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IFOR. OFYICE USE ONLY <br /> Recewed by:_ <br /> D~te:. <br /> <br /> MECHANICAL PERMiT'"APPLICATiON <br /> Please complete all Sections, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION ~_~ ?~ ~ <br /> <br /> fill <br /> <br /> I~ued by: ' *~i :/ <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br />Jo~Aad~ 5914 Shaw Highway, <br /> <br />City Aumsvi%le <br /> <br />I CrossSt, Silver FAils Hwy. <br /> <br /> Directions <br /> <br />IPERMITS AP-~, NON.TRANSFERABLE AND NON-RI~FUNDABLE AND <br /> E~PIRE IF WOR~ IS NOT STARTED WITHI~ lS0 DAys OF I~UANC~ <br /> OK IF WOKK 15 SUSPENDED FOR i$0 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br />co.us~,or Salem Htg. & Sht. Mtl. I~o,~ 581-1536 <br /> <br />MaillnsAddo~s P.O. Bo~j2OOS, Salem: OR 97309 <br />I'rol~¢~yo,~¢~ Morett Const. JPho.~ 749~2294 <br /> <br />(Bill Ka~pstra) <br /> <br />cotox~toe~ no~ [~_ No. 1505 <br />Contractor% Signature,~ ~: ~f~.~ <br /> <br /> FOR OWNER INhALaTIONS <br /> <br />/ob No, <br /> <br />Property Owner <br />~iling Address Phone <br />CiyBtme/Zip <br /> <br />The i~llation is being m~le on property I own which is not it~tended for ~-~le, <br /> <br />4. FEE E~DHEOULE (Com~k.~ n~l en~r to,al ~.AI b01ow) <br /> <br /> P~SmEh~rU, L [] co~vmacm~ [] <br /> <br />USE OF STRUCTLq~B: <br /> <br />NEW [] AIXERATION [] ADDITION ~-~ RELOCATION ~ <br />GA$[~ or ELECTRIC~ NO. X ~ ~ $UM <br /> $10,0o <br /> <br />Forced Air Furnace <br />100,000 BTU or less <br />Over 100,000 BTU <br /> <br />Saspended ]4eater <br />W~l I~t~ <br />~oor Mo~ted U~t H~ <br /> <br />Heat Pump ~ / Air Conditioner <br /> Up to 3 Ton <br /> ~ Tonto 15 Ton <br />~vapot~iv¢ Cool~ <br />E~t Systm, Co~ <br />Hood ~d E~t, Co~i~ <br /> <br />Domestic R~ge Hood <br />Domestic ~ust F~a <br /> ~d ~ V~ts <br /> <br />$ <br /> <br />-- $ 7.50 <br /> <br />__ $ 6.00 <br />__ $ 6.00 <br />__ $ 6,00 <br />__ $ 6,00 <br /> <br /> 1 $ <br /> $1 !.00 <br /> $ 4,50 <br />__ $ 4,50 <br /> $4.50 <br /> <br />$ 4.50 <br /> <br />__ $ ZOO <br />__ $ <br />__ $ 7.50 <br /> $4.50 <br /> <br />__ $30,00 <br /> <br />Gas Water Heater (relocation <br /> or replacement) <br />Gas Connection <br /> --per outlet, up to 4 <br /> --over 4, $8.00 plus <br /> additional <br /> <br />__ $ 7.50 <br />__ $ 2.00 <br />__ $ ,50 <br /> <br />For the Installation, Relocation <br /> or R~lace~t of ea. AVpYtan~ <br /> Vent not included in ~m <br /> Appliance permit, <br /> <br />Other (as required by Building OITwial) <br /> <br />__ $ 3.00 <br /> <br />We will provide plan ~eview service 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 when required <br />by the Oregon Struct~a/Specialty Code, Chapter 53. <br /> <br />~6'13.41 <br />Rev, 5/93 <br /> <br />$ <br /> <br />$ -- <br />S -- <br />$ __ <br />$ 16.80 <br /> <br /> <br />