Laserfiche WebLink
F& CiTY ;JsE ONLy <br />Received By:.__ Date: <br />Zotting By: City: <br /> <br />M.~RION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />% <br /> <br />Project Description: <br /> <br />PERg~ITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DA YS OF ISSUANCE OR IF <br />WORE I$ ~USPENDED FOR 180 DA}~. <br /> <br />2A. CONTRACYOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br /> Conlractor: <br /> Mailing Address <br /> City: State: Zip: <br /> Phone: <br /> Fax: <br /> <br /> Contractors Board <br /> Registration Nuraber: <br /> <br /> Contractor's Signature: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Propeay Owner: (please print) <br />Ma~ling Address: <br />city: state: zip: <br />Phone: Fax: <br /> <br />l am the PROPERTY OBTqER and owr~ reside in, or will reside in the <br />completed slr~¢ture and will be my own general contractor. I understand <br /> <br />offered for sale before or upon complellon, lfl 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 Cort~truction Contractors Board. I will immediat¢l), ttoti~, Marion Corn O' <br />of the nome of the contractor: <br /> <br />3. pLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We will provide plan review I <br /> <br />MC 15-41 Rev 9/98 <br /> <br />4. FEE SCHEDULE (complete sad enter total in Al) <br /> ( ) RESIDENTIAL ~COMMERCIAL ( )GAS <br /> ( ) NEW ( ) ADDIllON <br /> ( ) RELOCATION ~g) iLEPLACEMENT <br /> <br />~urnae~ (include'~ ducts / vents) <br />Forced Ah-up to 100,000 BTU <br />Forced Air over 100,000 BTU <br />Floor Furnace <br />Ducts (Alterations/Extension) <br /> <br /> ( ) EEffCTtttC <br />( ) ALTERATION <br /> <br />QTY <br /> <br />$12.00 = $ <br />$15.00 = $ <br />$12.00 = $__ <br />$15.00 = $ <br /> <br />Gas Ins-t~tion <br />Gas Furnace (up to 100,000 BTU) <br />Oas Furnace (over 100,000 BTU) <br /> <br />Oas Barbeque <br />Oas Piping ~t ~ ~'~"~ <br /> <br /> x $12.00 = <br />__ x $15.00 <br />-- x $15.00 <br />__ x $I5.00 <br />__ x $15.00 <br />__ x $15.00 <br /> <br />__ x $ 4.00 =$__ <br />-- x $ 1.00 <br /> <br />Suspended Heater <br />Wall Healer <br />Floor Mounted Heater <br /> <br />$12.00 <br />$12.00 <br /> <br />Heat Pm~n <br />Under 3 Ton <br />3 Ton and More <br /> <br />$12.00 = $ <br />$22.00 = $ <br /> <br />A~r Conditioner <br />Under 3 Ton <br />3 Ton and More <br />Evaporative C~oler <br /> <br />$15.00 = $ <br />$22.00 = $ <br />$9.00= $ <br /> <br />Exhaust [ Fans / Vents <br />COml Exhaust System <br />COml Hood & Exhaust <br />Domestic Range Hood (includes ducts) <br /> <br />x $ 9.00 - $ <br />x $ 9.00 = $ <br />x $ 9.00 = $ <br />x $6.00- $ <br />x $ 6.00- $ <br /> <br />X $ 6100 : $ <br /> <br />x $15.00 = $ <br />x $60.00 = $ <br /> <br />5. FEES <br />Al. BAXK FEE Assessed on ALL AI'PLIC4 TIONS: <br />A2. EnterTolal Fees from S¢¢lion #4 <br /> SUBTOTAL <br />A3 Add State Surcharge 605% x AI +A2 ) <br /> <br />B Enter .30% of line Al for Plan Review <br />C l h~vestigation Fee, if required <br />D. Reinspection Fee ($50.00) <br />E Additional Plan Review, $62 50~our, ( minimum one half hour) <br />F. Inspeclion for which no Fee is specdically indicated, $62.50/hr. <br /> (minimum one hour) <br />G. Inspection Outside Nom~al Business Houm, $62.50/hr, <br /> (mininlum tsvo hours} <br />[t Seismic Fee (.01% x Al) <br /> TOTAL AMOUNT DUE <br /> <br /> <br />