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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> FOR CITY VALIDATION 285 Church St NE' Room132 r=rtmH m~, /i ~'¢~"~-- <br /> ~ Sale. m, OR 97301 <br /> Keceived by:~ [ Dato: __ __ <br />[Date:~ ' iif(~ ' ~ <br /> coo .... <br /> MECHANICAL PERMIT APPLICATI~I~' $ 2 1 [ 'i :~ SCHEDU]~rcomple~andent~totalhAt~ow) <br /> Please complete all Sections, I through 5 \ <br /> I ....N COt N~ ~Sm~N~L ~ COM~.aC~" <br /> <br /> GAS ~ or ~EC~IC <br /> <br /> 11894 Silver Falls Hwy. <br /> <br /> Aumsville c~ Cascade Hw' <br /> <br />~m~yown~Dennis Ammon ~ <br /> <br />l~cd~on/Dd~ctiom <br /> <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Comme~or Eastman Heating t Pho.e 873-2810 <br />MailinsAdd~s 111 Fiske St. , Silverton <br /> <br />Contractor's Lice~s* No. 61 7 9 2 <br /> <br />Contractor's B~arg Reg. No. t Job No, <br /> <br />Contractor's Signatur~:~ <br /> <br /> FOR OWNER INSTALLATIONS <br />Pfopezt~ Owner (plea~print) <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br /> No. X Pee ,, Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,~00 BTU $ 6.00 -- <br />ove~ 100,000 BTU $ 7.00 <br /> <br />Floor Fumac~ $ 6.00 -- <br />Suspended Heater $ 6,00 -- <br />Wall Heater $ 6.00 -- <br />Floor Mourned Healer $ 6,00 -- <br /> <br />HEAT pUMp <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />Evaporativ~oler <br /> <br />GAS PIPING SYffFEM <br /> 1-¢ outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Buil&~g Ol~cial) <br /> <br />DWELLING PERMIT LABEL #of Labels <br /> <br />$6.5o 6.50 <br />$11.00 __ <br /> <br />so.so 6,50 <br />$11.00 -- <br /> <br />$ 4.~0 -- <br />$430 __ <br />$4.5O -- <br />$ 4.50 -- <br /> <br />$ 3.00 -- <br />$ 3.00 __ <br />$7.~ -- <br />$ 7.50 -- <br />$30.00 __ <br /> <br />$ 7,50 -- <br />$730 -- <br />$ 7.5o __ <br />$7.5O -- <br /> <br />$ 2.00 -- <br />$ .50 -- <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FEES <br /> Al, Enter totslof fe~s flom S~.//4 <br /> A2. Add 5% aurcharge (.05 x Al) <br /> ~ubtotal <br /> <br /> B. Enler 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigation Fez (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$23.00 <br />$ 1.15 <br />$. <br /> 24.15 <br /> <br />$24.15 <br /> <br /> <br />