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COMMUNITY DEVELOPMENT CENTER <br /> VALIDATION[ 285 Church St NE · Room 132 PERMIT NO: <br /> FOR <br /> CITY <br /> R~eived by.' Il Salem, OR 97301 Date: <br /> Date: ] 24 Hr Inspection Linc: 588-7904 <br /> Issued <br /> by: <br /> <br /> MECHANICAL PERMIT APPLICAT~'r 4 ~cI-mDuIm (C.,~pieto.,~d =,,t~= totali. Al b=~,~) <br /> Pleaso comploto all Sections, I throdl~ha5 ~U~j ? 0/ ~ ~ ~ <br /> - I ..~ RESIDENTIAL [] COMMERCIAL ~ <br /> LJ _ --.. USE OF STRUCTURE: <br /> 1. LOCATION OF I~STALLATION M/~RION ~0L~l I]YNEW O ALTERATION ~ '~ ~ON ca <br /> Hwy.BU[LDING !tiS' CTl~s ~ or ELECTRIC Ca <br /> 6238 ME Angel No. x F~ = Sore <br /> <br /> cay Silverton ~ORCED AIR FURNACE / <br /> up to 100,000 BTU $ 6.00 6.0 0 <br /> ~o~yO,,,=t Steve Mead . I ~ 873 6932 owr~OO,OOOa~U $ 7.0O <br /> <br /> Wall ltcatcr $ 6,00 <br /> <br /> PERMITS HON-TR^NSFER~ELE ^ND ~XPIRE IF WORK IS NOT I under 3 Ton $ 6.50 <br /> STARTI~J~ wrrniN 180 D^YS OF ISSU^NCE OR IF I 3 Ton a~d up $11.00 __ <br /> AIR CONDITIONER <br /> under 3 Ton $ 6.50 <br />2A. CONTRACTOR ~I'~I'ALLATION ONLY 3 Ton and up $11.00 -- <br /> <br />Con~c~rEastman Heatinq I Pho.e 873 2810 EvaporativeCoolcr $4.50 -- <br /> Comm~rcinl Exhanst System $ 4.50 -- <br /> Commercial Hood and Exhaust $ 4.50 <br />Mail|ngAddreas 1 1 1 Fiske St. Silverton DomeaicRan~liond $430 __ <br /> <br />Contractor's License No. and Dryer Vents $ 3.00 -- <br />Contr~¢tor'~ Board Rog. No.61 7 9 2 Job No. Wood StovdFimplac~ $ 7.50 <br /> <br /> Ga~ Log Lighter $ 7.50 -- <br />2B. FOR OWNI~ INSTALLATIONS o~ g~rl~qu~ $ 7.50 -- <br /> Othor $ 7.50 -- <br /> <br /> l-4outlcts(lmroutlct) ~ $ 2.00 2 o 00 <br />Mailing Addr~s Phone 4 and up outlets (per outlet) $ .50 -- <br /> <br />City/StatedZip Appliane~ Vents not melndcd in <br /> an appliance pctrait $ 3.00 -- <br />Owner's Signature: OTHER (ss req~irod by Buil~ag O~cial) <br />Agem's Signature: ~ DWnLLING PERMIT LABEL # of Labels N/C <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 />I Section 5B 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 totsl of tees fwm Sec. ~ $ '[ 8 t, 0 0 <br />A2. Add 5% surcharge (.05 x A 1)Subtotal <br /> <br /> B. Eater 25% of line Al for Plan Review <br /> (Al + .25), if l~quired $ __ <br /> C. Investigation Fee (if required) $ __ <br /> D. R¢inspection Fee ($25.00) $ -- <br /> <br /> TOTAL AMOUNT DUE $ 1 .q _ q 0 <br /> Receipt No. <br /> <br /> <br />