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M~O.N-~(~II~NTY BUILDING INSPECTION <br /> r:"~xgia f~"~ ~'~/o~,I~rY DEVELOPMENT CENTER <br /> .- ll~k~l~ C~urchSt NE' R~m132 <br />FOR CITY V~ID~ ~ / ~J~em, OR 97301 <br /> <br />~te: ~ J~ ~ <br /> 24 hr. Inspection Line ~T~42T <br /> / <br /> ~ce: Phone ~8~147 8:00am - 4:30pm l$$~ <br /> ~AR~ON cOON ~: <br /> <br />MECHANICAL 1 <br /> PI~ ~o~plele ~1 ~olion~, I through ~ <br /> <br />1. LOCATION OF INSTALLATI(~N <br /> <br />Job Address <br /> <br />Phone~-a <br /> <br />IPERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED W1THLN 1 BO DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Co,,ctor,,oa eg.,o. 3qq ,ob,o. <br /> <br />2B. FOR OWNB~ nqSTALLATIONS <br />PmgertyOwner(ple~sepri~) ~y ~.t hf J~ <br /> <br />Agent's gig~uture: <br /> <br />3. PLANREVIEW 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 />MC 1541 <br />REV 8/96 <br /> <br />4. FEB SCH]~DULB (Complete and ente~ total b Al below) <br /> <br /> RESIDEHTIAL J~ COMMERCIAL t'-I <br /> USE OF STRUCTURE~ <br /> NEW ~ ALTERATION ~ ADDITION I~l RELOCATION <br /> <br /> GAS I~1 o~ ELECTRIC C] <br /> No. X Fee <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />ov~ 100,000 BTU $ 7,00 <br /> <br />l~oor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />P]oor Mounted Heater $ 6.00 <br /> <br />HEAT pUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />,MR coNDrrlor4~R <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domesgc R~ge Hood <br />Domestic Exhaust Fans <br /> and D~er Vents <br />Fire Damper <br />Wood Stove/Fireplace <br />Furnace Ducts (Alt ~r at ion/Ext c~sio n) <br />Commercial ! ]ndnstriM Incinerator <br /> <br />$11.00 -- <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$4.5O <br />$4.50 -- <br />$4.5O <br />$4.5O -- <br /> <br />$ 3.00 -- <br />$ 3.00 <br />$ 7.50 <br />$ 7.50 <br /> $30.00 -- <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Walcr Healer <br /> Gas Log Lighter <br /> Gas Barbequ~ <br /> Oth~ <br /> <br />$ 7.50 -- <br />$7.5O -- <br />$7.5O __ <br />$7.5O -- <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per outlc0 <br /> 4 and up outlets (ger outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Builc~g O[l~cial) <br /> <br />DV~rE LL [ HO PRRM 1T LABnL # of Labels <br /> <br />$ 2.00 -- <br />$ .5o __ <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FBES <br /> Al. Enter total of fees from Sec.//4 <br /> /,2. Add 5% surcharge (.05 x Al) <br /> <br />B. Entar 25% of lineAl for Phm Review <br /> (Al + ,25), if required <br />C. Investigation Fee (if required) <br />D. Reinspcction Fcc ($25.00) <br /> <br /> <br />