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IFOR'OFFICE USE ONLY1 <br /> Received by:__ <br /> Date: ............ <br /> <br /> Phone 588-5147 S;00 a,m- ~ 4:30 p.m, <br /> Code-A-Phoae:58S-7904 <br />MECHANICAL PERMIT APPLICATION FAX: 588-7948 <br /> <br />Please complete all Sections, 1 through 5 <br /> <br /> 220 High Street NE ~ <br />Salem, Oregon 97301 <br /> <br /> Permlt No, <br /> S TE #: ARION COUNI <br /> <br /> Date: ~llH F~IM~ <br /> <br />Issued by: <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />pERMITS Ama NON-TP.~ANSFER AB LE AND NON-REFUNDABLE AND <br />F.X P l PS): IF WORK IS NOT STARTED WITH1N 180 nAYS OF iSSUANCE <br />OR IF WORK IS SUSPENDED FOR iS0 DAYS. <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's License No. <br /> <br />2B. FOR OWNER INSTAI.I,AI'IONS <br />Property Ownvt <br />Mail,ag Addres~ Phone <br />City/State/Zip <br /> <br />The installation is being made on pwpefly I owe which is not intended for sale, <br /> <br />Owncgs Signatur~ <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />Pd~SIDENTIAL [] COMMERCIAL I]-~ <br /> <br />BASE FEE <br /> <br />Forced Air Fumaee / $ 6.00 <br />100,000 BTU or less <br />Over 100,000 BTU I $ 7.50 <br /> <br />Floor Furnace I $ 6,00 <br />Susp~mdcd Hcatv'r -- $ 6.00 <br />Wall Heater I $ 6.00 <br />Floor Mounted Uxxit l-leater I $ 6,00 <br /> <br />Heat Ftm~p or Air Conditioner <br /> Up to 3 Ton <br /> 3 Tort to 15 Ton <br />Evaporative Cooler <br />Exhaust Systcan, Commercial <br />Hood and Exhaust, Commercial <br /> <br />Domestic 'Range Hood <br />Domestic Exhaust Fans <br />and Dryer Vents <br />Fire Dam~-r <br />Wood Stove <br />Furaace Ducts (Alteration, Extension) __ <br /> <br />Comme~ial or Industrial Incinexator <br /> <br />-- $ 6,00 <br />$11.00 <br />$ 4,50 <br />__ $ 4,50 <br />$ 4.50 <br /> <br />I $4.50 <br /> <br />3.00 <br />3,00 <br />7,50 <br />7.50 <br /> <br />__ $30,00 I <br /> <br />Gas Water Heater (relocation <br />or r~lacement) <br />Gas Connection <br /> --per outlet, up to 4 <br /> --over 4, $8.00 plus ea. <br /> additional <br /> <br />I $ 7.50 <br /> $ 2.00 <br /> <br /> $ 30 <br /> <br />For th<: Installation, Relocatioa <br /> or Replaccm<mt of ea. Appliance <br /> Vt-at not ~cluded in an <br /> Appliance permit. <br /> <br />Other (mq required by Building Official) <br /> <br />I $ 3.00 <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application, <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />5. FEES <br /> <br />$10.00 <br /> <br />$ __ <br /> <br />$ __ <br /> <br />Rev, 10/92 <br /> <br /> <br />