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[eceived By: <br /> <br />FOR CITY VALIDATION <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-44~7 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 58~-7945 <br /> <br />MECHANICAL PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> JoB DRESs <br /> <br /> CROSS S~/ <br /> D~ONS <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owaer (please print) <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <br /> <br /> Agent's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCI-II~DULE (CompleX: and enter total in Al below) <br />RESmENTIAL ~] COMMERCIAL ~ USE:. <br />NEW fi] ALTERATION I-I ADDmoN [~ RELOCATION fl R~X,LAC~ <br /> GAS I"{ £LF~-~C ~'~ ~ <br />BASE FEE ASSESSED ON ALL APPLICATIONS <br /> <br />GASFURNACE(up~,IOO,OOOBTU) / x $6.00 =S ~. ~O <br /> <br />5. FEES <br /> Al. Enter ~ml of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of Hue Al for Plan Review <br /> (Al + .25), if reqalred <br />C. Investigation Fee (if required) <br />D. Ruinspection Fee ($25.0(}) <br /> <br />Receipt NO. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC I5-41 7/97 <br /> <br /> <br />