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FOR CITY USE ONLY <br />Received By:~ _Date: <br />Zoning By:~' __ City: <br />Receipl g:__ /unoum:$ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />g:oo am - 4:30 pm <br />24 hr. Inspection Line 373-4427 F~X 58g-7948 <br /> <br /> MECHANICAL PERIV/IT APPLICATION <br /> Please complete all Seations, l through 5 <br /> <br />1. LOCATION OF INSTALLATION g///-~tO, <br /> <br /> City: Zip: <br /> <br />Cross Strael/Dira~tions: <br /> <br />Proj~-'t l~scriptinn: ;; <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />I$ NOT 3~TARTED t~[THIN 150 DAYS OF ISSUANCE OR IF <br />WOBX I$ SUSPENDED FOR 180 DAYS. , <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br />Mailing Address <br />City: State: Zip: <br /> <br />ContractomBoard <br />Registration Ntunbcr: <br /> <br />Gontraetor's Signature: <br /> <br />2B~ FOR OWNER INSTALLATION <br /> <br />Prope~y Owner: (pleaseptinO <br />Mailing Address: <br />City: State: Zip: <br />Phone: Fax: <br /> <br />I am the PROPERTY Oll2ffER and own, reside in, or will reside in the <br />completed structure a~ni will be my own genera/contractor. ! understand <br />that I must register os a construction contractor if the sttnwture is scm or <br />offered for sale before or upon completiot~ /fl hire subcontractors, I will <br />hire only subcontractors registered with the Construction Contractors Board <br />Ill change my mind and do hire a general contractor who is registered with <br />the Construction Contractors Board [ will immediately notij~, Marion Coun~ <br />of the name of the contractor: <br /> <br />Oumcr's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SECF[ON <br /> <br />Marion County does not require a plan review. We will provide plan review <br />service fi`you complete Section 51t and submit two (2) sets of plans and <br />specifications w th Ihis applicat on. <br /> <br />MC 1541 Rev 9~98 <br /> <br />g9.o5' 7 <br /> <br /> FEE SCHEDULE (complete and enter total in Al) <br />( )RESIDENTIAL ~COMMERCIAL ( )GAS ( )ELECTRIC <br />( )NEW ( )ADDITION ( ) ALTERATION <br />( ) RELOCATION ~ REPLACEMENT <br />~a~e (includes ducts I vents) OTy <br /> <br />ForcedAirupto 100,000BTU -- x $12.00 = $ <br />Forced Air over I00,000 BTU x $15,00 - $ <br />FloorFmmace __ x $12.00-$ <br />Ducts(Alterations/Ex~ension) -- x $I5.00 = $ <br /> <br />Log Lighter <br /> <br />-- x $12.00 = <br /> x $15.00 <br /> x $15,00 <br /> x $15.00 <br /> -- x $15.00 <br /> x $15.0~ <br /> <br /> x $ 4.00 <br /> x $ 1.00 <br /> <br />Hegter~ <br /> <br />$12.00 <br />$12.00 <br />$12.00 <br /> <br />Heat Pumo <br />Under 3 Ton <br />3 Ton and More <br /> <br />x $12,00- $ <br />x $22.00 = $ <br /> <br />Air Conditioner <br />Under 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />x $15.00 <br />x $22,00 <br />x $9.00= <br /> <br />Exhaust t Fans / Ven~s <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 />Addlti~mal Appliances <br />Woodstove / Fireplace <br />Fire Damper <br />Coml / Indushqal incinerator <br /> <br />x $15.00 = $ <br />x $ 6.00 - $ <br />x $60.00 = $ <br /> <br />5. FEES <br />Al. BASEFEEAss~ssedonALLAPPLIC4TION$: $ 25.00 <br />A2. EnterTotal Fees from Section #4 $ <br /> SUBTOTAL $ <br />A3 Add State Surcharge (.05% x A1 +A2) $ __ <br /> <br /> B. Eme~ .30% of line Al for Plan Review $ ~ <br /> C. Investigation Fee, ffrequired /$]~[ <br /> D. Reinspe~-~tion Fee ($50.00) [~ <br /> E. Additional Plan Review, $62.50/hour, ( nrinimum one half hour) '~ <br /> F, Inspection for which no fee is specilically indicated, $62.50/hr, <br /> (minlraum one hour) $ -- <br /> G. Inspection Out~ide Normal Business Hours, $62.50/hr, <br /> (minimum two houri) $ __ <br /> H. ~ismic Fee (.01% x Al) $ __ <br />~ .~ O ~. TOTAL AMOUNT DUE $ __ <br /> <br /> <br />