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, · MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER .... <br /> <br />R~eiv~ by:~ ~ I Salem, OR 973 1 <br /> <br /> '~~ I ~ Hr In~hon Line: 5 ~7 <br /> Offs: 5~510 8:~a.m.-4:30p~. ISSO~g~2/ <br /> F~: 58~79~ <br /> <br />MECHANICAL PERMff A PPLICAT ~ 4. ~[ <br /> <br /> Please complete all Sections, I through 5 <br />1. LOCATI ~O~ OF Ilq'~TALLATION <br /> <br />Job Addrc~ <br /> <br />c~ Aumsville c~s~ Main <br />l~p~o~ Tiny Hanson ~ 749-2337 <br /> <br />D~¢~/D0~ Windemere Meadows <br />2.5 ton heat pump add-on <br /> <br />PERMITS AP,~, NON-TRANSFEPdgBLE AND EX lq lLP~ IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />:AA.. COiNTRACTOR INSTALLATION ONLY <br />C~uactor Oregon Heating &l ~on~ 581-8747 <br />Cio lnfZQ 1' <br />~aill. gXda~, 2365 Front St NE, Salem <br />Contractor's License No,7~ <br />Contractor's Board Reg. No.~7 <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> Properly Ownor (please prim) <br /> Mailing Address Phone <br /> City/State/Zip <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br /> 3. PLAN RtiVIBW SECTION <br /> <br /> Marion County 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 /> specifications with this application. <br /> <br />MC 15-41 <br /> <br /> RESIDENTIAL~ COMMERCIAL <br /> USE OF STRUCTURE: ,q,.,~,~,l 1 -i <br /> NEW ~ ALTERATION [3 ADD~fTiON ~t R10LOCATION n <br />L Gg%Q~o~ECTRIC~ffi No. X Fee m Sum <br />BASE FEE $10.00 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCoolcr <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br /> <br />1 $ 6.50 6.5 0 <br /> $11.00 -- <br /> <br />$ 6.50 -- <br />$11.00 -- <br /> <br />$4,50 -- <br />$4,50 <br />$4.50 <br />$4.5O -- <br /> <br />$ 3.00 -- <br />$ 3.00 <br />$7.50 <br />$7,50 <br />$30.00 <br /> <br />ADDITIONAL APPLIANCE8 Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbeque <br /> <br />$ 7.50 -- <br />$ 7.50 -- <br />$ 7.50 -- <br />$7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Builv~t~ Ol~cial) <br /> <br />DWELLING PERMIT LABEL # of Labols <br /> <br />$ 2.00 <br />$ 30 -- <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FEES <br /> 6 <br /> 5 <br /> 0 <br /> Al. Enter total of fees from Sec. <br /> A2, Add 5% surcharge (.05 x A 1) $ .~ <br /> 8ubtolal $.__ <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (A 1 + ,25), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspeetion Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE $1 <br /> Receipt No. <br /> <br /> <br />