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FOR CITY VALIDATION[ <br />Reoeived by: <br />D~te: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> Stdem, OR 97301 <br /> <br /> 24 Hr lnspectioa Line: ~88-7g04 <br />Office~ $88-$147 $:00s.m.-4:30p.m. <br /> <br /> I <br />MECHANICAL PERMIT APPLICATION [ <br />Please complete all Sections, I through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXP~.I~ IF WORK IS NOT <br /> STARTED VdTHIN 1 ~0 DAYS OF ISSUANC~ OR IF <br /> WORK IS SUSPENDED FOR 1~0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />IPhone <br /> <br /> FOR OWNBR INgrALLATIONS <br />Prolgrty Owner (pl~prim) <br /> <br />MailinS Addr~s <br /> <br />City/State/Zip <br /> <br />Owner's Si~eture: <br /> <br />3. PLANR~VIBW S~CTION <br /> <br />MC L6.41 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEB SCHliDULlt (Complete ~nd enter to~al in Al ~w) <br /> ~DE~I~ COMM~CI~ ~ <br /> US~ OF ~UCT~i <br /> N~ ~ ~RATION O ~DfflON~AT[ON O <br /> GAS ~ ~ ~'['RlC ~ <br /> <br /> No. X F~ = 8~m <br />BA~E FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Healer $ 6.00 <br />Wall l'~atcr $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />I~.AT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR COIqDITIOHER <br /> under 3 Ton <br /> 3Tonaad up <br /> <br />Evuporaliv~Cooler <br />Conmaer0ial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Heod <br />Domestic Exhaust Fnns <br /> and Dry~ Vents <br />Fire Demper <br /> <br />Fuma~ Du~s (Algration/Extensi~ <br />Cmnmeminl / lndmtrial Inc'mcrator <br /> <br />ADDITIONAL APPLIAHC~S Gas Watar Healor <br /> GM Log Ligh~r <br /> <br /> O~her <br /> <br />GAS PIPING SYSTItM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (l~r <br /> <br />Applisnce Vents not included in <br />an appliance permit <br /> <br />OTHER (as requital by Bulldog O~cial) <br /> <br />DWBLLIN~ PRRMIT LABIiL #ofLab~ <br /> <br />$ 6.5O <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$4.50 <br />$4.50 <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 <br />S 3.00 <br /> <br />$ 7.50 <br /> <br />$7,50 <br /> 7.5O <br /> 7.~0 <br /> 7.50 <br /> <br />$ 2.00 <br />$ 30 <br /> <br />$ 3.00 <br /> <br />5. PRES <br />Al. ~nte, r total of fe~s from S~. Iai $~'-~ <br />A2. Add 5% s~ha~ (.~ x Al) <br />~bt~l <br /> <br /> B. ~r 25% of I~c A 1 f~ P~ R~ew <br /> (Al ~.~Lif~d $ ~ <br /> C. ~6gatbn ~ (if gq~) $. ~ <br /> D. R~ F~ (~.~) $. ~ <br /> <br /> <br />