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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt #: Amotmt :$ <br /> <br />NLARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00 am - 4:30 pm <br />24 hr. insp¢ctinn Line 373-4427 FAX 588-7948 <br /> <br />MECHANICAL pER3AIT APPLICATION <br />P~tne carapl~ all Sectloas, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> Parc, el ID: <br /> <br /> PERMITSARENON-TRANSFER.4BLEAND EXPIREIFWORK ] <br /> 15 NOT STARTED WITHIN 180 DAYS OF I~UANCE OR IF <br /> WORK IS SUSPEIWDED FOR 180 DA YS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE ~VHO IS <br />DOING THE WORK <br /> <br /> Mailing Address <br /> City: Stat~: Zip: <br /> <br /> Contractors Board <br /> Co~xlxaetor'a Sigllal~xe: <br /> Property Owne~z {please prtn0 <br /> <br />offend for sMe befo~ or u~n co~le~on. ~I hi~ ~bcontractor& I will <br /> <br /> Mation County does not require a plan review. We will provide plan review <br /> service if you complete Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-41 Rev 9~)8 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> ~RESIDENT1AL (t),,COMMERCIAL ( )GAS ( )ELECTRIC <br /> '(X)NEW ~[ADDITION ( ) ALTERATION <br /> ( )RELOCATION ,ff )'REPLACEMENT <br /> <br />Furnace (Includes ducts / ven~) <br />Forced Air up to I00,000 BTU <br />Forced Air over 100.000 BTU <br />Floor Furnace <br />Ducts (Alterations/Exteusion) <br /> <br />.QTY <br /> <br />-- x $12.00 <br /> x $15.00 <br />-- x $12,00 <br />__ x $15.00 <br /> <br />Gas Installation <br />Gas Fumaee (up to 100,000 BTU) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fireplace / Insert <br />G~ Water Heater <br /> <br />-- x $12.00 = <br /> x $15.00 <br /> x $15.00 <br /> -- x $15.00 <br /> <br /> x $15.00 <br /> <br /> x $ 4.00 = $ <br /> -- x $ 1.00 <br /> <br />S~pended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br /> x $i2.00 <br />~_ x $12.00 <br />-- x $12.00 <br /> <br />Heat Pump <br />Under 3 Ton <br />3 Ton and More <br /> <br />Air Cond~oner <br />Under 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />Exhaust 1 Fans / Vents <br />Corn[ Exhat~ System <br />Coral Hood & Exhaust <br />Domestic Range Hood (inoludes ducts) <br /> <br /> x $12.00 <br />__ x $22.00 <br /> <br /> x $15.00 = $ <br />--. x $22.00 = $ <br />__ x $9.00= $ <br /> <br />9.00 = $ <br />%00 = $ <br />$ 9.0~ = $ <br />6.00 = $_ <br />6.00 = $ <br /> <br />x $ 6.00 = $ <br /> <br />Additional Appliances <br />Woodstove / Fireplace <br />Fire Damper <br />Coral / Industrial Incinerator <br /> <br />__ x $15.00 <br /> x $ 6.00 <br /> x $60.00 <br /> <br />One/Two Fandly Dwelling Fee Squar~ Feet: __ x $ .04 - $ <br />l~,'eliingPermltLabels #of Labels t~ $ N/C <br />(For New Dwellings Only) <br />Other (as required by the Btdlding Ofl]ciai) $ <br /> <br />5. FEES <br />Al. BAgE FEE Assessed on ALL APPLICA TIONS: <br />A2. DaterTotal Fees from Section #4 <br /> SUBTOTAL <br />A3 Add State Surcharge~ x Al +A2) <br /> <br />B. Enter.30% of line Al for Plan. Review <br />C. havestigation Fee, if required <br />D. Reinapeetinn Fee {$50.00) <br />E. Add tonal Plan Review, $62.50&our, ( minimum one half hour) <br />F. Inspection tbr which no fee is specifica0y indicated, $62,50/hr, <br /> (minimum one hour) <br />G. Inspection Outside Normal Business Hours, $62.50/hr, <br /> (minimum two bouts) <br />H. Seismic Fee(.01%xA1) <br /> TOTAL AMOUNT DUE <br /> <br /> <br />