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FOR, OFFICE USE ONLY <br /> <br />COMPLETE ALL SECTIONS <br />1. Job Description <br /> <br />RESIDENTIAL <br />[ ] New SFD wtgaragc [ <br />[ I New Slid wi0 garage [ <br />[ ] Addition [ <br />[ ] Ahetanon [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00 a m,-4:;30 p,ra Phone 588-5147 <br /> Code-A-Phone 588-7904 Left Sl0e <br /> FAX 508-79218 <br />DWELLINC~;JM~AND/OR SEPTIC PERMIT APPLICATION <br /> 1 THROUGH 4 <br /> <br /> . dd m <br /> Dome 5 ~: ]~,J~ [ ] Alteration <br /> O/her <br /> <br />FOR OFFICE USE ONLY <br /> <br />Usc of Building <br /> <br />2. Location of Installation <br /> <br /> ] Sign <br /> ] Demo <br /> ] Other <br /> I I Change/Occupanc~ <br /> <br />To house 2-way land-mob~.~z_~fita.,c~m~10~.tgn equipment and propap~ generators. <br /> <br /> Job Addrc~i ..... <br /> 'lax Acc[, No Cross Street <br /> Halls Ridge $.gmrrWc ....... <br /> De~...roi~:, OR SimS° NEi/¢SE1/¢ /3g <br /> Subdl~ iskm l~t Blo~ <br />"~oNlc II~ne Park Space ~ <br />.... ~tlo,~ Townshi~ Range ~ne "Map <br />,,,~.,, 1 0S 5E WM Water Supply:: <br /> lint Width ~t Depth Acres ...... Img Lot .... Com~ Private W¢~ ~9~nng ~ ~ <br /> Ar¢.g...Occupie~t by O¢~ mpro~ :ments (per Fd:est Service], CommunitsWe~ [ ] C'it5 I 1 <br /> <br />3, Contractor Information <br />Propcn~ Owner MaiJing Address & Phone No <br /> National Forest Lands <br /> <br />Auth Agcnt/bcasce Mail:ns Address & Phone No <br /> <br />Detroit Raoger Dist~ HC 60~ Box 320, Mill City, OR <br />Contractor Business Name & Num}~r Marlin Address & Phone No <br />.~ohn Commercial Products [~ZqXL 35217 <br />Architect Mailing Addmx~ ~Phon~ No <br /> <br />4, Septic Information (Check where applicable) N/A <br /> <br /> Proposed No Bcdrooms;: Existing NO, Bedroom~ New Installation [] <br /> <br /> lh.qt Il@los Read) [] Will Call When Te~t Holes Read) [] <br /> <br />Olher Prelabric. atedCor0municati_on Equipment Strucl; <br />agree to budd according to ril~ ~ubmitted pla~ an~cification~, thc la~ or <br /> <br />5. Fee Schedules <br /> <br />972 ;0 <br /> <br /> D <br /> <br /> re <br /> <br />New One-and-Two Family D~ellmg Code <br />(includes El, Me, PI) <br /> <br />(1)gq Ft__ .... x,28 <br />(2) 5% State Surcharge (05 x Al) <br />(3) Base Fee for Plan Review <br />(4) Zoning Surcharge (Lf Appl cable) <br /> <br />Stmct0ral Permit <br />(Permit fcc determined by valuation <br /> El, Me, PI are separate pcrmit~ ) <br /> <br />(1) Permit <br />(2) 5% State Surcharge (05 x BI) <br />(3) Zonijig Surcharge ( 05 x B1) <br />(4) Plans Check (65 x 81) <br /> <br />Septic bees (Includes DF~Q Surcharge) <br />(1) Site E~alua,ion <br />(2) New Sclaie IJIs~allauon Permit <br />(3) Authodzatic~ Notice <br />(4) Existing S)stem Report <br />(5) Major Repair <br /> Minor R~pair (tank only) <br /> <br />(1) Dn~e~ay ~/curb @ 5750 <br />(2) Driveway wto curb @ $1700 <br />(3) Site Plan Re'dew (commercial only) @ 579 00 <br />(4) Investigation Fee <br />(5) Reinspection Fee @ $25(D <br />(6) Other in~pec~ion~ not listed above <br /> <br />Valuation: 5 <br /> <br /> 185.00 <br /> <br />Subtotal:: 5 <br /> <br />Valuation: <br /> <br />Subtotal;; $.__ <br /> <br /> x $40 = --, __ <br /> <br />37.00 <br /> <br /> <br />