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FOR CITY USE ONL , ,'~ nO ~,~, er, ?OMMUNITY DEVELOPMENT CE <br />Re*eived By: Date: -., ¢ ~. ~{}~3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />Zoning By: _City: ~ I ,- · 8:00am - 4:30pm <br /> <br />Receipt #: Amount: $__ ~.~4 HR Iaspection Line 373-4427 FAX 588-7948 <br />.................................... _... i%1~s 18s~C'~10]~: FEE SCHEDULE (eOml~t~ and ~nt~r total in Al) <br /> MECHANICAL PERMIT APPLICATION~°]*'w' ( ) RESIDENTIAL ( ) COMMERCIAL ( ) GAS <br /> Please complete all Sections, I through 5 [ ( ) NEW ( ) ADDITION <br /> ( ) RELOCATION ( ) RI~PLACEMENT <br /> <br /> ( ) EL~CIRIC <br />( ) ALTERATION <br /> <br />1. LOCATION OF INSTALLATION <br />Iparcel ID: <br /> Site Address: [ j 6 ~0~.~ t~ ~..~ c.Jf <br /> city: <br /> <br /> NON. TRANSFERABLE AND EXPIRE IF WORK I <br /> PERMITS <br /> ARE <br />I IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />[ WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INIHCATE <br /> / <br /> <br /> Mailing Address: <br /> City: Statc: Zip: <br /> <br />Phone: <br /> <br />Contractmm Bo~d <br />R~gistration No.: <br /> <br />Contractor's Signature: <br /> <br /> FOR OWNER INSTALLATION <br />Property Owns:: (p/ease print) M ~ <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside tn <br />the completed structure and will be my own general contractor. 1 <br />understand thai I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon comp/etiott Ill <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If [ change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Boat~ I will immediately notify Marion County of the <br />name of the contractor. <br /> <br />Agent's Sigaam~e: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> p aris and sp~ifical~ons with this application. <br /> <br />MC 15-41 Rev 9/98 <br /> <br /> ~ (includes ducts / v~nts) <br /> Forced Air up to l00,000 BTU -- x $12.~0=$__ <br /> ForcedAiroverl00,000BTU -- x $15.00=$ <br /> FIoorFumace -- x $12.00=$__ <br /> Ducts (Alterations/Extension) -- x $15.00 = $ <br /> <br />G~Fumace(uptol00,000BTU) -- x $12,00::$ <br />G~Furnace(ovcrl00.000BTU) -- x $15.00--$__ <br />GasFir~placc/lnsen -- x $15.00~-$__ <br />~Ga~ Water Heater -- x $15.00 .~ $ -- <br />Ga~ Log Lighten x $15.00 = $ -- <br /> <br /> Ga~ Piping ~ $4,00 :~$ f.O0 <br /> Each outer up to 4 out]ets x <br /> <br /> Domestic Dryer Vents -- x $6.00 = $ <br /> <br /> a,ll~tanak~taaa~ I x $1~.0o = $I~'"t <br /> O,aetl'wo~Famllyl~*~ngl~e:,~l~a~Fe~: x $ ,04=$__ <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ __ <br />$__ <br />$__ <br /> <br /> <br />