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FOR, OFFICE USE ONLY <br />Reee,ved by: . <br />Date: <br /> <br />MECHANICAL PERMIT A'PpLICATION [ <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br /> 1, LOCATION OF INSTALLATION <br /> <br />jobAddress 9101 Shaw Sq. Rd. <br /> <br /> Aumsville, Or. 97325 <br /> <br />City ] Cross ~t, <br /> <br />Dh-e~ons Ne~.~ to Catholic Chruch A~ Shaw <br /> <br /> PERMITS APE NON-TRANSFBRABLE AND NON-REFUNDABLE AND <br /> EXPIRE IF WORK IS NOT STAKT~D WITHIN ti0 DAYS OF ISSUANCE <br /> OR IF WORK IS SUSPENDED FOR I g0 DAYS- <br /> <br /> lA. CONTRACTOR INSTALLATION ONLY <br />[co,~c~fEastman Heating [~o,0873 2810 <br /> <br />MaillngAddmss 111 Fiske Street <br />pmo¢~o,~,r Roger Cone /Phon~749 3922 <br /> <br />Contractor's Liccnsc No. <br />Conlx~tofsBoa~P~g. No, 6~ 792 [lobNo. <br />Contractor's Signature: (~ ~7-~ ~~ <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Properly Owner <br />Mailing Add.ss Phons <br />City/State/Zip <br /> <br />The inst~lla~ion is being made on propeW/I own which is not in~nded fir sale, <br /> <br />Owaefs Signature <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />4, 1~ 8CII~IHII~ (C4.~k-~ ~g ~1 {~A1 ~) <br /> <br /> RESIDENTIAL [] COMMEP. CiAL [] <br /> <br /> USE(~STRUCTUI~; <br /> <br /> NEW['~IALTERATION[~ADDITION[~RELOCATION[~ <br /> <br />RAS~F~E $10.00 <br /> <br />Forced Air Furnace <br />lO0,O00 BTU or <br />Ov~ 100,000 BTU <br /> <br />Floor Furnace <br />Suspead~d l-Ieat~ <br />Wall Heater <br />Floor Molm~d Unit HeaWt <br /> <br />Heat Pump [] / Air Conditioner [] Upto 3 To~ <br /> 3 Ton to 15 Ton <br />l~.vaporative Cooler <br />F. xhaust System, Commeruial <br />Hood and Exhau$t, C~mme~ctal <br /> <br />Domestic Range Hood <br />Domestic Exhaust Fans <br />and Dryer <br />Fire Daml~r <br />Wood Stove <br />Furnace Ducts (Alterati~ ~xtenalon) __ <br /> <br />Commercial or ~duslrial Ia¢ineretor <br /> <br />$ 6.00 <br /> <br />-- $ 7,50 <br /> <br />6.00 <br />6.00 <br />6,00 <br />6.00 <br /> <br /> $6.00 6,00 <br /> $11.00 <br /> $ 4.50 <br />__ $ 4.50 <br />__ $ 4.50 <br /> <br />__ $ 4,50 <br /> <br /> $ 3,00 <br />__ $ 3.00 <br />__ $ 7.50 <br /> $4.50 <br /> <br />Gas Water Heatex (relocation <br /> or reglacemant) <br />Cms Connection <br /> --pet outlet, up to 4 <br /> --'over 4, $8.00 plus <br /> additional <br /> <br />__ $ 7.50 <br /> <br />__ $ 2.00 <br /> $ ,50 <br /> <br />For the Iustalhtion, Relocation <br /> or Replacvmant of ea. Appliance <br /> Vent not included in an <br /> Appliance permit. <br /> <br />Other (as requixod by Building Official) <br /> <br />__ $ 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 />R~v, ~/95 <br /> <br /> FEES <br /> <br />A2, A44 $%,~ (,05 ~Ai) <br /> <br />D. <br /> <br />s 16.00 <br />s .80 <br />$ __ <br /> <br />$ -- <br />$ <br /> <br /> <br />