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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt #: Amounts <br /> <br />I MECHANICAL PERMIT APPLICATION <br /> Please complete all~ecdons, 1 through 5 <br /> <br />MARION COUNTY BUILD1NG INSPECTION <br />COMMUN[TY DEVELOPMENT CENTER <br />3150 Lancz~er Dr. NE- Suite C Salem. Oregon 97305 <br /> <br /> 24 hr. Inspec~on Line 373M4: FA~_ 5.~88-7948 , <br /> <br /> ~[~ ~mSIDENTIAL ( J COMMERCIAL t ) GAS ( ) ELECTPdC <br /> ] ,NEW )~p[ ITION (,ALTERATION <br /> ~RELOCATION LACEMENT QTY <br /> <br />2A. CONTRACTOR INFORMAT ION -- PLEASE I]~DICATE WHO IS <br />DOING T %W? RK <br /> <br />Property Owner: (please prmo <br />Mailing Add,ess: <br />City: Slate: Zip: <br />Phone: Fax: <br /> <br />I am the PROPERTY OWNER and own. reside in. or will reside in the <br />completed strucmre and wdl be my own general contractor, f understand <br />that I mu~t register as a conswuclion contractor ~f the structure is sold or <br />offeredforsalebeforeoruponcompletion lf[hiresubcontractors, lwill <br />hire only subcontractors registered with the Construction Contractors Board. <br />If l change m) mind and do hire a general contractor who is registered with <br />the Construction Contractors Board I will immedtatel) notify Marion Coun~ <br />of the name of the contractor: <br /> <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. pI~kN REVIEW SECTION <br /> <br />Marion Counly does not require a plan review. Wc wdI Plovtde plan review I <br />se~ice if you complete Section 5B and submit two (2) s~s of plans and <br />specifications with ams appbcauon <br /> <br />4. FEE SCHEDULE (complete and enter total ia Al) <br /> <br /> Furnace (includes ducts / vents) <br />limited <br /> Air up to 100,000 BTU <br />~c~ed Air over 100_000 BTU <br /> <br />x $12.00 <br />x $15.00 <br />x $12.00 <br />x $15.00 <br /> <br />Gas Installation <br />Gas Furnace (up ~o 100,000 BTD) <br />Gas Furnace (over 100.000 BTU) <br />Gas Fireplace / lnslaI <br />Gas Water }{cater <br />Gas Log Lighter <br />Gas Bathcque <br /> <br />$12.00 = $ <br />$15.00 = $ <br />$15.00 = $ <br />$15.00 = $ <br />$15.00 = $ <br />$15.00 = $ <br /> <br />Gas Piping <br /> Each outlet up lo 4 outi~cs <br /> Each addifiooal outlet over 4 outlets <br /> <br />x $ 4.00 <br />x$ <br /> <br />SuspeaaMd H~ater <br />Wall H~atex <br />Flc<~ Mounted Heater <br /> <br />x $12.00 = $ <br />x $12.00 = $ <br />x S12.00 = $ <br /> <br />Under 3 Ton <br />3 Ton and More <br /> <br />x $12.00 = $ <br />x $22.00 = $ <br /> <br />Air Conditioner <br />Uede~ 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />x S15.00 = $ <br />x g22.00 = $ <br />x $9.00= $ <br /> <br />Coral Hood & Exhaust <br />Dom~ic Range Hood (includes duets) <br />Dom~tic ExhausX Fans <br />Domestic Dryer Vents <br />Appliance Vents i~stallo:i and <br /> <br />x $ 9.00 =$ <br />x $ 9.00 = $ <br />x $ 9.00 = $ <br />x $ 6.00= $ <br />x $ 6.00 = $ <br /> <br />x $ 6.00 = $ <br /> <br />Coral / Industrial lneinemto~ <br /> <br />x S60.00 = $ <br /> <br />One/Two Family Dwelling Fee Square F~: x $ .04 = $ <br />D'n~lling Permil Labels # of Lahels ~ $ N/C <br />(For New Dwellings Only) <br />Other (as required by the Building Official) $ <br /> <br />5. FEES <br />BASEFEEAssessedon~LLAPpLICATIONS: $ 25.00 <br />Al. EnterTotal F~s from Section 84 $ <br />A2 Add State Surcharge (.05% x A 1 ) <br />SUBTOTAL <br />B. Enter .30% of lirg A1 fo~ plan Review <br />C. Investigation Fee, if required $ <br /> <br />D. Reinspe~oa F~e ($50.00) <br />E. Additional Plan Review. $62.50/ho~r. ( minimum one half hour) $ <br />F. lnsp~tion for which no fcc is specifically indicated. $62.50/hr. <br />(minlmum ~ hour) $ <br />G. Inspection Outside Normal Business Houm $62.50thr. <br />(minimum eu~ hours) ~ ~-~-~t~ <br />FI. Seismic Fee (.01% x Al ) <br /> TOTAL AMOUNT DUE <br />MC 1541 R~v 9/98 <br /> <br /> <br />