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( ) Re~Sy for ir~sl3eOtiOfl MARION COUNTY ( ) Will ca, for ~s,~c~io~ <br />Date: Salem, O~go~ 97~1 BLDG. PERMIT NO: <br /> <br />Installer: <br /> <br />Phone:__Address: <br /> <br />Application is made for; ( ) New Installation ( ) Replacement <br /> ) Addition ( ) GaS Connection <br /> <br />Appliance <br /> <br />Make <br /> <br /> NO. FEE AMOUNT <br /> Base Price 10.00 <br /> Forced air furnace 100,000 BTU or less 6.00 <br /> Forced air furnace over' 100,000 BTU 7150 <br /> Floor Furnace 6.00 <br /> Suspended Heater ........ 6,00 <br /> Wall Heater 6.00 <br /> FlOor Mounted Unit Heater 6,00 <br /> Heat, ,P~,,.m.p ....... 6.00 <br /> ,~ir Handling Unit to 10,000 cu, ft, , ........ 4,50 <br /> Air Handlin~.l Unit over 10.000 cu. ft. , , 7-50 <br /> Evaporative Cooler .......... 4.50 <br /> Exhaust System Commercial 4.50 <br /> Ho~d and Exhaust Commercial 4.50 <br /> Domestic Range Hood§ ......... 4,50 ......... <br /> Domestic Exhaust Fans &Dryer Vents 3,00 <br /> Domestic Wood Stove 7.50 <br /> Commercial or Industrial incinerator 30.00 <br /> Fire Damper 3.00 <br /> Gas Water Heater ~.~ ....... i I ¢:l~ <br /> Gas Connection w/o Appliance (1-4 each) .I <br />over 4- $8.00 plus ea. addnl. ~_. 2,00 <br />Appliance or accessory to any heating or <br />Comfort cooling ~ystem not covered 4.50 <br />,,,Other (as per Mechanical Code): <br /> FEE <br />Please return COMPLETE APPLICATLQN 4% <br />with the indicated fee,~ / PLAN REVIEW FEE <br />~_____~z~)[,''/' INVESTIGATION FEES <br />FLEET SURCHARGE <br />TOTAL <br /> <br />Floor area __ <br /> Fuel <br /> <br />BTU input <br />Vent Size <br /> <br />COMMENTS: <br /> <br />I agree to install according to the submitted plans and specifica ~t~ons, the laws of the State of Oregon and e <br />Ordinances of Marion County. PERMIT EXPIRES IF WORK NOT COMMENCED WITHIN 180 DAYS. I further warrant <br />that ~ comply with the provisions of ORS 701.005 to 701.t25 because: <br /> <br />( ) I am a registered contractor or ( ) the authorized representative of a registered.contractor. <br /> <br />( ) The work will be performed by a registered contractor. <br />( ) I am performing work on a property I own or occupy. <br />( ) Other (please speci,~_ <br />SIGNATURE OF APPLICANT~-~'~'''~'~¢ <br /> <br />BLDRS BOARD REGISTRATION # <br /> <br /> <br />