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FOR CITY USE ONLY <br />Received By; .Date: <br />Zoning By: .City: <br />Receipt #: Amount; $ <br /> <br />MECHANICAL PERMIT APPLICATION I <br /> Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br />Parcel Owner: <br /> <br />Phone: ~.~ '-~ <br />Cross Street/Directions: <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br /> IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />I WORK IS SUSPENDED FOg 180 DAIS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE <br />WHO I8 DOING TH~ WORK <br /> <br /> Contractors Board <br /> <br /> Contractor's Signature: ~J~ ~ <br /> <br />2B. FOR OWNER INSTALLATION <br />property Owner: (please print) <br /> <br /> Mailing Address: <br /> <br /> City: State: <br /> Phone: Fax: <br /> <br />Zip: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br /> 8:00am - 4:30pTa <br /> 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br /> 4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> ( ) RESIDENTIAL ( } COMMERCIAL <br /> ( ) NEW ( ) ADDITION <br /> ( ) RELOCATION ( ) REPLACEMENT <br /> <br />L J~/Df~ F~eor Furnace <br />/ t2.~ 3 Ton a~d More <br /> <br />I am the PROPERTY OWNER and own, reside ir~ or will reside in <br />the completed structure and will be my own general contractor 1 <br />understand that I mu~t register as a construction contractor if the <br />structure is sold or offered for sale before or upon completion. Ill <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. ff l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will t~mediately notify Marion County of the <br />name of the contractor <br /> <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REYIEW SECTION <br />IMarion County does not r~quffe a~plan review. We will provide plan <br />review service if you complete Section 5B and submit two (2) sets of <br />plans and specifications with this application. <br /> <br />MC 1541 Rev <br /> <br />( ) GAS ( ) ELFzCTPdC <br />( )ALTERATION <br /> <br /> OTY <br /> <br />, x $12.00=$__ <br />x $15,00=$__ <br />__ x $12.00=$__ <br />x $15.00=$__ <br /> <br /> [ x $12.00=$__ <br />-- x $15.00=$__ <br />~T__x $15.00= $ <br />x $15.00=$__ <br />__ x $15.00=$__ <br />-- x $t5.00=$__ <br />  x $4.00= $__ <br /> x $1.00= $__ <br /> <br />$12.00= $ <br />$12.00= $ <br />$12.00= $__ <br /> <br />$12.00= <br />$22.00= <br /> <br />$15.00= $__ <br />$22,00= $__ <br />$9.00= $__ <br /> <br />$9.110 = $ -- <br />$9,00 = $ -- <br />$9,00 = $__ <br />$6,00 = $ -- <br />$6.00=$__ <br /> <br />-- x $6.00=$__ <br /> <br />__ x $15.00=$__ <br />__ x $6.00=$__ <br />__ x $60.00=$__ <br /> <br /> x $ .04 = $ -- <br /> <br /> ~f Labels __@ $- I'11¢ <br /> <br />5. FEES <br />BASE FEE Assessed on ALL APPLICATIONS: $ <br /> Al. Enter total of fees from Sec, g4 <br /> <br /> A2. Add State Surcharge (.05% x Al + Base F~e) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for plan Review <br />C. Investigation Fee (if requital) <br />D. Ralnspection Fee ($50.00) <br />E. Additional Plan Review ($62.50dtr, <br /> minimum oaR-half hour) <br />E Inspection for which no fe~ is specifically indicated, <br /> ($62.50/hr, miaimum one hoar) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50far, minimum two hours) <br />H. Seismic Fee (.01% x Al)) <br /> <br />$ <br />$__ <br /> <br />$__ <br />$__ <br /> <br />$__ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />