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FOR CITY USE ONLY <br />Receivad By:. ~Dats: <br />Zoning By: City: <br />R~cip~ #:__ Amounts <br /> <br />MECHANICAL PERMIT APPLICATION <br /> <br />Plta~e complete all S~on~, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION C~)UNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suits C, Sa[em, Oregon 97305 <br />8:00 ara - 4:30 pm <br />24 hr. Inspection Line 373-4427 FA~X 588-7948 <br /> <br />Parcel ID: <br /> <br />Site Address: <br /> <br />City~ ' Zip: <br /> <br /> Project I~scription: <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXi~IRE IF WORK <br /> t$ NOT STfl~RTED gTTfllN 180 DA Yg OF ISSUANCE OR [F <br /> WORK I$ SUSPENDED FOR 180 <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br />PropeCff Ownec (please prinO <br /> <br />Mailing Address: <br /> <br />City: State: Zip: <br />Phone: Fax: <br /> <br />I am the PROPERTY OWNER and ow~ reside in, or will reside in the <br />~completed structure and will be my own general contractor. [ understand <br />that I must register ct~ a construction contractor if the str~cture is sold or <br />offered for sale before or ~tpon completion. If! hire subcontractors, I will <br />hire only subcontractors registered with the Construction Contractors Board <br />lf l change my mind and do hire ct general contractor who is registered with <br />tim Construction Contnactors Board, I will immediately natify Marion Coun~ <br />of the name of the contractor: <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. We will provide plan review <br /> service ~f you complete Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 1541 Rev 9/98 <br /> <br /> RECEIVED <br /> APR 2 ! 1999 <br /> MARION COUNTY <br />F~E SCHEDULE (complete <br />X} RESIDENTIAL ( )~MMERCI~ ( )G~ <br /> <br />) NEW ( ) ADDITION <br />) RELOCATION ( ) REPLACEMENT <br /> <br /> Furnace (includes ducts / vents) <br />Forced Air up to 100,000 BTU <br />Forced Air over 100.000 BTU <br />Floor Furnace <br />Ducts (AItsratio ns/Extensio n ) <br /> <br />Gas ln~allation. <br />Gas Furnace (up tu 100,000 BTU) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fireplace / l~ert <br />Gas Water Heater <br />Gas Log Lighter <br />Gas Baffoeque <br />Gas Piping <br />Each outlet up to 4 outlets <br />Each additional outlet over 4 outlets <br /> <br />QTY <br /> <br />__ x $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 /> x$ 1.00 = $ <br /> <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 Pmno <br />Under 3 Ton <br />3 Ton and More <br /> <br />Air Conditioner <br /> <br />Under 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />x $12.00 = $ <br /> <br />x $15.00 = $ <br />x $22.00 = $ <br />x $ 9.00 = $ <br /> <br />Exhaust / Fnns / Vents <br />Coml Exhaust System <br /> <br />x $ 9.00 - $ <br />x $ 9.00 = $ <br />x $ 9.00 = $ <br />x $ 6.00- $ <br />x $ 6.00 = $ <br /> <br />x $ 6.00 = $ <br /> <br />x $15.00 = $ <br />x $6.00 = $____ <br />x $60.00 = $ <br /> <br /> One/Two Family Dwelling Fee Square Feet: __ x $ .04 $ <br /> Dwelling Permit Labels # of Labels __ ~ $ N/C <br /> (For New Dwellings Only) <br /> Other (as required by the Building Official) $ <br /> <br />5. FEES <br />Al. BASE FEE Assessed on ALL APPLIC~4TIONS: $ 25.00 <br /> <br />A2. EnterTctal Fees from Section #4 <br /> <br />A3 Add State Surcharge 605% x Al +A2) <br /> <br />B. Enter.30%of[ine Al for Plan Review <br />C. Investigation Fee, ifrequirad <br />D. Reinspection Fee ($50.00) <br /> <br />SUBTOTAL <br /> <br />E. Additional pLan Review, $62.50/hour, ( minimum one half hour) $ __ <br />F. Inspection for which no fee ~s apecifically indicated, $62.50/hr, <br /> (minimtnn one hour) $ <br />G. inspeclinn Outside Normal Business Hour, $6ZS0/hr, <br /> (minimum two hours) $ <br />H. Seismic Fee (.01% x Al) $ <br /> TOTAL AMOUNT DUE $ <br /> <br /> <br />