Laserfiche WebLink
FOR OFFI~CE USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem= OR 97301 <br /> <br />800am-430gm Phone588-St47 <br />Code-A-Phone 588-7904 <br /> FAX 58~.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 />R Eb~i~ENTiAL COMMERCIAL <br /> <br /> New SFD wlo garage [ I R~.locate [ ] Addition [ ] Demo <br /> Addition [ ] Dgrno [ 1 Alteration [ I Other <br /> Almration [ ] Other [ 1 Change/Occupancy <br /> <br />2. Location of Installation <br /> <br />Section ~,E ']0~ns}up ~X ' ~ange ~' ~nc ~ S ~ap Water Supply:: <br /> <br />3, Contractor Information <br /> <br />Mailin %ddress & Phon <br /> <br />M~filmg Address & Phone Nc <br /> <br /> Contntctor Business Name & Numl~r Mailin~ &ddmss & 'Pho~l¢ No <br /> <br />4. Septic Information (Check where applicable) <br /> <br /> Proposed S,rc Ev~uation <br /> <br /> 'lg~t llola~ Rcad~ <br /> <br />l[xistJng Site Evaluatical [] <br /> <br />Dam 2 ank Last Pumped;: <br /> <br />} ] ] agree to build ~¢t-ord~n~g m~~nd ,~p¢c,£ication~, the laws <br /> <br />5, Fee Schedules <br /> <br />(inclotte~ El, Me, <br /> <br />(2) 5% State Surch~ge (05 x Al) = ~ <br />O) Ba~e Fee EOt Plan Review = 185.00 <br />(4) 7~n[ng Sumharge (If Apphcable)~ ~ = /~. ~ ~ <br /> <br />(1) P~it Fee <br />~) 5% State Surcharge ( 05 x B I ) <br />(3) l~nmg Sumharge ( 05 x <br />(4) Plan~ Check ((G x i~l) <br /> <br />Septic Fees 0'ncludes DEQ Sm'charge) <br />(I) Site E'~aluatlon <br />(2) New Septic Jal~tallatic~l Permit <br />(3) Amhonzatlon N~b.e <br />(4) E~tmg System Report <br />(5) Major Repair <br /> Minor Repair (Lank only) <br /> <br />Subtotal: <br /> <br />D <br /> <br />(I) Dnvewa~ '~/cr~xb ~ $3 50 <br />(2) Driveway w/o curb @ $I7 O0 <br />(3) Site Plan Revtc~ (commemial only) (c~ $7900 <br />(4) Investigation Fcc <br />(5) Rein~peclion Fee @ $25 O0 <br />(6) Other insl~cuons not h~ted abo'~ e <br /> <br />x $40 = <br /> <br /> <br />