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MARION COUNTY BUILDING INSPECTION <br /> 220 High SUeet NE .~ <br /> Salem, OR 9~ ~ r~ .~, n ~t/ .~_ <br /> <br /> BUU DING eRMi <br /> <br />COMPLETE ALL SECTIONS, 1THROUOH4 MARt0N C0UNI¥ <br />1. job Description BUILDING XNS?Eff[10N <br /> <br />RESID~L COMMFI~.CIAL ( ) New <br />)Addition ( )Relocation ( )Addition ( )Sign <br />) Almration ( )Dmuollti<nl ( )Alteration ( )Demolifica <br />~)AcccaaoE~ ( )Other ( )ChangeofOc¢~pa.n.¢y ( )Other <br /> <br />Square P~:U~ gasemem: ......... I M~ R~r: ...... ~ S~nd R~t:' , ....... [ ~.r: <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br /> ~1 own, m~ide in. or will malde ~n the completed stmctui~, <br /> ( ) I undentand that I must register as a constmctien conUactor if the stmctui~ is sold or offered for sale before or Ul:xrn completion, <br /> ( ) /willlmmyowngeaeralconuactor. <br /> <br />If I ldm sabcon~actors, I will hJxe only subcontractors registered with the Construction Con.actors Board. If I change my mind and do htre a general contractor, I will contract <br />with a coatraciof who is registered with~ Constmctloa Contractots Boapt, and will immediately nc~y Marion County of the name of ~h. contractor. <br /> <br />I ,m, re, gi~terod builder OR th~ authodz~xl repmsente~i+ of. x~giste~d builder. <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> to determine valuation ~aed ~ <br /> squar¢ footage.) <br /> (1) Permit Fee <br /> <br /> (2) 5% Stet* Surcl~rge (,05 x Al) <br /> <br /> (3) Stracmnd Plan Review (,65% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (.40% x Al) <br /> (5) Zoning Sumhalge, il applie, able (,05% × A 1 ) <br /> <br />= <br /> <br />(1) Driveway w/¢orb@ $7,50 <br /> <br />(2) Driveway w/o curb @ $17,00 <br /> <br />(3) Sim Plan Review (¢crnmemial ca[y) @ $79.00 <br /> <br />(S) Ia~estlg~tlon <br /> <br />(6) Reinspeetlon Fee @ <br /> <br />(7) Other hSl~¢tionsllo~[~ted above <br /> <br />TOTAl. <br /> <br />hereby certify that the above information is correct sad that I have mad and understand the Informatkra Notice to Pmpegy Owners about Construction Responsibilities on the <br />reverse sid~ o~ thi~ form, f~ f~ /~ ~ 7 <br /> <br /> Site eval.aiiomt, septi¢.electt~¢aL l(u..4~nl.d m¢¢hanicaI work i~,ttiie se,mte,,ts. Check with Marion C0unty Buiidthg Inspection before submitting this a~lieatio.. <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />