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FOR CITY USE ONLY Received By: Date: Zoning By: ' '~ City: i Re~ipt #: Amount: MECHANICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALLATION PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK Contractor: Mailing Address: City: State: Zip: Phone: Contractors Board Registration No.: Contractor's Signature: FOR OWNER INSTALLATION Mailing Address: ~ ~ st~cta~ is soM or offend for sale befo~ or ~pon completio~ If 1 Contracto~ BoaM, I will ~di~ely not~ Marion Cou~ of the O~er's Signa~,~ A . ~ Agent's Si~at~ 3. PLAN REVIEW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this app cation, MC 1541 Rev 9/98 MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 4. FEE SCHEDULE (complete and enger totalinA,) 9q-g7 ff ? ) RESIDENTIAL ( ) COMMERCIAL ( ) GAS ( ) ELECTRIC ( ) NEW ( ) ADDITION ( ) ALTERATION ( ) RELOCATION ( ) REPLACEMENT ~ (include~ duets / v~nts) ForcEd Air up to 100,000 BTU -- x $12.00 = $ -- Forced Air over 100,000 BTU -- x $15.00 = $ -- Floor Furnace -- x $12,00 = $ -- DuctS (Alterations/Extension) -- x $15.00 = $ Gas Furnace (up to 100,000 BTU) -- x $12,00 = $ -- Gas Furnace (over 100,000 BTU) -- x $15.00 = $ -- GasFireplace/lnsert -- x $15.00=$__ Gas Weter Heater -- x $15.00=$___ Gas Log Lighter -- x $15.00 = $ -- Gas Batheque -- x $15.00 = $ -- Gas Piping Ea~ outlet up to 4 outlets -- x $4.00 = $ __ Each additional outlet over 4 outlets -- x $1.00 = $ Suspended Heater -- x $12.00 = $ __ WallHeater __ x $12.00=$__ Floor Mounted Heater -- x $12.00 = $ -- Ueder3Ton -- x $12.00=$__ 3 Ton and More -- x $22.00 = $ Air Conditioner Und~r3Ton -- x $15.00=$__ 3 Ton and More -- x $22.00=$__ Evaporative Cooler -- x $9.00 = $ Coral Exhaust System -- x $9.00 = $ -- Coral Hood & Exhaust -- x $9.00 = $ -- Domestic Range Hood (incPldes ducts) -- x $9.00 = $ -- Dolr~stic Exhaust Fans J , x $6.00 = $ -- Domestic Dryer Vents -- x $6.00 = $ -- Appliance Vents installed and not included in an appliar~e permit -- x $6.00 = $__ Woodstove / Fheplace -- x $15.00 = $ -- Fire Damper __ x $6.00 = $ -- OnefIWoFamilyl)~egingFee:SquareFeet: -- x $ .04=$__ Dwelling Permit Labels gof Labels @ $ ~ (For New Dwellings Only) Oth*r (as required by the Building Official) $ -- 5. FEES BASE FEE Assessed on ALL APPLICATIONS: $ Al. Enter total of fees from Sec. g4 A2. Add State Sumharg-~ (,05% x A1 + Base Fee) B. Enter 30% of llne Al for Plan Review C. Investigation Fee (if r~quired) D. Reinspection Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) E Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one Imur) G. Inspection Outside Normal Business Hours, ($62.50thr, minimum two hours) H. Seismic Fee (.01% x Al)) 25.00 $ $ __ SUBTOTAL~ 5 __ $ __ TOTAL AMOUNT DUE $