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FOR CITY USE ONLY <br />Received By:_ Date: <br />Zoning By: City: <br />Receipt #: Amount:$ <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> t~leose aomptete all Sectinns, l through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> COMMUNITY' DEVELOPMENTCENTE[~-"~['~i~x~I'~ -[7 --~':'~' <br />3150 Lancaster Dr. NE - Suite C, Salton, Orego~t.[~[~[~[/l, ,, ~- ~' <br /> 8:00 ~' 4:30 pm ~ ~, - Y X~~ .x <br /> <br /> l/ ' ' 6 <br /> PER, fITS ~ NON-TRANSFERABLE AND EXPIRE IF WORK <br /> IS NOT STARTED WITHIN 180 DA YS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAIS. <br /> <br />2A. CONTRACTOR INFOIOdAT1ON -- PLEASE INDICATE ~'HO IS <br />DOING TIlE WORK <br /> <br /> con~a~tor: Best Heating & Control, Inc. <br /> Mailing Address P. O. BOX 567 <br /> ci~,: Scio State: OR Zip: 97374 <br /> <br /> Phone: 394-3461 / 1-800-278-2378 <br /> <br /> Fax: (503) 394--3309 <br /> <br />Property Owner: (please pHn0 <br />Mailing Address: <br />City: State: Zip: <br />Phone: Fax: <br /> <br />I am the PROPKRT}' OWNER ami own, reside in, or will reside in ate <br />comple~.d sttatcture and wilt be my own general contractor, l understand <br />that I must register as a construction cone'actor if the senwture is sold or <br />offered for sale before or upon completion, lf l hire xubcontractors, I wilt <br />hhv only a'ubcontmzctors registered with the Construction Contractors Boar~ <br />Ill change rtty mitld and do hire a ge.eral contraclor who is registered with <br />the Construction Con~rctctors BoarcL I will immediately notify Marion County <br />of the name of the contractor: <br /> <br /> Owner's Signalure: <br /> <br /> Agent's Siguature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion Coun _ty does not require a plan review. We will provide plan ~view I <br />service if you complete Section 55 and submit two (2) sets of plans and <br />specifications with thin application. <br /> <br />MC 15-41 Rev 9/98 <br /> <br /> ) RESIDENTIAL .~CO~gCIAL <br />)NEW ( ) ADDITION <br />( ) RELOCATION ( ) REPLACEMENT <br /> <br />Furnace (includes ducts / vents) <br />Fomed Air up to 100,000 BTU <br />Forced Air over 100.000 BTU <br />Floor Furnace <br />Ducts (Atterations/Eziensio n ) <br /> <br />Gas Furnace (up to 100,000 BTU) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fireplace / Insert <br />Ga~ Water Heater <br />Gas Log Lighter <br /> <br />))GAS ( ) Et.15CTRIC <br /> ALTERAllON <br /> <br />QTY <br /> <br />$12.00 ~ $ <br />$15.00 = $_ <br />$12.00 = $__ <br />$15.00 = $~4 <br /> <br />$15.00 = $ _ <br />$15.00 = $ <br />$15.00 = $ <br />$15.00 = $ <br /> <br />$ 1.00 = $ <br /> <br />Heaters <br />Suspended Heater <br />Wall Heater <br />Floor Mountsd Heater <br /> <br />x $12.00 = $ <br />x $12.00 = $ <br />x $12.00 = $ <br /> <br />lleat Pumo <br />Under 3 Ton <br />3 Ton and More <br /> <br /> x $12.00 = $ <br />__ x $22.00 = $ ..... <br /> <br />AirCondifioner <br /> <br />Under 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />x $15.00 = $ <br />x $22.00 = $ <br />x $ 9.00 = $ <br /> <br />Exhaust / Fans / Ven~ <br />COrn[ Exhaust System <br />COml Hood & Exhaust <br />Domestic Range Hood (includes ducts) <br />Domestic Exhaust Fans <br />Domestic Dryer Vents <br />Appliance Vents installed and <br />not included in an appliance permit <br /> <br />x $ 9.00 $ <br />x $ 9,00- $ <br />x $ 9.00 = $ <br />x $ 6.00- $ <br />x $ 6.00- $ <br /> <br />x $ 6.00 = $ <br /> <br />tdditlonal Appliances <br />Woods~ove / Fireplace <br />Fire Damper <br />Coral / Industrial Incinerator <br /> <br />x $15.00 <br />x $ 6.00 <br />x $60.00 <br /> <br />OnetTwo Family Dwelling Fee Square Feet: __ x $ .04 = $ <br />[hveIRng Permit Labels gofLabels __(~ $ N/C <br />(For New Dwellings Only) <br />Other (as required by the Building Official) $ <br /> <br />5. FEES <br />Al. BASE FEE Assessed on ALL APPLICATIONS: <br />A2. EnterTotal Fees from Section #4 <br /> SUB'IOTAL <br />A3 Add Slate Surcharge (.05% x Al +A2) <br /> <br />B. Enter ;30% of line Al for Plan Review <br />C. Investigation Fee, if required <br />D. Reinspection Fee ($50.00) <br /> <br />$ <br />$ <br /> <br />E. Additional Plan Review, $62.50/hour, ( minimum one half hour) <br />F. Inspection for which no fee is specilically indicated, $62.50/hr, <br /> (minimum one hour) <br />G. Inspection Outside Normal Business [louts, $62.50/hr, <br /> (minimum two hours) <br />H. Seismic Fee (.01% x Al) <br /> TOTAL AMOUNT DUE <br /> <br /> <br />