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JFOR O~FFICE USE ONLY] MARION COUNTY BUILDING INSPECTION ['FOR OFFICE USE ONLY <br /> Received By: City ~f AUS~Iv±lle 220 High Street ~ affi* ~ ~ ~ ~'Re~fi~ments: <br /> Zoning Validation'. B.~ . ,/ Salem OR 97301 ~wl~l ~ wl~ ~l[ ~ll ~12~t:11 t~' ..... '"' ''~1 ~ear: <br /> Dg~; 7 - ] 7- ~ 2 } 8:~- ~:3~m Phone 588-1~ [' ~t Si~~ l R~ ;' S~d~ <br /> F~588-7948 OU~ I ~ I~'~ <br /> <br /> BUILDING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Job Description ~IJlLOIN~I <br /> <br />RESIDENTIAL COMMERCIAL ( ) New Usc of Structure: <br />( ) Addition ( ) Relocation (x ) Addition ( ) Sigt~ <br />( ) Alteration ( )Demolition ( )Alteration ( )Demolition Canopy over the <br />( )Accessory ( )Olher ( )ChangcofOccupancy ( )Other gas pumps <br /> <br />DcscrlpllonofWork: Construction of Canopy <br />Tins*( x) or l~f~r( ) t No. Stori¢~ ,,, lO¢¢amn[LoadorNumb~ofEmployc*s No. geth'oom,q: <br /> <br />2. Location oflnstallatlon P.O. Box 826 <br /> <br />Prope~yOwner C,ur~minqs Transfer Co. [MaflingAd~m~ Albany, Or. 97321 PhoneNo. 928~3385 <br />JobAddmss 810 Main Street TaxAcct. No.'"""~0010~160 Cr'--ossS~mel 8th Street <br />Aums~$11et Ore. 97325 ..... SlleNo. <br />Subdivision A~ville Addition Lot 1 Bilk 9 <br /> <br />Scaion 25 Township 8 Range 2W Z~e ,,,Co~, Map ~a~r Supply', <br /> ...... Priva~Wel[ ( ) Spring ( <br />LotWid~ 62~ ~tDc~h 100' A¢~ I~cg.~ Comer Y~ CommunliyWe~( ) City ~) <br /> <br />3. Contractor Information P.O. Box 826 <br />P~o~yOwner Cumminqs Transfer Co. IMailingAdd~ss Albanv~,,,,.gre. 97321 '1Ph°neN°: <br />( ) I own. reside in. or will m~klc in the completed structure, <br /> <br /> ( ) I will be my own general contractor. <br /> <br />928-3385 <br /> <br />ContractorBusinesaname&#: Double R Products 40432 [MailingAddtess: 901 NW E-St, <br /> (x) IamarcgisteredbuildcrORthcauthodzedtepresentativeofamglstet~dbuilder. Grants Pass Or. 97526 <br /> <br />Phone: <br /> .., 476-1~R7 <br /> <br />Archltectname: Wood Enqineerinq <br />4/Fee Schedule <br /> <br />Mailing Address: Ur~g).qu.a, Or, <br /> <br />I i>hoae: 459-299~ <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> <br /> ~quare fo, orate.) <br /> <br /> (1) Pemtit Fee <br /> (2) 5% State Surcharge 605 X Al) <br /> <br /> (3) Smlctural Plan Review (,65% x Al) <br /> (4) Fire & Life Safety Plan Review (,40% x A 1) <br /> (5) ?xming Surcharge. if applicable (.05% x A 1) <br /> <br />~tuadon:$__10,000 <br />80.50 <br />4.03 <br />= ___5.,2.33 <br /> <br />4.03 <br /> <br />(1) Driveway w/curb @ $730 <br /> <br />(2) Driveway w/o c lrb (r~ $1700 <br /> <br />(3) Site Plan Review (com~ncrclal only) @ $79,~0 <br />(4) Additional Plan Reviews or Addendmn~ <br /> <br />(5) Investigation <br /> <br />(6) geinsl[~ction Fcc @ $25.00 <br /> <br />(7) Other hlspections not Hsted above <br /> <br />TOTALS 140.89 <br /> <br />[ hcl'chy certify that the above information is o3rmct and that I have read and understand the ~nfomlat on Notice o Property ( whets about C~mstmcdon Resporlsibilities on thc <br /> <br />MC 15.73 Rev. 11/91 <br /> <br /> <br />