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Type of Per ~'~ Q c~' ~'~ ~ ~ c~
<br />Address:: ?2_q Goi¢ Cl-,b IRA
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<br />I,~¢,Phona:: ~7~,~-'~L~5' Address::
<br /> Phone:: ~7~9~2-~'~0 Address::,
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<br />Application is made for:: ( ) New Installation ( ) Replacement
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<br /> ( ) Addition (X) Gas Connection
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<br />Appliance
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<br />Make
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<br /> ITEM NO FEE AMOUNT
<br />[,,..Base Price .... ! ,!0,00
<br /> New or replacement forced air
<br /> furnace Is 100,000 B..TU ...i 6.00 _
<br /> New or replacement forced air
<br /> furnace over 10O,~,O00 BTU ......... 7,50 __
<br /> New InstalLFIoor Furnace ,,, 6,00
<br /> ~eplacement Floor Fume.ce 6,00
<br /> New Instal!.Suspended Heater 600 ........
<br /> Replacement Suspended Hqater 6¢0
<br /> New Install Wall Heater 600
<br /> Replacement Wall, H,eater 6.00
<br /> New Floor Mounted Unit H~ater 6,00
<br /> Replae.a Floor Mounted Unit Heater 600
<br /> $oiler/Compr. 3. hp 100~000 BTU 6.00
<br /> Boiler/Compr. 15 hp 600,000 BTU 1100
<br /> Boiler/Comp[. ~.0 hp 1,000,000 BTU ..... 15,00
<br /> Boiler/Compr. 50 hp 1~750,000 .~TU 2250
<br /> Boiler/Compri q.¥.er 50 hp 1,750,000 BTU .... 37.50 .
<br /> Air Handling Unit to 1~).,..000 cu.. ft. 4.50
<br /> Air Handlin~ Unit over 10,000 cu. ft.. 750
<br /> ....Evaporative Cooler .. 450 . . ..........
<br /> Exhaust S~/stem.. C..o m m e r ciel 4.50
<br /> Hood and Exhaust Commercial 4,50
<br /> Dom~st,ic Incinerator & Wood Stove .... 7.5(~..
<br /> Commerci.~.!...o.r Industrial Incinerator 3000
<br /> Gas Connection w/o Appliance (1-4 each) 200 2.00
<br /> over 4 - $8,00 plus ea. addnl,, .......... i ,5,O,..
<br /> Appliance or Accessory to any heating or
<br /> Comfort .coohn,q system not covered ~. ~ ~. 4.50
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<br />BTU input Floor area __
<br />Vent Size Fuel __
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<br />COMMENTS::
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<br />I agree to install according to the submitted plans and specifications, the laws of the State of Oregon and the
<br />Ordinances of Marion County, Permit expires if work not commenced within 180 days, I further warrant that I comply
<br />with the provi io.a of ORS ,00S to 70 ,,f25 beoa,. e:
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<br />(X)
<br />(
<br />( )
<br />( )
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<br />I am a registered contractor or ( ) the authorized representative of a registered contractor,
<br />The work will be performed by a registered contractor,,
<br />I am performing work on a property I own or occupy,,
<br />Other (please specify)
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<br />BLDRS BOARD REGISTRATION
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