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FOR CITY VALIDATION <br />Received by: <br />])ate: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF IlqSTALLATION <br /> <br />COMMUNITY DEVELOPMENT CENTER p~l~ [~. ~ ~l~\t II <br /> 285 Church St ~' Room 132 ~3~'~' ' ~ * <br /> S~em, OR 97301 D~/~? ~ [~ ~9~g ~ <br /> ~Hr In~t~a L~o: 5~7~ by~OR <br /> Off~ 588-5147 8:~.-4:30p.m. Issu~ <br /> <br /> 4. F~ 8CH~ (~plete ~d ~t~ m~l ~ A1 beBw) <br /> <br /> NEW ~ AL~RA~ON ~ ~D~ON ~ATION ~ <br /> GAS ~ or E~C~IC ~ <br /> <br />IPERMITS ARE NON-TRANSFERABLE AND EXHRE IF WORK I$ NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR 1F <br /> WORK IS SUSPF. IqDED FOR 180 DAYS. <br /> <br /> 2A. cOIqTRACTOR ~ISTALLATION ONLY <br /> <br />2B. FOR OWNBR IIqSTALLATION8 <br /> <br />Property Owner (please print) <br />Mailing Addreas Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent'. Signature: <br /> <br />3. PLAN RBVIBW 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 />life 15-41 <br /> <br /> No. X F~o ~eSum '~ <br />BASE FEE <br /> <br />FORCED AIR FURNACB <br />up to 1O0.0O0 BTU $ 6.00 __ <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Fnunace $ 6.00 -- <br />Suspended Heater $ 6.O0 <br />Wall Heater $ 6.00 -- <br />FloorMouatcdHeatar $ 6.00 -- <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 />EvaporativeCooler <br />Commercial Exhaust Sy,l~m <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> mad Dr~cr Vents <br />Fire Damper <br />Wood Stove/Fireplace <br />Furnace Ducts (Alteration/Extension) <br />Commercial / Industrial In¢ineratur <br /> <br />$ 6.50 -- <br />$11.O0 -- <br /> <br />,6.5o 0.5o <br />$11,00 <br /> <br />$4.50 <br />$ 4.50 -- <br />$ 4.50 -- <br />$ 4.50 <br /> <br />$ 3.00 <br />$ 3.O0 -- <br />$ 7.50 -- <br />$7.50 <br />$30.O0 <br /> <br />Oa~ Barbeque <br />Other <br /> <br />$7.50 -- <br />$ 7.5O <br />$7.5O -- <br />$7.50 <br /> <br />O/~ PIPING 8yffi~M <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per oufleO <br /> <br />Appliance Vents not included in <br />an npplimme permit <br /> <br />OTHER (as required by Bailing Offcial) <br /> <br />DWELLING pERM1T LABEL # of Lalmls <br /> <br />$ 2.00 -- <br />$ .50 -- <br /> <br />$ 3.O0 -- <br /> <br />N/C <br /> <br />5. FEES <br /> Al. Enter total of f~e~ from Sec. #4 <br /> A2. Add 5% ~urchar~ (.05 x Al) <br /> <br />B. Enter 25% of lioc A 1 for Plan Review <br />(Al + .25), if required $__ <br />C. Investigation Fe.o (if required) $__ <br />D. Reimp~tion Fee ($25.130) $.__ <br /> · 05 <br />Receipt No. <br /> <br /> <br />