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D EPT'~.,~IIF' B UILDI N G INSPECTION
<br />Ap-pi, Rec~l.: ~ JA~ '~'~ 3 'Ii::i'. ? ~' Senator Building #225
<br /> 220 High St,, N,E. 2nd Floor Permit No.:
<br /> ~ Salem, Oregon 97301
<br />
<br /> ; .... ~ -~ 588-5147-- 588-5148
<br />Date: t- ................. CODE-A-Phone ...................... 8:00A.M. Date:
<br />
<br />Type of Permit:
<br />
<br />Address: 20?47 [-[iwa~ 99E
<br />
<br />Owner:. Martin W. Maskers
<br />
<br />BJdr. & No'
<br />Plans by;
<br />
<br />Site Evaluation and Septic Permit
<br />
<br /> NE, Aurora, Or 97002
<br />
<br />266-4143
<br />
<br />Phone: 678-2580
<br />Phone:
<br />
<br />Phone;
<br /> ICond. Use r
<br />
<br /> Tax Lot No,;, 40648-000
<br />
<br />Sec.: , 13 Twnshp ' 4s J:lge.: lw
<br />Address: 640 N. ]Baker Dr, CazLby, OR
<br />
<br />Address:
<br />Address:
<br />
<br />Variance/Adj. FT/FO Occupancy [ Type of Const.
<br />
<br /> Min Req. Front I Sides ' Rear
<br /> Setbacks: 2 01 8 ! i
<br />
<br />Use of Bldg.:
<br />
<br />4
<br />
<br />Lot NO.: ........... 81k, No,:
<br />Area of Bldg, 2ed
<br />Main Fir.: ___Fir,:
<br />
<br />Sub. dy.:
<br />Sase- Total
<br />merit: Area;
<br />
<br />Roof Type:. Truss/Stick'
<br />Heating Wood
<br />System; ,Stove:
<br />Septic Tank New
<br />Site Eval.: .Instal,;
<br />Exist, No,
<br />System; ,Gals,;
<br />
<br />VALIDATIONS:
<br />Zoning: Mechanical:
<br />Date', ~ ,~? Date:
<br />Septic Tank; ~ Plans:
<br />Date; , Date;
<br />
<br /> Height:
<br />Water ~x ,$
<br />.Supply: W ~- L/,.,-
<br />
<br />Lot Size: 24~000 Corner? no
<br />
<br />Valuer Join
<br />Bldg. Permit
<br />Fee: (+ 5%)
<br />
<br />Elect. Fee;
<br />
<br />Mech, Fee:.
<br />
<br />Plumb, Fee;
<br />State
<br />Surcharge; {4%)
<br />
<br />Plans Chk, Fee:
<br />Septic Tank
<br />Permit Fee; 140.00 + 75.00
<br />
<br />/ agree to build according to the aubmit~
<br />State of Oregon and the Ordinances of
<br />NOT COMMENCED WITHIN 180 DAYS.
<br />the provisions of ORS '701.005 to 701,12'~
<br />
<br />( ) I am performing work On a propert)
<br /> Or Occupy
<br />( ) I am e registered builder OFf ( ) t,
<br /> authorized representative of a
<br /> regiatered builder
<br />
<br />REMARKS:
<br />
<br />EQ Surcharge: 1,..~.~0_0_,_+__,,~,~,,Q.~0_
<br />
<br />)TAL FEE: ___..,,.2~.~.,* 00
<br />.DG,
<br />iCEIPT NO '
<br />iveway
<br />rmit Fee:
<br /> Plan
<br /> ~iew Fee; .....
<br /> ~lic Works
<br /> ;eipt No,;
<br />
<br /> ,tract to the best of my know/edge,
<br />
<br />I have read this application in its entirety
<br />
<br />".CZ--- 7
<br />
<br />S IGNATUREOFAPPLICANT; ! ~.,~ /' / /~
<br /> PLEASE NOTE: Driveway and sidewalk inspection are required by Public Works: 588-5036
<br />
<br /> Other permits required by this dept.: Plumbing n Electrical [] Mechanical [3
<br />
<br />
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