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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 7 ............. 'l 285 Church St NE · Room 132 PERMIT NO: <br /> UR Ul'l']f VAL&I2A'I'IUIN { Sa{em, OR 97301 <br />Received by:~ ! Date: __ <br />Date: [ 24 Hr Inspection L/ne: 5~.7¢~4 <br /> <br />MECHANICAL PERMIT APPL{CATIO~q'~ '(~ '~ ~ti(~)c-_~ (C~pl~te,.d ont~ total i~ A, b~o.) <br /> Please complete all Sections, I througl~i~ SIP - ~ ]U~ -- <br /> J RESIDENTIAL = COMMERCIAL <br /> <br />1. LOCATION OF INSTALLATION ~AB, ION 6 <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Mm{ling Address f~) ~- v <br /> <br />Contractor's Board Re,~~_~ Job No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Fi~p~rty Owner (~s~ <br /> <br /> 3. PLAN REVIBW SECTION <br />~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 />LsPecifications with this application. <br /> <br />!UN~ ov s~ucru~: <br />nC~ ALTERATION ~ ADDITION m RELOCATION <br />~r~A~ or ELEC~IC ~ <br /> No. X F~ ~ 8urn <br /> B~E FEE $10.~ <br /> <br />FORCED AIR FURNACE <br />up ~ 1o0,000 BTU / $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 5.00 -- <br />Wall Heater $ §.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUNIP <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />AIR CONDITIONER <br />under 13 Ton $ 6.50 <br />:3 Ton and up $11.00 <br /> <br />EvaporativeCooler $ 4.50 <br />Commercial Exhaust System $ 4.50 <br />Commercial Heed and Exhaust $ 4,50 <br />Domestic Range Hood $ 4.50 <br />Do~nestic Exhaust Fans <br />and DtTer Vems $ 3.00 <br />Fire Damper $ 3.00 <br />Wood SlovdFireplac~ $ 7.50 <br />Furnace Ducts (Alt e~stion/Extension) $ 7.50 <br />Commercial ! Industrial Incinerator $30.00 <br /> <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 -- <br /> <br />GAS PIPING $YffrEM <br /> 1-4 outlets (per outlet) <br /> 4 and up mstlets (per outlet) <br /> <br />Appliance Venls not included in <br />an appliance permit <br /> <br />OTHER (zs tvqoired by B~dlffdt~ Ol~cml) <br /> <br />$ 2.00 ~,~ <br />$ ,50 -- <br /> <br />$ 3.00 <br /> <br />5. FBBS <br /> A 1. Enter total of feea from See. ~4 <br /> A2. Add 5% auteharg~ (.05 x Al) <br /> <br />8~btotal <br /> <br />B. Eater 25% of line Al for Plan Review <br /> (Al + .25), if required <br />C. lnv~tigation Fee (if requital) <br />D. Reimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br />Receipt No. <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />N/C <br /> <br /> <br />