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I FOR OFFfCE_USE ONLY <br />[Zoning'Validation: ~/~Y/' <br /> / <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:30~m Phone 585-$ I47 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 <br /> <br /> OFFICE USE ONLY ..... <br />:'TY::: <br /> de:/o; I%htsid5 <br /> <br />1. Descri ~tlon <br /> <br />ZE~L ~L ( ~cw U~e of Structure: <br />()Addition ( )R~afion ( )Addition ( <br /> <br />[mss( ) or mfmr( ) [ No. Smfiea [m~lL~'orNm~of~ployees No. Bed~s: ........ <br /> <br />2. Location of Installation <br /> <br />Subdivision .... L~ ,~ <br />Se~o~ To~s~p ~ge Z~* Map Wa[er <br /> ...... P~va~e Welt ( ) S~g <br />LotWld~ ~51, L~D~ ~ ~ Ac~ I~g.~, Comer CommuMtyW~( <br /> <br />3. Contractor. Information -~'z-e.~a~a <br /> <br /> ~I own. r~sido in. or ~ mime iii the completed stmcillm. <br /> ( ) I tmdemtand that I must mgis~r as a const tutti,ri ccatractor if th~ ~trocPJro i$ sold or offend for sal¢ before or u~m completion. <br /> <br /> ( ) I will tm my own g~alCral contmaor. <br /> <br />If I him subcontractors, I will lfi~ only subcontractors registerexl with the Gonstmation Contractors Board, ]~ I change my mind and do hire a general contractor, I will contract <br />· ~th a contractor who l$ regiate~d withe Const met(eh Contractors Board, and will immediately notify Marion CouBty of thc name of the contraezor. <br /> <br /> (" ""'" ! am a regi~u,r~d Uuild~r & th, aumo~r~d r~hntatiw of a r~i~t,r*a buUd~r, <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br />to dewrrain¢ valuation based ca <br />square feyo[a ge.) <br />(1) Permit <br />(2) 5% State Surcharge 605 xA1) -- <br />O) Stmetura! Plan Review (.6~% x Al) <br />(4) Hm & [,ifc Safety Ha~ Review ¢40% x Al) <br />(5) Zoning Surcharge. if app~¢able <br /> <br />Valuation: <br /> <br />(l) Driveway w/eueo @ $7.50 <br /> <br />(2) Driveway w/o curb@ $17.00 <br /> <br />O) Site Plan Review ¢ommerclal only) @ $79.00 <br /> <br />(4) Additional Pla~ Reviews or Add~ndrmas <br /> <br />(5) InvestigatiOn Fee <br /> <br />(6) Reinspeetion Fee @ $25,00 <br /> <br />(7) Other ItBpections not listed above <br /> <br /> Si~e evaluations, septic, electrical, plum~and mechanical work requlm seperate perrdit~. Check with Marion County Building Inspect(eh before subrnittieg thi~ application. <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />