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: FOR CITY USE ONLY <br />~ Received By: , Date: <br />', Zoning By: City: , <br />~ Receipt ~ Amount: $ <br /> <br /> MECHANICAL PERM_IT APPLICATION <br /> Please complete all Sections, I through $ <br /> <br /> , LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> I Project Descd~on: <br /> <br /> NON. TRANSFERABL8 AND EXPIRE IF WORK <br /> PERMITS <br /> ARE <br /> 1S NOT STARTED WITHIN 180 DAYS OF 1SSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. CONTRACTOR INFORMATION -- PLEASE INDICATE <br /> WHO IS DOING ~ WORK <br /> <br />1 <br /> <br /> 211. }'OR OWNER INSTALI.~~.TION <br /> <br /> Prol~r~y Ow~r: ~tea.~¢ prinO <br /> <br /> Mailing Address: <br /> <br /> City: SE: Zip: <br /> Phon*: <br /> <br /> I am the PROPERTY OWNER and o~a, reside in, or will reside in <br /> the completed structure and will be my own general contractor. 1 <br /> understand that I mu~t register c~ a construction contractor (f the <br /> structure is sold or offered for sate before or upon comptetion, lf l <br /> hire subcontractors, I will hire only subcontractors registered with <br /> the Construction Contractors Boar& lf l change my mind and do <br /> hire a general contractor Who is registered with the Construction <br /> Contractors Board, I will immedialely notify Mar~on County of the <br /> narn~ of the contractor. <br /> <br /> Owner's Signature: <br /> <br /> ~ Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a pisa ~vinw. We will provid~ plan <br /> re'dew ~er~ic~ if you ¢omplet~ Seati~u 5B a~d s'abmi~ l~vo (2) acts of <br /> p aris and specifications with this application, <br /> <br />MC 15-4I Rev 9/98 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMML~ITY DEVELOPMENT CEN'I~R <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00am - 4:30pm <br />24 HR Impecfion Line 3734427 FAX 555-7948 <br /> <br /> 4. FEE SCHEDULE (complete and enter to~al in Al) <br /> <br /> ~ RESIDENTIAL ( ) COMMERCIAL ( ) GAS ( ) ELECTRIC <br /> ~ NEW ( ) ADDITION ( ) ALITaRATION <br /> ( ) RELOCATION ( ) REPLACEMENT <br /> OTY <br /> ~ (~tud~ duc-~ I <br /> Forced Air up m l00,000 BTU -- x $12.00=$__ <br /> Forced Air ov~100.0~O BTU -- x $11.00~$__ <br /> Flo~t Furnace ! __ x <br /> Dacts (Alterations/Extcasion) -- x $15.00 = $__ <br /> <br /> Oas Fumace (up to l00,000 BTU) -- x $12.00~$__ <br /> Oas Furnace (ovcr l00,000 BTU) __ x $15.00=$__ <br /> O,~ Fk~ptac~ / Iusen x $15,00 = $ -- <br /> Oas Wa~r Heater x $15.00 ~ $ -- <br /> Oas Log Lighter __ x $15.00=$__ <br /> Oa~,BaRx:qu~ __ x <br /> <br /> Suspended Hca~er __ x $12.00 = $ __ <br /> WallHeater -- x $12.00=$__ <br /> <br /> UnderSTon -- x $12.00=$__ <br /> 3 Ton and More -- x $22.00 = $ -- <br /> <br /> Under3Ton __ x $15.00=$__ <br /> ~TonaadMore __ x $22.00=$__ <br /> EvapOrative Cooler __ x $9.00 = $ __ <br /> <br /> Coml Exhaust System -- x $9.00 = $ -- <br /> Coral Hood & Exhaust -- x $9.00 = $ -- <br /> Dom~tic Range Hood (includea d~ts) __ x $9.00 = $__ <br /> Domosttc Exhaust Fans __ x $6.00 = $ -- <br /> Dome~ie l~er Vent~ __ x $6.00 = $ -- <br /> Applisa~ Vents installed and <br /> no~ included in an applianc~ p~nnit -- x $6.00 = $__ <br /> <br /> Wo~dstov~ / Fir~l~c~ x $15.00--$__ <br /> C. oml! lndasl.qal lndn~rator __ x $60.~0 -- $ -- <br /> <br /> Odi~ (am required by tl~ Building Official) $ -- <br /> <br />RASE FEE A~$e~ed on ALL APPLICATIONS: $ <br /> A 1. Ent~- totai of f~ez fro~ S~c. ~4 $ <br /> ~, A~ State S~e (.05~ x A1 + B~ F~) $ <br /> B, ~ 30% of line Al f~ P~ Review $ -- <br /> <br /> ($62.50~, ~n~um ~e h~) $ <br /> $ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />