:__ C:ty:__ <br />Receipt #: Amount:$ <br /> <br />[MECII~NICAL pERMIT APPLICATION <br /> Please complete ali Seaions, 1 through <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancas~ex Salem, Oregon 97305 <br /> <br /> FAX 588-7948 <br /> <br /> ( ) COMiV~RCIAL t ~ GAS ( ) ELECTRIC <br /> 0.,e~? t~ NEW ( )ADDITION I I ALTERATION <br /> ~ , t. RELOCATION ( ) REPLACEMENT QTY <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />Parc, elD: <br /> <br />Site Address: <br /> <br /> Zip: <br />Parcel Ovmec ~ <br />Cross Stree~/Directi~ <br /> <br />IS NOTSTARTED WITItlN 180 DAYS OFISSUANCE OR IF <br />WORK IS SUS~EIqT~ED FOR 180 DA 1~ <br /> <br />2A. CONTRACTOR II~fEORMATION -- PLF~SE I~DICATE WHO IS <br /> <br />Property Owner: ~please pnnO <br />Mailing Address: <br />-City Stale: Zip- <br />Shone: Fax: <br /> <br />I am the PROPERTY OWNER and own, reside in. or will reside in the <br />:ompleted structure and will be my own general contractor. I understand <br />that I must reenter as a construcffon contractor if the structure ~ sold or <br />offered for sale before or upon completion. Ifl hire subcontractors, l wdl <br />hire only subcontractors regt~tered with the Constructton Contractors Board. <br />Ill change my mind and do hire a general contractor who is registered with <br />the ConsWacaon Contractors Board. I will immediate~ notify Marion County <br />of the name of the contractor: <br /> <br />Owner's Signature: <br /> <br />Agent's Signature' <br /> PLAN REVIEW SECTION <br /> <br />Marion Count) does not require a plan review. We will provide plan review <br />smwice if you complete Section 5B and submit two (2) sets of plans and <br /> <br />4. FEE SCHEDULE (complete a~ enter total ia Al) <br /> <br /> BTU <br />Forced ASr over 100,000 BTU <br />Floor Furnace <br />Ducts ( Alt eratiom/Exteasionl <br /> <br />x $12.00 <br />x $15.00 <br />x $12.00= <br />x $15~C <br /> <br />Gas Furnace (apto 100.000 BTU) <br />Gas Furnace lOVer 100,000 BTU) <br />Oas Fireplace / Insert <br />Gas Wat~ Heater <br />Gas Log Lighter <br />Gas Bar~lU¢ <br /> <br />Gas Piping <br />Each outlet up to 4 outlets <br />Each additional cattier over 4 outlets <br /> <br />x $12.00 = $ <br />x $15.00 = $ <br />x $15.00= $ <br />x $15~0 = $ <br />x $15.00 - S <br />x $15.00 = $ <br /> <br />x $ 4.00 <br />x $ 1.00 <br /> <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />x $12.00 <br />x $12.00 <br />x $12.00 <br /> <br />3TonaedM~e <br /> <br />x g12.00- $ <br />x $22.00 = $ <br /> <br />Air Conditioner <br /> x g 15.00 <br />Ueder 3 Ton -- <br />3Ton~ndMore __ x $22.00 <br />EvaporativeCoole~ x $ 9.00 = <br /> <br />Exhaust / Fans t Vents <br /> x $ 9.00 <br />Coral F~xl~ust <br /> x $ 9.00 <br />Coral Hood & Exhaus~ <br />Domestic Range Hoed (inclndes ducts) x $ 9.00 = <br />DomesticF~hausl Fat~ x $ 6.00 <br />DomesticDwe~Vents x $ 6.00 <br />Apptmace Ve~te installed and <br />not included in an appliance penmi x $ 6.00 = <br /> <br /> x $15.00 <br /> FirelYamper x $ 6.00 <br /> Coral / IndasaSal Incinerator x g60.00 <br /> <br /> One/TwoFamil] Dwelling Fee SquareFeet x $ .04 <br /> <br /> Dwell(ag P, trait Labels # of Labels ~ <br /> (For New Drillings Only) <br /> Other (as required by the Building Official) <br /> <br />5. FEES <br />BASE FEE Assessed on ALL APpLICATIONS: <br />Al. EnterTotal Fees fi'om Section #4 <br />A.7_ Add State Surcharge (.05 % x All <br /> <br />B. Enter .30%oflineAl for plan Rcwew <br />C. Investigation Fee, if required <br /> <br /> $ 25.00 <br />SUBTOTAL: $ ~ <br /> <br />D. Reimpection Fee ($50.00) <br />E. Additional Plan Review. $62.50/hoar. ( minimum one half hour) $ _ <br />F. Inspection for which no fee is specifically indicated, $62.50thr. <br />I.m~aimum ~e hour) $ <br />G. Inspection Outside Nounal Busine~ Hours, $62.50/hr. <br /> <br /> <br />