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1 <br />FOR OFFICE USE ONLY] <br />Received by: <br />Date: ..... <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br /> 1, LOCATION eF INSTALLATION <br /> <br />Job Address <br /> <br /> i~'-pE~m _~5..t~n heal; pump <br />M. ARIQN COUNTY BUILDING ~.;J : .... ~, ~f/ j~. ~ <br /> <br /> 220 m~ S~eet ~ ~ ~ ' <br /> S~em,~egon97301 ,~; ~ 5 ~9~:~. ':~:' <br /> Phone 588-5147 8:00 a.m. - 4:30 p-m. ~,~ ~. PormR No. <br /> <br /> I~ued by: <br /> <br /> ,86_Zz6_gu t.tevi 1 le ..... <br />~ Cross St, <br /> <br />PERMI l'S AlEE NON-TRANSFERABLE AND NON-P~,,,FUNDABLE AND <br />EX?IPdZ IF WORK IS NOT STARTED wrIltIN 180 DAYS OF iSSUANCE <br />OR IF WORK tS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br />c°"t~c-tKSO~eg, cwa~.H, eag&a~-9~Co~!inJ~P~on¢ 58! -8747 <br />MailingAddress P.O. BOx 4327 Salem 97~02 <br /> <br />2B, FOR OWNER INSTALLATIONS <br />prope~y Owner <br />Mailing Address Phone <br />City/State/Zip <br /> <br />The installation is being made on property I own which ia not intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />RESIDENTIAL ~ COMMERCIAL <br /> <br />Forccd Air Furnace $ 6.00 <br />100,000 BTU or loss <br />Over 100,000 B'I~ -- $ 7.50 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater __ $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted Dnit Heater $ 6.00 <br /> <br />-- $ 6.00 <br />$11.00 <br />$4.50 <br />__ $ a.50 <br />$ 4.50 <br /> <br />__ $ 4.50 <br /> <br /> $ 3.00 <br /> $ 3.00 <br /> $7.50 <br />__ $ 7.50 <br /> <br />__ $30.00 __ <br /> <br />__ $ 7.50 <br /> <br />__ $ 2.00 <br /> $ .50 <br /> <br />__ $ 3.00 <br /> <br />Heat Pump or Air Conditioner <br /> U~ to 3 Ton <br /> 3 Yonto 15Ton <br />Evaporative Cooler <br />l-~xhau.qt System. Commercial <br />Itood and Exhaust, Commercial <br /> <br />Domestic Range Hood <br />Domestic Exhaust Fans <br />and Dryer Vents <br />Fire Damper <br />Wood Stove <br />Furnace Ducts (Alteration, Extension) <br /> <br />Commercial or Industrial Incinerator <br /> <br />Cms Water Heater (relocation <br /> or replacement) <br />Gas Connection <br /> ~-per outlet, up to 4 <br /> --over 4, $8.00 pins ea. <br /> additional <br /> <br />For thc Installation, Relocation <br /> or Replacement of ea. Appliance <br /> Vent not included in art <br /> Appliance permit. <br /> <br />Other (as requi~od by Building Official) <br /> <br />6-00 <br /> <br />We will provide plan review 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 Structttral Specialty Code, Chapter 53. <br /> <br /> FEES <br /> <br />D, Reinfection Fee ($25.00) <br /> <br /> TOTAl, AMOIJNT DUB <br /> <br />* .80 <br /> <br />¥1C15-41 ReeeiptNo. <br />Rev, 10/92 <br /> <br /> <br />