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MARION COUNTY BUILDING INSPECTION~ ~-~--~-~ <br />FOR OFFIC~USI~ O2qLY~[~.~ ~o lt~gh Street <br /> FOR <br /> OFFICE <br /> USE <br /> ONLY <br />Received by: ~5~1 ~w"' ICitySetba~kReq~rmentv' I <br />Z~ing Validatio~ [ Salem, OR 97301 <br /> <br />Date: /4,,,,,z,,~' f ~ / C~e-A-mme 588-79mF~ 588-7948 I <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PER~T APPLICATION <br /> co~'~'l'~ ALL SEC~XONS, 1 THROUG~ 4 <br /> 1. Job Descrip~on <br /> <br />Residential(L) New~) Replacement( ) Garage or Carpor[ <br /> ( ) Attached <br />Commercial( ) New( ) Replacement( ) ( ) Detached <br /> <br />Manufacturer's Ycarof Colorof Length: ~/0 I Widl <br /> <br />2. Location of Installation <br /> <br />Subdivision Lot ] Block Urban Growth Boundary? <br /> <br /> Range ~ ~/ Z~e Map <br />Sec6m · ¢ Tomshlp <br /> l'fiva~eW~ ( ) Sprig <br /> <br />3. Contractor Information <br /> <br />(~ I own. reside ~, or w~ reside <br /> <br />( ) I w~ ~ my om g~erM ~ntraaor, <br /> <br />If I hire aubeonlcacXors, I will hive only subcontractors registered with thc COnatmcxion Contractor~ Board. <br /> <br />Lf 1 change my mind and do hire a general ¢onh~dctor~ I wi]I cxOntlag[ with a contractOr who is registered with the Construction Contractors Board, and will <br />irrenedlately notify Marion County of the same of th, contractor, <br /> <br /> · ) I <br /> <br />Fee Schedule <br /> <br />A. (1) Manufaeture;l Home <br /> <br /> ot Modular Unit Plaeemenl/Conneetlon <br /> <br /> ~) State Fee <br /> <br /> (3) State Surcharge <br /> <br /> (4) Zoning Surcharge (15.~ ffapplicable) <br /> <br />$I <br /> <br /> 15.00=_ <br /> TOTAL <br /> <br />B- (1) Mfg,'d Structure Storage Fee <br /> @ $25,00=__ <br />(2) Mfg.'d Structure Storage Renewal @ 25,00 =__ <br />(3) Zoning Surcharge (15,00 if applicable) @ 15,00 =__ <br /> <br />C. ~dditional Inspectlma @ ,$60,00 <br />or R~spection I' .,' .... ~.. ,-e,~[ ~ ~;~ <br />D, Investigation Fee <br /> <br /> @ 40,00 per hour (2 hour minimum) <br /> <br /> TOTAL= <br /> <br /> RECEIPT: <br /> <br />hereby certify that the above information i~ correct and that ][ have fend and under, rand the Information Notice to Property Owners al>out Coosu0cllon Respon athLllti¢~ <br />on [he re&erie ~ide of this form, <br /> <br /> <br />