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FOR CFrY VALIDATION{ <br />R~eivedby: ] <br /> <br />MARION CO UNT~IIDII~G~I~Sl~ 8Ci~IbN <br /> COMMUNITY D~V~LOPM~NT <br /> ~5 ~h St ~ · R~m 132 <br /> SMem, OR 97301 <br /> <br />PERMIT NO: <br /> <br /> Date: <br /> <br /> 24 Hr Inspection Li~e: 588-7904 <br />Off'we: 58~-~147 8:00mm.-4:30p.m. <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />{PI~ NON-'rR~d~{SI~LE EX~ IF WORK IS NOT <br /> ARE <br /> AND <br /> STARTE1) WITHIN 1~) DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAY$. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> Cen~aCtor'~ License No. <br /> <br />2B. FOR OWNILR INSTALLATIONS <br /> <br />l~ol~ny Owner (ple~so pr~) <br /> <br />Mailing Address I Phone <br /> <br />City/State/Zip <br /> <br />Ovmer's Signature: <br /> <br />Agent's Signature: <br /> <br />PAX: 588-7948 ~, <br /> <br /> 4, FEll SCHBDL1L~ (Complete and ~nt~r iota[ i{l Al be~ <br /> <br /> KESIDENTIAL COMMERCIAL i <br /> USE _o~ ~TRUCTURE: <br /> NEW'~ALTERATION [~ ADDrrlON ~ RELOCATION ~ <br /> GAG' or ELECTRIC ~] <br /> Ne. X Fee = Sum <br /> BASE FEE $10.00 <br /> <br />PORCED AIR FURNACE <br />up to 100,000 BTU ~ $ 6.00 <br />over 100,000 BTU $ ?.00 <br /> <br />Floor Ftuna~ $ 6.00 -- <br />Svsl~nded Hcat~r $ §.00 <br />Wall Heater $ 6.00 <br />Floor Moun~.d H~ater $ 6.00 <br /> <br />HEAT pUMp <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />EvaporativeCeol~ $ 4.~0 <br />Commercial Exhaust System $ 4,50 <br />Comm~ial Heod and Exhaust $ 4,50 <br />Domestic Range Hood $ 4.~0 <br />Dome~li¢ Exhaust Fans <br />and Dryer Vents $ 3.00 <br />Fl~ Damper $ 3.00 <br />Wood Slove/F/rgpia~ $ 7.50 <br />Furnace Duets (Alt~ratio~/Exla~sion) $ ?.50 <br />Comm¢~ial ! Indvs~al Incinerator $30.00 <br /> <br />Gas Bad~ue $ ?,50 <br />O~her $ 7.50 <br /> <br />GAS PIPING SyffFEM <br />1-4 outlets (per outlet) ~ $ 2.00 <br />4 and up outlela (pe~ outlet) $ 30 <br /> <br />~H~R (as r~d by B~I~ O~vial) <br /> <br />D~LLING ~ L~L g of ~ <br /> <br />N/C <br /> <br /> 3. PLAN RBVIBW 8BCTION <br />IMarion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section SB and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 1541 <br /> <br />5. FEES <br /> A 1. Enter total of fees from Se~. ,94 <br /> A2, Add 5/% surcharge (.05 x Al) <br /> <br />~btotal <br /> <br />B. Enter 25~ of Hue A1 for Plma Rev/ew <br />(Al + .25), if requi~d $.__ <br />C. lnv~t/gadon Eec (i f r~quired) $ <br />D. Reimpec tion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Ree, eip ~ No. <br /> <br /> <br />