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FOR CITY USE ONLY <br />Received By: .Date: <br />Zoning By: .City: <br />Receipt ~ Amount: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ProjectDescription: z <br /> <br />PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK I <br />15 NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION -- pLEASE INDICATE <br />WHO IS DOING THE WORK <br /> <br /> Mailing Address: ~?.1~- pit": m IJ~ /~. ~S '~ <br /> <br /> 51)3-K q- tVS <br /> Contractors Board OlJ! <br /> Registration,. No.: 07~ · <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Zip: <br /> <br />Property Owner: (p/e~e print) <br /> <br />Mailing Address: <br /> <br /> State: <br /> <br /> am the PROPERTY OWNER and own, reside in, or will reside in <br /> ty own general contracto~ 1 <br />ttnderstand that l must register as a construction contractor if the <br />structure is sold or offered for sale before or upon complet~or~ If 1 <br />hire subcontractors, I will hire only subcontractors registered with <br />t~e Construction Contractors Board. If l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Marion County of the <br />name of tbe contractor. <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan r~view. We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with this application. <br /> <br />MC 1541 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING I~SPECTION <br /> , COMMUNITY DEVELOPMENT CENTER <br />--&IS0 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br /> <br /> Inspection Line 373-4427 FAX 588-7948 <br /> <br /> q~q.~ 4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> ~P, ESID~ (,COMMERCIAL ()OAS ()ELECTRIC <br /> --"~2LWOC ( )ADDmON ()ALTERATION <br /> <br /> ^ilO <br /> <br />~ (include~ ducts / vents) <br />Forced Air up to 100,000 BTU <br />For~ed Air over 100,000 BTU <br /> <br />Gas Furnace (up to 100,000 BTU) <br />Gas Fumac~ (over 100,000 BTU) <br /> <br />Gas Log Lighter <br />Gas BWoeque <br /> <br />Gas Piping <br /> <br />Under 3 Ton <br /> <br />~ Rang* Hood (~clud~a d~e~s) <br /> <br />OTY <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 $12.00=$__ <br />-- x $12.00=$__ <br /> <br /> -- x $12.00=$__ <br /> -- x $22.00=$__ <br /> <br />I , 15 <br />__ x $22.00=$__ <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 $6.00 = $ .-- <br /> <br /> -- x $15.00=$ <br /> -- x $6.00 = $__ <br /> -- x $60.00=$__ <br /> <br /> x $ .04 <br /> ~of Labels @ $ ~ <br /> $__ <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: $ <br /> Al. Eater total of fees from Sec. ~ <br /> A2. Add Sta~ Smcharge (.05% x A1 + Ba~,~ F~) <br /> St TOTA $ <br /> B. Eater 30% of line Al for Plan P~view $ __ <br /> C. hvestigation Fee (if required) $ __ <br /> D. Reinspection Fee ($50.00) $ __ <br /> E. Additional Plan R~vlew ($62.50thr, <br /> mi~aura otb-half hoar) $ -- <br /> E lml~ction for which no fee ia q~2~ficaily indkated,(c~i <br /> ($62.50/hr, minimum one hour) $ __ <br /> G. Inspection Outside Nolxnai Bu sin~a Rour8, <br /> ($62.50/ht, minimum two hourO <br /> H. Seismic F~ (.01% x Al)) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />