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Date: __ ] <br /> <br /> Cod~A-I~on¢: ~88-7904 <br />MECHANICAL PERMIT A,PPLiOATION --] <br />Please complete ali Sections, 1 ~ <br /> <br />MARION COUNT~ BUILDING INSPECTION <br /> <br /> 220 High Street lq~ <br /> Salem, Oregon 97301 <br /> <br />Phone $88-5147 8,00 a,m, ~ 4!30 p.m. <br />FAX: 588-7~48 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />1. LOi~TION OF INSTALLATION <br /> <br />~ Croa~ St, <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-R]~33NDA~L~ A~D ] <br /> BX2IP.~ IF WO~ IS NOT STARED ~ 180 DAYS OF I~UANC~ [ <br />O~ IF WO~ I$ $USP~DBD ~R 1 ~~ <br /> <br /> 2A. CO~OR IN~ALLATION ONLY <br /> <br />Con~s Licea~ No, <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />P~opelW O~ncr <br />M~iliag Address Phone <br />City/State/Zip <br /> <br />Ti~ in~llatioa is being made on propeRy I own which is not intended for s~le, <br /> <br />ewers Si~an[r~ <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />SB ~ submit two (2) sets of plans and specification/~ with <br />th/s application. <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, ;md specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />Rev, $/~$ <br /> <br />R~SIDE~r~AL [] CO~C]AL [] <br /> <br />USe C~ STRUCT-dRE: <br /> <br />NEW [] ALTERATION ~ ADDITION [] RELOCATION [] <br />GAS~] Or ELEC~IC~ <br /> NO+ X ~ <br /> <br /> Forced Air Purnaoe <br /> 100,000 BTU or l~ss <br /> Over 100,000 BTU <br /> <br /> Floor Furnac~ <br /> Sus!wnded Heater <br /> Wall Heater <br /> Floor Mounted Ulfit Heater <br /> <br /> Heat Pump [] / Air Conditioner Up to 3 Ton <br /> 3 Tanto 15 Ton <br /> Bvaporatlve Cooler <br /> Exl~ust System, Commercial <br /> Hood and Exhaust. Commercial <br /> <br /> Domestic Range Hood <br /> Domestic Exhaust FSU$ <br /> and Dryer Vents <br />Fire Damper <br />Wood Stove <br />Furnace Ducts (Alte~alion, Exte~.ian) __ <br /> <br />Comraetclal or Industrial Incl. uerator <br /> <br />Gas Water Heater 0~locatiun <br /> <br />Gas Connection <br /> --p~ outlet, Rp to 4 <br /> --owr 4, $$.00 plus ea. <br /> additional <br /> <br />For the Installatien, Relocation <br /> or Replacemem ofea. Appliance <br /> Vent not included in an <br /> Appliance permit, <br /> <br />Other (as required by Building Official) <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 <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 />__ $30,00 <br /> <br />-- $ 7.50 <br /> <br />__ $ 2.00 <br /> $ .50 <br /> <br />__ $ 3.00 <br /> <br />· ' SUM <br /> $10,00 <br /> <br />5. FEES <br /> <br /> . Re/aspe~ioa Fee (g25.00) <br /> <br /> TOTAL A MOU~T DUE <br /> <br /> Re.irt No, <br /> <br /> <br />