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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt #: Amount: $. <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Pwject Descdptlon:f~.- ~ ¢ ~L~/_4~ <br /> <br />PERMITS ~ NON. TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE <br />W/IlO IS DOING TIlE WORI~ <br /> <br /> Mailing Addr~s:~ ~ ~~ <br /> City: ~'~4~ State: ~)~ <br /> <br /> Contractors Board ! ~.~j~-) ~ <br /> .gi, atio. No.: <br /> <br />2B. FOR OWNER INSTALLATIO~ · <br /> <br />Property Owner: (please print) <br />Mailing Add~ess: <br /> <br />City: Slat~: Zip: <br />Phone: Fax: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor 1 <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completio~t lf l <br />hire subcontractors. I wil~ hire only subcontractors registered with <br />the Construction Contractors Board. lf l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately nottfy Marion County of the <br />name of the contracwr <br /> <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require 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 15-41 Rev 9/98 <br /> <br />MARION COUNTY BUILDING I~SPECTION <br />COMMUNITY DEVELOPMENT CENTi~R <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00am - 4:30pm <br />24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enler total in Al) <br /> <br />~IDENTIAL ( ) COMMERCIAL )ff~)~O~ ( <br />( ) NEW ( ) ADDITION ( ) ALTERATION <br />( ) RELOCATION ( ) REPLACEMENT <br /> <br />OTY <br /> <br />Furnace (includes ducts / vents) <br />Forced AJr up to l00.000 BTU -- x $12.00=$__ <br />Forced Air over l00,000 BTU -- x $15,00=$__ <br />Floor Furnace -- x $12.00 = $ -- <br />Ducts (Alterafiona/Extension) -- x $15.00 = $ -- <br /> <br />Gas Installation <br />Gas Furaacc (up to l00,000 BTU) __ x $12.00=$__ <br />Gas Furnace (ovex l00,000 BTU) -- x $15,00--$__ <br />Gas Fireplace / Insert -- x $15.00 = $ __ <br />GasWa~rHcatar __ x $15.00=$__ <br />Gas Log IAghtar -- x $15.00 -- $ -- <br />C, asBarbeque -- x $15.00=$__ <br /> <br />Gas PipIng <br />Each outlet up to 4 outlets ~ x $4.00 = $__ <br /> Each additional outlet over 4 outlets -- x $1.00 = $__ <br /> <br />SuspendedHeater __ x $12.00=$__ <br /> <br />Under 3 Ton __ x $15.00 = $__ <br />3 Ton and More x $22.00 = $__ <br />Evaporative Cooler x $9.00 = $ -- <br /> <br />Coral Hood & Exhaust __ x $9.00 = $__ <br />Domestic Range Hood (in¢ludea ducts) __ x $9.00 = $ -- <br /> <br />Domestic Dryer Vents __ x $6,00=$__ <br /> <br />Fire Damper -- x $6.00 = $__ <br />One/l°~FamllyDwellingFee:SquareFeec -- x $ ,04=$__ <br />(For New Dwellings Only) <br /> <br />) FAZCTRIC <br /> <br />N/C <br /> <br />~. FEES <br />BASE FEE Azsess~d on ALL APPLICATIONS: $ <br /> Al. Enter tcasl of fees from Sec. gq <br /> <br /> A2. Add State Surcharge (.05% x Al + Base Fee) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigation Fee (if required) <br />D, Reinspeaion Fe~ ($50.00) <br />E. Additional Plan Review ($62.50~r, <br /> minimum one-half hour) <br />E Inspection for which no fee is specifwally indica~d,~~' <br /> ($62.50/hr, minimum one hour) <br />0. Inspection Outside Normal Business Hours, <br /> ($62.$0/hr, minimum two hours) <br />H. Seismic Fee (.01% x Al)) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br />$__ <br />$__ <br /> <br /> <br />