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FOR CITY USE ONLy <br />Rec~ved By: .Date: <br />Zoning By: City: <br />Receipt g: Amount: $ <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Section~, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> Site Address: <br /> <br /> City: <br /> <br /> parcel Owner: .~Ktffa'~l~q /~.A/. /-/...(.., <br /> <br /> Phone: ,5'0 ~, <br /> <br /> Cross Street~Directions: <br /> <br />Project Description: ..~/q~,~_~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT SYARTED WITHIN I80 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 />Contractors Board <br />Registration No.: <br /> <br />Contractor's Signattrce: <br /> <br />Oty: ~4~ State: ~ Zip: <br /> <br />s~ucmm is soM or ~emd~r sale be~m or upon completio~ ff l <br />t~ Co~t~tion Con~ors B~ lf l c~ge my ~ ~ do <br />C~ B~ I will i~ately nati~ Marion Co~ of <br /> <br /> Owner's Signature: <br /> <br /> A~.ent's Signature!~~ <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan review. We will pwvide plan <br /> review service if you complete Section 5B and submit two (2) gets of <br /> plans and spec ficationg w th this appLicat on. <br /> <br />MC 15-41 Rev 9/98 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT cEKrER <br />3150 Lancaster Dr. NE - Suite C, Sal~rn, Oregon 97305 <br />8:00am - 4:30pm <br />24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> 4. FEE SCHEDULE (comp]O.e and enter togd in Al) <br /> <br /> ( )ILESIDENTIAL .~.)COMMERCIAL ( )(}AS ~f~t!LECFRIC <br /> ~ NEW ( ) ADDITION ( ) ALTERATION <br /> ( ) Z~LOC^~ON ( ) ~PI.AC~M~t, rr <br /> OTY <br /> <br />Furnam (includes duets / vents) <br />Forced A/r up to l00,i~0 BTU __ x $12.00=$__ <br />Fowed Air over l0o,000 BTU __ x $15~00=$ <br />Floor Furnace __ x $12.00=$.__ <br />Ducts (Alterations/Extension) -- x $15.00 = $ -- <br /> <br />GasFumace(uptel00,00oBTU) __ x $12.00=$ <br />Oas Fumace (over l0o.00O BTU) __ x $15.00--$__ <br />GasFireplace/Inse. ~ x $1~.00--$ <br />Oas Water Heater __ x $15,00=$__ <br />Oas Log LigMex __ x $15.00=$__ <br />OasBad:equ¢ -- x $15.00=$__ <br /> <br />Gas Piping <br />Each outlet up to 4 outlets -- x $4.00 = $ -- <br /> <br />WaU neate~ ~ x $12.0O = $ 4,.L¥-z~ <br /> <br />Dwelling Permit Labels ~of Labels <br />(For New Dwellings Only) <br />Other (as required by the Building Official) <br /> <br />$9.~0 = $__ <br />$6.00 = $__ <br /> <br />$6.00 = $ -- <br /> <br />$15,00 -- $ -- <br />$6.0O = $__ <br />$60.0O = $ -- <br /> <br />$ ,04 = $~ <br /> _~ $ ~1~: <br /> <br /> E~t 30% of linc Al for plan R~view <br /> <br />C. Investigation Fee (if required) <br />D. Relnsgection Fee ($50.00) <br /> Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br /> Inspection for which no fee is specifically indicated./~ <br /> ($62,50/hr, minimum one hour) <br />CL Irapection Outride Normal Bu SilmSS Horn's, <br /> ($62.50/hr, minimum two hours) <br />H. Seismic Fee (.01% x Al)) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />