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FOR CITY USE ONLY Received By: .Date: Zoning By: City: Receipt #: ...~Amount: $ MECHANICAL PERMIT APPLICATION Please complete all Sections, 1 through $ L LOCATION OF INSTALLATION Parcel ID: Project Description: IPERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK Conh'actor: Mailing Address: City: State: Zip: Phone: Contractors Board Registration No.: Contractor's Signata~: 2B. FOR OWNER INSTALLATION I am t~ PROPER~ OWN~ and ow~ msMe in, or will msMe in the completed stratum ~ will be my own general contracto< 1 u~ersmnd t~t I m~t mgister ~ a co~tmction contractor ~the structure is soM or offered for sale before or upon completion, lf l him su~ontr~tors, I will him only s~cont~tors mgistered with the Comt~ction Contractors Boa~. lfl change my mi~ and hire a general contractor who is mgistemd with the Comt~tlon Con.actors Boa~, 1 will immediately not~, Ma~on Co~ of the ~oft~contract~ . ~, Agent's Signatu~: 3. PLAN REVIEW SECTION Marion Couniy does not require a plan review. We will provide plan I review service if you eompleta Section 5B and submit two (2) sets of plans and specifications with this app cation, MC 15-41 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 enter total in Al) ( ) RESIDENTIAL ( ) COMMERCIAL ( )NEW ( ) ADDITION ( ) RELOCATION ( ) REPLACEMENT Furnace (includes ducts / vents) Forced Air up to 100,000 BTU Forced Air over 100,000 BTU Floor Furnace Ducts (Alterations/Extension) Gas Installation Gas Furnace (up to 100,000 BTU) Gas Furnace (over 100,000 BTU) Gas Fireplace / Insert Gas Water Heater Gas Log Lighter Gas Barbeque Gas Piping Each outlet up to 4 outlets Each additional outlet over 4 outlets Suspended Heater Wall Heater Floor Mounted Heater Heat Fumo Under 3 Ton 3 Ton and More Air Conditioner Under 3 Ton 3 Ton and More Evaporative Cooler Coral Exhaust System Coral Hood & Exhaust Domestic Range Hood (includes ducts) Domestic Exhaust Fans DomesOc Dryer Vents Appliance Vents installed and not included in an appliance permit Additional Annliances Woedstove / Fireplace Fire Damper Coml ! Industrial InCmerator One/Two Fumily ~ F~: Square Feec -- Dwelling Permit Labels (For New Dwellings Only) Other (as required by the Buildthg Official) ( ) GAS ( ) ELECTR1C ( ) ALTERATION OTY -- x $12,00=$__ -- x $15,00=$__ -- x $12.00 =$.__ x $15.00=$__ -- x $12,00--$__ -- x $15.00=$__ -- x $15.00=$__ -- x $15.00=$__ -- x $15.00=$__ __ x $15.00=$__ -- x $4.00=$ -- x $1.00 = $__ -- x $12.00=$__ __ x $12.00=$ __ x $12.00=$__ -- x $12.00=$__ -- x $22.00=$__ __ x $15.00=$__ __ x $22,00=$__ -- x $9.00=$__ -- x $9.00=$__ -- x $9.00=$__ -- x $9.00=$__ -- x $6.00=$__ -- x $6,00 = $__ -- x $6.00=$__ -- x $6,00 -- $__ -- x $60.00=$__ x $ .04 = $__ gof Labels __@ $ ~[~ S. FEES BASE FEE Assessed on ALL APPLICATIONS: $ Al. Enter total of fees from S~c. g4 A2. Add State Surcharge (.07% x Al + Base Fee) SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (if reqdired) D. Ralnspeetion 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 hour) G, Inspection Outside Normal Business Hours, ($62,50/hr, minimum two hours) H, Seismic Fee (,01% x Al)) TOTAL AMOUNT DUE .~.00 $ $__ $__ $__ $__ $__ $__ $__ $__ $