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FOR CITY USE ONLY <br />Zoning By: City: <br /> <br />MARION COUNTY BU[LDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C. Salem, Oregon 97305 <br />8:00 ~ - 4:30 pm <br />24 hr. In,portion Lin~ 373-4427 FAX 58g.7948 <br /> <br /> I <br /> MECI~tNICAL PERMIT APPLICATION ] <br /> Please compline all Se~ion~, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br /> IS NOT STARTED IbT~HIN l gO DA Y~ OF ISSUANCE OR IF <br /> WOR~ IS SUSPENDED FOR 180 DA YS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br />Mailing Address: <br />Ciw: State: Zip: <br />Phone: Fax: <br /> <br />I am the PROPERTY OtlWF~ and own. reside in. or will reside in the <br />cornpleted stFUclure attd will be my ow. gene~Jl contractor. I undersla~ut <br />that [ must register as a construction contractor Cf the stt~tcture is sold or <br />offered for sale before or upon completion. [fi hire ~ubcontractors, [ wdl <br />hire only ~bcontroctors registered with the Construction Contractors Board <br />If[ change nU, mind attd do hire a general contractor who is registered with <br />t~e Constructinn Contractors Board 1 will immediately no6fy Matlon Coun(y <br />of the name of tire contractor: <br /> <br /> Agent's Signature: <br /> <br />3. PlAN RI~VIEW SECTION <br /> <br /> Marion Count3, does not requir~ a plan review. We will provide plan review <br /> service if you complete Section 5B and submit two (2) sets o f phxns and <br /> specifications with this application. <br /> <br />MC 15-41 Rev 9/98 <br /> <br />MARION ¢OUNTY'- <br />BUILDIN6 INSPEGTION <br /> <br />(-~RESIDENT1AL ( )COMMERCIAL <br />( ) NEW ( ) ADDITION <br />( ) RELOCATION (,~i~EPLACEMENT <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 (Alterations/Extension) <br /> <br />( ) GAS ( ) ELECTRIC <br />( ) ALTERATION <br /> <br />9TY <br /> <br />$12.00 <br />$15.00 <br /> <br />G~ Furnace (up to 100,000 BTU) <br />G~ Furnace (over 100,000 BTU) <br />Gas Fireplace / Inseri <br /> <br />Gas Log Lighter <br /> <br />Gas Piping <br />Each outlet up 1o 4 outlets <br />Each additional outlet over 4 outlets <br /> <br /> $12.00 - <br />x $15.00 <br />× $15.00 <br />x $15.00 <br />x $15.00 <br />x $15.00 <br /> <br />x $ 4.00=$ <br /> $ 1.00 <br /> <br />Stmponded Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />$12.00 <br />$12.00 <br />$12.00 <br /> <br />Heat Puma <br />Under 3 Ton <br />3 Ton and More <br /> <br />x $12.00 <br />x $22.00 <br /> <br />Air Conditioner <br /> <br />3 Ton and Mor~ <br />Evaporative Cooler <br /> <br />x $15.00 = $ <br />x $22.00 = $ <br />x $ 9.00 = $ <br /> <br />Exhaust / Fan~ / Vents <br />(2omi Exhatmt System <br />Coml Hood & Exhaust <br />Bomesdc Range Hood (includes ducts) <br /> <br />x $ 9.00 <br />x $ 9.00 <br />x S 9.00 <br />x $ 6.00 <br />x $6.00= $ <br /> <br />x $ 6.00 <br /> <br />Additional Annllanc~ <br />Woo&stove / Fireplace <br />~tre Damper <br />Cam[ / Industrial Incinerator <br /> <br />x $15.00 <br />x $ 6.00 <br />x 560.00 <br /> <br />One/Two Family Dwelling Fee Square Feet: __ x $ .04 = <br />l)weHing Permit Labels # of Labels __ (~ S N/C <br />(For New Dwellings Only) <br />Other (as required by the Building Ottinial) <br /> <br />5. FEES <br />Al. IIASE FEEAssessed on ALL APPLICATIONS: $ 25.00 <br />A2. EnterTotal Fees from Section #4 S /~- 0o <br /> SUBTOTAL S <br />A3 Add. State Surcharge (.05% x Al <br /> <br />B. Enter.30%ofline Al For Plan Review S <br />C. Investigation Fee, if required <br />D. Reinspoetion Feo ($50.00) S __ <br />E. Additional Plan Review, 262.50thour, ( minimum one hal£hour) S -- <br />F. Inspection for which no lee ia specifically indicated, $62.50/hr. <br />(ndnimum one hour) S -- <br />G. Inspection Outside Normal Business Houm, $62.50/hr. <br />(minimum two hour~) $ .-- <br />[4. Seismic Fee (.01% x Al ) <br /> TOTAL AMOUNT DUE <br /> <br /> <br />