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~ ~ MARION COUNTY
<br /> T. OF BUILDING iNSPECTION
<br />
<br />Appl, Eec& __ ~.~ Senator Building # 295
<br /> 220 High St. N,E, 2nd Floor Permit No,
<br />
<br />444
<br />
<br />By,' ~ Salem, Oregon 97301
<br /> __ , By;; Dottle
<br />[ =, $88-51,~ - 5~8-6148
<br />Date ~'i// .~/" ~ ~ ............ CODE-A-Phone 588-5373 ........... 8:00 A,,M,, Date 4/3/85
<br />: __ f,,,,, ~ ..... , , ,, ;
<br />
<br />Bldr, & No,;; Phone: , Address: .....
<br />Map Fag. Zone, , Zone Chg part,, I cond U~, verier, ce I Fire Zone Occupancy [ Typt~E~
<br />
<br />U?~,f-~ldg Ne Eldtm* Min Req Front Sides Rear
<br />
<br />Lot No4 ..... [ilk. NO,;. _Sub dv, T'olo'/4L/Yue~' g .... Lot Size Corner? ....
<br />
<br />Area of BI.d~,,i . / 2.d So~e- ~ : , .,
<br />Main FJr/~ ~1~ Fir,: ~ ment-
<br /> BId~. Permil
<br />~oof Typm ~ Truss/Sticb ..... Fee: (+ 5%) /
<br />Heating Wood ~ Water ~
<br />System~ ~ Stove~ ~' Supply:. Elect. Fee: ................
<br />
<br />Septic Tank . ~ New
<br />Site Evah ~ Instal,4 ~ Mech. Fee~ ,
<br />Exia,, No
<br />System~_ ~. Ggls =. Plumb. Fee
<br /> State
<br />VALIDATIONS: Surcharge
<br />Zoning= Mech~nicah
<br />Date:: Date,
<br />Septic Tonk~ Plans; ~
<br />Date .......... Date, ~
<br />
<br />I agree to build according to the submitted plans and specifications, the laws of the State
<br />of Oregon and the Ordinances of Marion County. Permit expires if work not commenced
<br />within 180 days I further expressly warrant that I comply with the provisions of ORS
<br />7~)) 005 to 701.125 because
<br /> I am performing work on a property I own or occupy
<br /> I am a registered builder OR ( ) the authorized (
<br /> representahve of a registered builder (
<br />
<br />Plans Chk Fee:
<br />,Septic Tank
<br />Permit Fee: ....
<br />
<br />TOTAL FEE~
<br />
<br />RECEIPT NO,:-
<br />
<br />The work will be performed by a registered builder
<br />Other (please specify)
<br />
<br />REMARKS::
<br />
<br />PLEASE NOTE:: Driveway and sidewalk inspections are required by Public Works:: 585-5036
<br />Other permits required by this dept:: Plumbing [] Electrical ~
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