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~OK~2ITY USE ONLY <br />Received By:_ Date: <br />Zoning By: City: <br />Receipt #: Amotmt:$ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Sa[em, Ocegon 97305 <br />8:00 am - 4:30 pm <br />24 hr. Inspection Line 373-4427 FAX 588-794S <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please ~mpl~e all Se~ons, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br />Site Address: <br />City: Zip: <br />Parcel Owne~ <br />Phone: <br />Cross 81ree'dDireefions: <br /> <br /> Project Description: <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE V~IO IS <br />DOING THE WORK <br /> <br /> Mailing Address <br /> City: Sta~: Zip: <br /> Phone: <br /> <br /> Registration Number: <br /> <br />I am the PROPERTY OWNER and owt~ reside in. or will reside in the <br />completed structure and will be my own general contractor. [ understated <br />that I must register as a construction contractor if the structure is sold or <br />offered for sale before or upon completion. If I hire subcontractors, [ will <br />hire only subcontractors registered with the Consi~tction Contractors Board <br />lf l change my ndnd and do hire a general contr~tor who is..r~g?tered with <br />Agent'* Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not requir~ a plan review. We will provide plan review <br /> service ffyou complete Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-41 Rev 9/98 <br /> <br />4. FEE SCHEDULE (complete and enter t~tal in Al) <br /> <br />) RESIDENTIAL ( )COMMERCIAL <br />) NEW ( ) ADDITION <br />) RELOCATION ( ) REPLACEMENT <br /> <br />gm'nace (includes ducts / vents) <br />Forced Affup to 100,000 BTIJ <br />Forced Air over 100,000 BTU <br />Floor Furnace <br />Ducts (Aiterations/Extension) <br /> <br />( ) GAS ( ) ELECTR1C <br />( ) ALTERATION <br /> <br />QTY <br />~_ x $12.00 <br />__ x $15.00 <br />__ x $12.00 <br />__ x $15.00 <br /> <br />Gas Fumac~ (up to I ~0,000 BTU) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fireplace / insert <br />Gas Water Heater <br />Gas Log Ligh~r <br />Gas Barbeque <br />Gas Piping <br /> <br />Each additional outlet over 4 outlets <br /> <br /> $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 /> $ 1.00- $ <br /> <br />Heater~ <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 />Heat Pump <br />Under 3 Ton <br />3 Ton and More <br /> <br />512.00 = $ <br />$22.00- $ <br /> <br />x $15.00 = $ <br />x $22.00- $ <br />x $ 9.00 = $ <br /> <br />9.00 <br />9.00 <br />9.00 <br />6.00 <br />6.00 <br /> <br />6.00 <br /> <br />Additional Appliances <br />Wood.stove / Fireplace <br />Fire Damper <br />Coral / industrial Incinerator <br /> <br />x $15.00 <br />x $ 6.00 <br />x $60.00 <br /> <br />One)Two Family Dwelling Fee Square Feet: x S .04 - $ <br />Dw'elling Permit Labels g of Labels @ $ N/C <br />(For New Dwe IFmgs Only) <br />Other (as t~quired by the Building Official) <br /> <br />5. FEES <br />Al. BA~VE FEE A~sessed on ALL APPLIC4TION$: <br />A2. EnterTotal Fees from Secbon #4 <br /> SUBTOTAL <br />A3 Add State Surcharge (.05% x Al +A2) <br /> <br />B. Enter.30% of line Al for Plan Review <br />C. Investigation Fee, if required <br />D. P~inspection Fee ($50.00) <br />E. Additional Plan Review, $62.50/hour, ( minimum one barf hour) <br />F. Inspection for which no fee is specifically indicated, $62.50/hr, <br /> (minimnm one hour) <br />G. inspection Outside Normal Business Hours, $62.50Par. <br /> (minimum two hours) <br />ti. Seismic Fee (.01% x Al) <br /> <br /> $ 25.00 <br /> $ <br /> $ <br /> $ <br /> <br /> $ <br /> $ <br />TOTAL AMOUNT DUE $ <br /> <br /> <br />