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IF,~RION COUNTy BUILDING INSPECTION <br /> <br />Date ~ ~'\'~' ...... ~ SAlem, Oregon 91301 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> <br />Situs Address; {-',) t ~, [ ~ Site N0.: <br /> <br />A~dress:' - J . . I ~/I <br /> <br />Home Ballderl~ Registration NO,: ~ ~3 ~/~ O~ ~_~ <br />ResidentiaL: ~ Commercial: .... Use of Building: <br /> <br />New: [] <br /> <br />Alteration: [] Addition: [] ,~ Relocation: <br /> <br />IOccupancy Change: [] <br /> <br /> NO, FEE AMOUNT <br />Base Price <br />~orced air furnac~ ii~00 ,000 BTU Or las~,__ 6.00 <br />Fomed air furnace over 100,000 iSTU 7.~0 <br />Floor Furnace 6.00 <br />Suspended Heater 6.00 <br />Wail Heater 6.00 <br />FlOor Mounteri Unit Hee,~er 6.00 <br />Heat Pump 6,00 <br />~Ai! Hendtlng U nit,t.o 10,000 ~u, ft 4.50 <br />Air Handling Unit over 10,000,cu. ft. 7-50 <br />EvaporatiVe Cooler 4.50 <br />Exhaust System Commemisl 4,50 <br />Hood and Exhaust Commercial 4,50 <br />,Domestic Range H~?ds 4.50 <br />Domestic Exhaust Fans & Dryer vents ' 3,00 <br />Domestic Wood Stove <br /> <br />Comr~ercial or Industrial Incinerator <br />Fire DamPer <br /> <br />Gas Concec~ion w/o Appliance (1-4 each) <br /> over 4- $8,00 plus es. addnl. <br /> <br />Appliance or accessory to any heating er <br /> Comfort cooling system not covered <br /> <br />Other (as per Mechanical Code): <br /> <br />On-Site Technical Review <br /> (Apply et Marion CO. only) <br /> <br />Reinapeoflon Fee <br /> <br /> FEE <br />STATE SURCHARGE <br />PLAN REVIEW FEE <br />INVESTIGATION FEE <br />FLEET SURCHARGE <br />CiTY FEE <br /> TOTAL <br /> <br />AMOUNT <br /> <br />Please return COMPLETE APPLICATION with the indicated fee. <br /> <br /> am performing work on a properly I own or occupy, <br /> em a registered builder OR ( ) the authorized representative of :~IGNATURI~ OF APPLICAN ~['/ ~ <br /> registered builder. <br />i,~ The work Will be pedormed by a registered builde~ <br /> ther , <br />i'll atgme to IRSt~II according to the subm[[~ed plans And spe~ifioetions, the laws of the state of Oregon end the o~tnances of Marion County, <br /> <br />Rev. $/87 <br /> <br /> <br />