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Received By; <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. Ne, 22S <br /> 220 Hlgl~ street NE <br /> Salem, Oregon 97301 <br /> <br />MECHANICAL PERMIT APPLICATION <br /> <br />I Owner; ....... Phon~': Address; <br /> Denny Wellin <br />Situs Address: ~Jte No.: Cross Street: <br />J 14745 Smith Lane NE <br />:"'~s'~a~l~r: Phode; Address: ......... <br /> <br />Home Builder's Registration No,: <br />Residential; <br /> <br />Commercial: Use of Building: <br /> <br />Alteratlerl: [] Addition: [] <br /> <br />Relocation: I-I OccupancyOhange: [] <br /> <br /> NO, FEE AMOUNT <br />Base Price 10.00 <br />fur na,._ce 100,000 STU or le~S 6.00 <br />Forced <br />Famed air furnace over 100,000 BTU 7.50 <br />Floor Furnace 6.00 <br /> <br />Wall Heater 6,00 <br />'~i~or Mounted Unit Heater 6.00 ..... <br />Heat Pump 6.00 <br />Air Handling UnTrt te 10,000 cu. ft, 4.50 <br />Air HaadllaH,Unit ever 10,000 cu. ft, ,,,,,,, 7,50 <br />Evaporative Cooler,, 4.50 <br />Exhaust System Commemlal, 4,50 <br />Hood and Exhaust Commercial I 4,50 <br />~rnestic Rang_e. HoodsI 4,50 <br />Domestic Exhau,st Pans & Dryer Ven!s 3.00 <br />Domestic Wood Stove 7.$0 7.50 <br /> <br /> NO. FEE AMOUNT <br />Fire Damper 3.00 <br />Gas Connection w/o Appliance (1-4 ~'~h) 2,00 <br />Applianc~"~r accessory to any heating or <br />O'[her (as per Meohanlcal Code): <br />On-Site Technical Review <br />(Apply, at Marion Co, only) __ <br /> FEE <br /> STATE SURCHARGE .8 <br /> FLEET SURCHARGE $ 7.61 <br /> CITY FEE <br /> TOTAL $ <br /> <br />Please return COMPLETE APPLICATION with the indicated fee, <br /> <br />t am a registered builder OR ( ) the authorized rep~senrat, IVe of SigNATURE OF APPUCANT: <br /> <br />MO 15-41 <br />Rev, 3/87 <br /> <br /> <br />