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FOR CITY USE ONLY ~ <br />P,~.~ive~l By: Date: ~ <br />~Zoning By: City: { <br />Receipt ~. Amount! $ ~ <br /> -~ ....... ,,_... _...~ ........ <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Pltose complete all Sections, I through $ <br /> <br />L LOCATION OF INST~LL~TION <br /> <br /> Parcel ID: <br /> <br /> pERMITS APE NON-~ItANSFERABLE AND F-J[~IRE IF WORK ] <br /> IS NOT STARTED WITHIN 180 DAYS OF IS~UANCE OR IF ] <br /> WOPJ~ IS SUSPENDED FOR 180 DAYS. ] <br />2A. CONTRACTOR INFORMATION ~ PLEASE INDICATE <br />WHO IS DOING THE WORK <br /> <br /> Contractors Board <br /> t o.: Iff~~ <br /> <br />211. FOR OIR~ER IN$1M~.TION <br /> Prope~ Owne~. (please p~nt) <br /> <br /> City: Sme: Zip: <br /> <br /> st~cture is sold or offered for sale be~re or upon completiotr lf l <br /> <br /> the Construction Contractors Board. If I change my mind and do <br /> <br /> Contracton Boarv~ I will immediately not~fy Marion County of the <br /> <br /> Owen's Si~ature: <br /> <br /> Agen. t's Signature: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00am - 4:30pm <br /> 24 HR Inspection L'me 373..4427 FAX 588-7948 <br /> <br /> REgEIVEO <br /> 1997 <br /> <br />4. FEE SCHEDULE (complet~ and enter total in Al) <br /> <br /> ~ P. ESIDENTIAL ( )COMMERCIAL <br /> ( ) NEW ( ) ADDITION <br /> ( ) RELOCATION ( ) RI~LACI~FaNT <br /> <br />Furnace 0ndudes dncts / v~ts) <br />Flan~d Air up to 100,000 BTU <br />Fow~t Air over 100,000 BTU <br />~1oo~ Furnace <br />Duc~ (Alte~afions/Exten~on) <br /> <br />Oas Fm'nace (up to 100,000 BTU) <br />Gas Furnace (ov~ 100,000 BTU) <br />Gas F'uephc~ / lnse~ <br />Gas Water l~ate~ <br /> <br />Ga~ Baeeeque <br /> <br />~ Dryer ~%nts <br /> <br /> MARION COUNT' <br /> <br />( ) ALTERATION <br /> <br />s=0o=$/gZD <br />$15.00 = $__ <br />$12.00 = $ <br />$15.00 = $ <br /> <br />$12.~0 = $__ <br />$15.00=$__ <br />$15.00=$__ <br />$15.00=$__ <br />$15.00 -- $ <br />$15.00=$__ <br /> <br /> $1.~0 = $__ <br /> <br />$1~.00 = $__ <br />$12.00=$__ <br />$12.00=$__ <br /> <br />$12.00 =$__ <br />$22.00 = $__ <br /> <br />$15.00 = $ <br />$22.00 = $ <br /> ~.00 =$__ <br /> <br /> $9.00 <br /> $9.00 <br /> <br /> $6.00 = $__ <br /> $6.00 = $__ <br /> <br /> $6.00 = $__ <br /> <br />$15.00 = $ <br /> $6.00 =$__ <br /> <br /> $ .04=$__ <br /> <br /> $__ <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of liu~ Al for Plan Re~iew <br />C. Investigation ~ (if required) <br />D. Reinspection Fee ($50.00) <br /> <br />minimum one-half hour) $ -- <br />F. Inspection for which no f~e is s~y indicated, ~¢ <br />($62~0/hr, minimum one hour) $ -- <br />O. Inspection Outside Normal Business Houm, <br />($6230/hr, minimum two hours) $ -- <br />H, Seismic Fee (.01% x Al)) $ -- <br /> <br />s <br />$__ <br />$~ <br />$__ <br /> <br />rOr L, owrr s <br /> <br /> <br />