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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By~ City:. <br />Receipt #: Amotmt:$ <br /> <br />MARION COUNTY BUILDING iNSPE(51'ION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Laneastsr Dr. NE - Suits C, Salem, Oregon 97305 <br />g:00 am - 4:30 pm <br />24 hr. Inspection Line 373-4427 FAX 588-7948 <br /> <br />MECIIANICAL PERMIT APPLICATION <br /> <br />Parcel ID: <br /> <br /> Project Description: <br /> <br /> PERAfflTS AP~ NON-TRAAr~FERd°RLE AND I~IaIRE IF WORK <br /> IS NOT STARTED WITIIIN IgC DA IS OF ISSUANCE OR IF <br /> WORK I$ SUSPENDED FOR 180 DA <br /> <br />lA. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br />Prop~a'y Owner: (please print) <br /> <br />Mailing Address: <br /> <br />Ciw: Slate: Zip: <br />Phone: Fax: <br /> <br />oft& name of the contractor: <br /> <br /> Ovmer's Signature: <br /> <br /> Agent's Signature: <br />3. PLAN RgVIEW SECTION <br /> <br />Marion Counly does not require a plan review. We will provide plan review <br />service if you comple{e Section 5B and submit two (2) sets of plans and <br />specifications with thi~ application. <br /> <br /> I q ED <br /> <br /> q -b 3q' 6mm0. c0u <br /> <br />~SIDENIIAL ( )COMMERCIAL ( )GAS ~L~IC <br /> <br />( ) NEW g,,-~DDITION <br />( ) RELOCATiON ( ) REPLACEMENT <br /> <br />Furnace (includes ducts / vents) <br />Forced Ak up to 100,000 BTO <br />Foeeed Ak over 100,000 BTU <br />Floor Furnace <br />Duets (Alterations/Extension) <br /> <br />( ) ALI~RAT[ON <br /> <br />QTY <br /> <br />x t$12.00 <br />x $15.00 <br />__ x $12.00 <br />__ x $15.00 <br /> <br />Gas Bat'o~lUe <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 />Flora 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 /> x $12.00 <br />T x $22.00 <br /> <br />Ah- Conditioner <br /> <br />Under 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />x $15.00 = $ <br />x $22.00 = $ <br />x $ 9.06 = $ <br /> <br />Exhaost / Fans / Vents <br />Corn[ Exhaust System <br />Coral Hood & Exhaust <br />Domestic Range Hood (includes ducts) <br />Domes'lie Exhaust Fans <br />Domestic Dwer Vents <br />Appliance Vents installed and <br />not included in an appliance permit <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 />Additional AonEnnces <br />Woodstove 1 Fireplace <br />Fire Damper <br />Coml / I~dustrial Incinerator <br /> <br />x $15.00 = $ <br />x $6.00= $ <br />x $60.00 = $ <br /> <br />One/Two Family l~'elling Fee Square Feet: __ x $ .04 = $ <br />Dwelling Permit Labels # of Labels ~ $ N/C <br />(For New Dwellings O~ly) <br />Other (as required by the Building Official) $ <br /> <br />S. FEES <br />Al. BASE FEEAssessed on ALL APPLICATIONS: $ 25.00 <br />A2, EnterTotsl Fees from Section #4 $ <br /> SUBTOTAL S ~L/~_ 0~) <br />A3 Add State Surchaxg~ (.05% x A I +A2) $ <br /> <br />B. Enter.30% of line Al for Plan Review $ <br />C. Investigation Fee, ifr~quired $ <br />D. Reinspection Fee ($50.00) $ __ <br />E. Additional Plan Review, $62.50thour, ( minimum one half hour) $ <br />F. Inspection for which no fee is specifically indicated, $62,50/hr, <br /> (minimum one honr) $ <br />G. Inspection Outside Normal Business Hours, $62.50/hr, <br /> (minimum two hours) <br />H. Seismic Fee(.01%xAI) <br /> TO'FA!., AMOUNT DUE <br /> <br /> <br />