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FOR OFF/ICE USE ONLY MARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY <br /> ~' ~_~, ~20 High Street NE <br /> Ci[¥ZoningValldadom~ tg'~, ........ Salem, OR97301 <br /> 8:00 a,m,-4;30 p,m. Phone 588-5147 ' /~ ' <br /> <br /> ............. FAX 588-7948 "_~/~ _~1 '"~ /~ ~ <br /> DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLI~~/J'¢''- ¢" - <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />RESID}'(N'I'IA L 1,~Ace COMMERCIAL <br />I ] NewSFDw/garage 1~" essory [ ] New [ ] Sign <br />[ ] New SFD w/ogarage [ ] Relocate [ I Addi*ion [ I Demo <br />i ] Addition [ ] Demo I ] Alteration [ ] Other <br />I ] Alteralion [ ] Other [ ] Change/Occupancy <br /> <br />Use ~ <br /> ofItu. ing: C r/Cv r'C <br /> <br />Location of Installation <br /> <br />3. Contractor Information <br /> <br />5. Fee Schedules <br /> <br />Mailing Addmg~ & Phone No. <br /> <br /> racto~' Bu~iness/~.3 Name~O & Num~rv~ M~ ~. & Phone No. <br /> <br />4. Septic Information (Check where applicable) <br /> <br /> '['esl IIoins Ready ~ <br /> <br />Site Evaluatio~l [] Existing Site <br /> <br />Date Fat k Las Pumped: <br /> <br />[ ~/?IheUilwdo;~ will be per formed by a regis:emS builder, <br /> <br /> / <br /> <br />A. New One-and-Two Family Dwelling Code Valuathm: $.__ <br /> (includes El. Mc', PI) <br /> <br />( l ) Sq, Fl, x .28 = _ .... <br />(2) 5% State Surchaege (,05 x A I) = <br />(3) Base Fcc for Plan Review = .,J 85,00 <br />(4) Zoning Surcharge (If Applicable) <br /> Subtotal: $___ <br /> <br /> (2) 5% Slate Surcharge, (,!)fix BI) ~ ~~.. _~,~ <br /> I.) Plans Cheek 065 x BI) &' <br /> Subtotal: <br /> $~ <br />C. Septic Fees (Include~ DEQ Surcharge) <br />(1) Site Evaluation <br />(2) New Sep~.ic Installation Permit .... <br />(3) Authorization Notice <br />~ (4) Existing System Repo~' <br />(5) Major Repair <br />Minor Repair (hank only) <br /> <br />(l) Driveway wi curb @ $7.50 <br />(2) Driveway w/o curb @ $17,00 <br />(3) Sim Plan Review (commemial only) (~ $79.00 <br />(4) investigation Fee <br />(5) Reinspectim Fcc @ $25,00 <br />(6) O~her inSlmctioils not listed above <br /> <br />. x$40= <br /> <br /> <br />