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! <br />FOR OFFICE USE ONLYI <br />Received by: <br />Date: .,, <br /> <br />MARION COUNTY BUILiDING INSPECTION <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />220 High Street NE <br />Salem, Orego~ 97301 <br /> <br />Phon~ $88.5147 g:00 gm, - 4:30 <br /> Code-A-Phone: 585.7904 <br /> FAX: 588-7948 <br /> <br />L LOCATION OF iNSTALL_ .ATION <br /> <br />Dtre~ions <br /> <br />pERMITS APE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIR~ IF WORK IS NOT STARTED WITHIN 180 DAYS OF I~UANCE <br />ORIF WORE IS SUSPENDED FOR 180 DAys. <br /> <br />Conttactoffs ~om'd Res, No, <br /> <br /> ZS, r,oa OWNER INS~;~LATXOZ~S~) <br /> <br />Ptopeay Owner <br /> <br />No. <br /> <br />MMliag Addwss <br /> <br />Cit./State/Zip <br /> <br />The installation is be/uS made oa pmpe~y [ owu which ia not iu~euded for sale, <br /> <br />Owner*s $1~t~ure <br /> <br /> 3, In,_~N REVIEW SECTION <br /> <br />We will provide plan review ~rvice if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application, · ,, ~, <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specifications whe~ required <br />by the Oregon $~'uctural Specialty Code, Chapter 53. <br /> <br />~t'C 1~.4~ <br />R~. 2/92 <br /> <br /> Date: <br /> Issued by: ~) ,,)~I~ 1 ?- <br /> <br /> NE~ ALl. nON ~ ~DI~ON ~ ~ON ~ <br /> NO, X ggg = SUM <br /> <br />Fo~d ~ ~ace ~ $6,00 <br />100,000 B~ or less <br />Ov~ ~00,000 B~ .... $ 730 <br /> <br />~loor F~c~ $ 6.00 <br />S~ded ~at~ ~ $ 6,00 <br />W~t ~at~ ~ $ 6.00 <br />Floor Mo~ted U~t ~eat~ ~ $ 6.00 <br /> <br />Hea~ ~p er ~ Condition~ <br />Up to 3 To~ ~ $ 6.00 <br />3 Ten to 15 Ton $11.00 <br />Evaporative Cool~ ~ $ 4.50 <br />E~a~t Syst~, Co~i~ ~ $ 4.50 <br />~ood ~d ~a~t, Co~ial ~ $ 4.50 <br /> <br />Domestic R~go ~ood ~ $ 4.50 <br />Domestic E~a~t F~s <br />~ ~ V~ts ~ $ 3.00 <br />F~e D~ ~ $ 3,00 ....... <br />Wood Stove ~ $ 7.50 <br />~ace Ducts (~t~atian, Ext~sion) ~ $ 7.50 <br /> <br />Com~mcrcial or Industrial Inoin~ator __ $30,00 __ <br /> <br />Gas Water ~{{eater (relocation <br />orreplacemertt) ~ $ 7.50 <br />Gas Coanoction w/o Appliance <br />--per outlet, up to 4 .,,/ $2,00 '~ <br />--over 4, $8,00 plus ea, <br />additional $ .50 <br /> <br />For the Installation, Relocation <br /> or Replacement of es, Appliance <br /> Vent not included in an <br /> Appliance permit. <br /> <br />Other (as requited by Building Official) <br /> <br />(Al' x .25) <br /> <br />__ $ 3.00 <br /> <br /> <br />