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Receiv · . Senator Bldg. No. 225
<br /> 220 High Street NE
<br />Date, - ~ Salem, Oregon 97301
<br />
<br />Situs Address,
<br />
<br />Home Builder's Registration NO::
<br />
<br />MECHANflCAL PERMIT APPLICATION
<br />
<br /> Site NO
<br />
<br /> Phone::
<br />
<br /> ......
<br />Cross Street::
<br />
<br />Residential/ , Commercial
<br />New;;~'''''''''~ .... Alteration [] Addition;: []
<br />
<br />Use of Building::
<br />el0c~atJlo~'n; ~ J~/'~1 ' '~t/~pancy Change []
<br />
<br /> NO FEE AMOUNT
<br />Base Price 10,,00
<br />Force¢,,air furnace 100,000 B~-U or less 6.00
<br />Forced air furnace oygr 100,000 B3'U ........ 750
<br />Floor Furnace S 00
<br />Suspended Hea!er .......... 600
<br />Wa]J Heater 600
<br />Floor Mounte~'i~ii'H~ater ........ 6,00
<br />Heat P~,mp 6,00
<br />Air Handliog Unit to 10,000 cu,, ft,, 450
<br />Air Handling Unit ov~,?,10,000 cuft ,.,,,,,, ,,,7,,50
<br />Evapor~!,!,ve Cooler 4,50
<br />Exhaust System Com~,ercJal 4,50
<br />Hood and Exhaust Commemial 460
<br />Domestic_.R,~nge Hoods ...... ~/' 450 .~, .~
<br />D~omestic Exhaust Fans & Drye,r, Vents ~ 3,,00 ~,..O ~
<br />Domestic Wood Stove 7,50
<br />
<br /> NO FEE AMOUNT
<br />Commercial or Industrial Incinerator 30,00
<br />....~!re Damper ~__ 300
<br />Gas Water Heater 7.50
<br />Gas Connection w/o Appliance (1-4 each) 200
<br /> over 4- $800 plus ea addnl 50
<br /> ,Appliance or accessory to any heating o~' ..............
<br /> Comfort cooling, s?!em not covered 4,50
<br /> Other (as per Mechanical Cede);;
<br /> On-Site Technical Review
<br /> (Apply at Marion Co,, only,! ....
<br /> Reiaapectio~ ,F~e .....
<br />
<br /> STATE SURCHARGE
<br /> PLAN REVIEW FEE $
<br /> "VEST[GAT ON $
<br /> FLEET SURCHARGE
<br /> CITY FEE $
<br /> TOTAL
<br />
<br />Please return COMPLETE APPLICATION with the indicated fee,,
<br />
<br />Iarn a registered builder OR ( v¢ ,,,,= authorized representative of SIGNATU RE OF APPLICAN
<br />a registered builde~
<br />Tho work will be performed by a registered builder
<br />Other
<br />
<br />MO 15-41
<br />Re~, 3/87
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