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FOR OEFICE USE ONLY, <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Sa[em, OR 97301 <br /> <br />8:00 am.-4:30 p,m, Phone 588-5147 <br />Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br />FOR OFFICE USE ONLY <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />~1. Job Description <br /> <br />RESIDENTIAL ~Ac COMMERCIAL <br />[ ] NewSFDw/garage [ cessory [ ] New [ ] Sign <br />[ ] NewSFD w/ogarag¢ [ ] Rel~ate [ ] Addition [ ] Demo <br />[ [ Addition ] ] Demo [ ] Alteration [ ] O~er <br />[ ] Alteration [ ] Omee [ ] C~a~e/~cupan~ <br /> <br /> Use of Building: ~'~15 y- ~O~t <br /> <br />2~ Location of Installation <br /> <br />SccPon ~ 'I'own,hip ~ ~ Range~ ~ ~n~ Map Wa/er Supply, <br />i~t' Wh~, ~t Dept'~o0 / I Ac.s ~g,~, Comet ~ Community We, Private We, [[ ]] CitySpring[][ ] <br /> <br />3~ Contractor IBforrl~atJoll <br /> <br />p,/,,m,ctor Bu~ines, I~ame~y~er Mailing Address & Phone <br /> <br />4. Septic Information (Check where applicable) <br /> <br /> Propos~ No, Bedrooms: Existing No, Bedrooms: New ]~atallation [] <br /> Proposed Site Evaluation [] <br /> <br /> 'l'¢s[ I Isles Ready [] Will Call When Test nole~ Ready [] <br /> Existing Site Evaluation [] Exlstblg Site [[valuation No,: <br /> <br /> l;,xi~tixlg Drainfie/d Length: 'rank Size: <br /> <br />f~' 1 have read this application in its entirety and certify that the stated information <br /> <br /> performing work on a propany I own or occupy, <br /> <br />acme ~O build ac~to the ~u~[tt~ ~lans and spe~ifinatlo~s. ~e laws of <br /> <br />5. Fee Schedules <br /> <br />A, New One,and-Two Family Dwelling Code Yaluatlon: $__ <br /> (incltl<les El, Mc, PI) <br /> <br />(l) Sq. Ft. ---- x .28 <br />(2) 5% State Surcharge (,05 x Al) <br />(3) ga~c Fee for Plan Review <br />(4) Zoning Surcharge (If Applicable) <br /> <br />(Permit fee determined by valuation, <br /> <br />= _1,85,P0 <br /> <br />Subtotal: $ .... <br /> <br />Valuation: <br /> <br />(1) Pemlit F~e <br />(2) 5% State Surcharge 605 x BI)~ [~ L~ <br />(4) Plans Check (,6S <br /> Subtotal: $ <br /> <br />Septic Fees (Includes DEQ Surcharge) <br />(t) Site Evaluation <br />(2) New Septic Installation Permit <br />(.3) Au~ofiT~tim N~ine <br />(4) Exi~tlng Sysmm Report <br />(5) Major Re.ir <br /> Mince Re.ir (unk rely) <br /> <br />(1) Driveway w/curb @ $7,50 <br />(2) Driveway w/o curb @ $17.00 <br />(,3) Site Plan Review {commarcial Only) @ $79,00 <br />(4) Investigation Fee <br />(5) Reinspection F~e @ $25,00 <br />(6) O~ct inslx3mions no~ ii,ted <br /> <br />..... <br /> 'pot,.: <br /> <br /> <br />