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~ ~' tiMJbRI~i~LC..OiJNTY BUILDING INSP~C~ON m ~ ~ ~ <br /> <br /> FOR'CXTY V ID N.I 28S~r,~ St NE' Room 132 '/ - <br /> ~m~ a ..... t~al~, OR 97301 _ <br /> R~eiv~ by: ~ Tag / ~ 1~5 ' uato: ,. ~ <br /> <br /> Date' ' <br /> · ~]a~ .... ~ Hr Inaction L~ 5B~7~ <br /> <br /> .....UIM U0~: 58~5~47 8;~a.m.-4:30p.m. 1550~ Dy: <br /> <br /> MECHANICAL PERMff APPLICATION 4. F~ SCH~ (Complcm and enter {oul in Al below) <br /> Ple~e complete ~l Sections, I through 5 RESID~I~ ~ t COMM~RCI~ ~ <br /> <br /> 1- LOCATION OF IlgSTALLATION <br /> <br />.. ~?.T_, ,5.d_a,?_ ~, <br /> <br />· D?- srip-t!}~]LDdimcti°na i <br /> <br /> pu,? aaa-on <br /> <br /> STARTBD wrrlllN 180 DAY8 OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />COlqTRACTOP. I~ISTALLATION ONLY <br /> <br />City/81atetZip <br /> <br />Aecnt's ~ignuture: <br /> <br /> 3. PLANRBVItlW 5BCTION <br />IMarion County does not require a pla.n, review. <br />ye will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this applica,don. <br />MC 15-4 l <br /> <br /> USB ~ STRUCTUR]~: <br /> UI ADDrrlON ~}~RELO~i, TION 121 <br /> NI3W ~l[ ALTERATION <br /> GAS Ct or ELECTRIC ~ <br /> No. X l~eo ~ ~um ,, <br />BASE FEE <br /> <br />FloorFumace $ 6,00 -- <br /> $ 6.00 <br /> <br />HEAT PUMP <br />3 Ton and up $11,00 -- <br />~mdar g Ton . $ 6,50 <br /> <br />EvaporativeC~)ler $ 4.50 ~ <br /> <br />Co~crcial Hood and g~amt $ 4.50 <br />~mestlc R~ge H~d $ 4,50 ~ <br /> <br />mtd ~er Vents ~ $ 3.00 , ,, <br />Fi~ Damper $ 3,(~ ~ <br />Wood $tov~impla~e $ 7.50 ~ <br />Eu~ce Duc~ (Alt~alio~xtensio~) $ q,~ ~ <br /> <br />~ ~,aN AL APPLIANCI~8 <br />ter Heater $ 7,50 <br />Gas Log Lighter ~ $ 7,50 <br /> <br /> OTHER (as requiced by Buihb'~g Ot~aiuO <br /> <br />Al. Enter tolal of leas from Sec, #4 <br />A2, Add 5% ~urc{larg~ (.05 x A I) <br /> <br />B. Enter 25% of line A 1 ibr Plan Review <br /> (A I 4, ,25), if required <br />C. lavestigation Faa (if requlred) <br />D. Relnspeetion Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br />R~¢ipl No. --, <br /> <br /> <br />