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FOR OFF/JCE USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br />8:00 a,m,-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 />~t~ /6) / 1 Roan /0 <br /> ? <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLICATION ~z~/-~ ,;L.g <br />COMPLETE ALL S£CTIONS, 1 THROUGH 4 <br />1. Job Descr)pt)on <br /> <br />I~.ESIDENTIAL ~Acc COMMFERCIAL <br />[ ] New SF'D w/garage [ cssoty [ ] New [ ] Sign <br />[ ] NcwSPDwlogarage [ ] Relocate [ ] Addllion [ ]Demo <br />[ I AddiLion [ [ I)CiIIO [ ] Altcratinn [ ] Other <br />[ J Alteration [ I Other [ ] Change/Occupancy <br /> <br />2. Location of Installation <br /> <br />Depth i Acres Iacg. Lot ~: Comer~Z' PrivateWeIl [ ] Spring <br /> <br />3. Contractor Information <br /> <br />5. Fee Schedules <br /> <br />Mailing Address & Phone No. <br />Mailing Address & Phone No. <br /> <br />4. Septic Information (Check where applicable) <br /> <br />New Installation <br /> <br />'['estIloles Ready [] <br /> <br />Will CaU When Test IIolcs Read <br /> <br />[ ~'T}m work will be performed by a ~.'.gistcred builder, <br />I 1 <)Iher <br /> <br />N~w One-and-Two Family Dwelllng Code Valuallo,: $___ <br />(includc~ RI, Me, FI) <br /> <br />(1) Sq, Fi. · .28 = _ <br />(2) 5% State Surcharge (,05 x Al) <br />(3) Rase Fee for Plan Review 185.00 <br /> g Surcharge ~ff Applicabl~) <br /> Subtotah $ ...... <br /> <br />B, Structural Pcmri[ <br />(Permit fee d¢lcrmined by vathatkm, <br />El, Mc, PI am ~eparate pemfics.) Valuation: <br /> <br /> (1) Pem~it Fee .~ <br /> (2) 5% State Surcha~e (.05 x BI) <br /> <br /> (~) Plan~ Check (.65 x <br /> Subtotal: $ ~ .~ <br /> <br />C, Septic Fee~ (Includes DEQ Surcharge) (Il Sim Ewl,alion <br /> (2) New Seplic ~stallation Pemfit <br /> <br /> (4) Existing Sysmm <br /> (5) Major Re~rir <br /> Minor R~ir (tank oaly) <br /> <br />(I) Driveway w/curb @ $7.50 <br />(2) Driveway w/o cud~ @ $17.00 <br />(3) Sim Plan Review (cc~lmercial only) @ $79.00 <br />(4) Investigation Fee <br />(5) Reinsp~cfion Fee @ $25,00 <br />(6) Other inspections not l[sled above <br /> <br />..__ × $40 ~ <br /> 're..: $~_. _J~ <br /> <br /> <br />