Laserfiche WebLink
I FOR OFFICE ~SE ONLY] <br />Received by: d)~ ~;~d~>~-- I <br /> Zoning Val~dationL ~/?Z~z/ / <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:130 am.4:30pm Phone 588-5147 <br /> Code-A-Phoa¢ 588-7904 <br /> FAX $$8-7948 <br /> <br /> MANUFACTURED STRUC TUR.,.I~ PLA~i~ ~ <br /> pERMIT AppLICA~I ION I%LUL! 1~ i~U <br />COMPLETE ALI, SECTIONS, 1 TI-IROUGIt 4 <br />1. Job Description c~-~ ~,~ ..... ~ <br /> <br /> FOR OFFICE US~E ONL~Y <br />/cJ Sa ek Requirements: <br /> <br />Reddenti~I( ) New <br />Commercial( ) N~w( ) Replacement( <br /> ......... <br /> <br />2. Location of Installation <br /> <br /> Owner aL{ lO v4_ Marling Addmsa <br />IobAddmss <br /> <br />Tax A~ct, No, <br /> <br />Site No. <br /> <br />S~¢¢# <br /> <br /> Township Map <br />Dot Width I::: Lot Depth 4 Comer <br /> <br />JUrban Growi~ Boundary2 <br /> Y( )N(), <br /> PfivateWell ( ) Spring <br /> Community Well ( ) City <br /> <br />3. Contractor Information <br /> <br />( ~ I o~. reside m, ~ ~ reside in ~e cmplemd ~ctum. <br />( ) I un.rotund ~a[ I mun m~s~r as a constmc~m ~ntracmr ff ~e s~a~ is gold or offered for sab b~om or u~ cmple6on, <br /> <br />( ) I w~ be my own g~et~ <br /> <br />If i kite subcontractors, I will hire only subgontraetor~ registered with the Conslmetion Contractors Board, <br />If I change my mind and do hire a general contractor. I will contract with a ¢omraetor who is registered with the Constmetlon Contractors Board, and will <br />immediately notify Marion County of thc name of thc contractor, <br /> <br />4. Fee Schedule <br /> <br />A, (1) Man~fa¢~red}Iome <br />or Modular Uni~ Place. mere/Connection @ $182,00 = <br /> <br /> (2) State Fee @ 20.00= <br /> @ 9.10 = <br /> O) State St~rehatge ~ 15,~ = <br /> (4) ~ng Su~ha~e (15,~ ifappllcable) , ~ ~ <br /> <br />B. (1) Mfg.'d Stmemm Storage Fee <br /> ~ $25.~=~ <br />(2) Mfg.'d S~ctum Storage R~ew~ ~ ~,~ = <br />(~) 7~ning Sumha~e (15,~ if applieaMe) ~ 15.~ = <br /> <br />C, Additional Inspection <br /> <br />D. Investigation Fee <br /> <br />E, Olher inspectlons not llsted <br /> @ 40.00 per hour (2 hour minhnum) <br /> <br />@ $60.00 =____ <br /> <br />@ $40.00 <br /> <br />TOTAL= <br /> <br />hereby certify that thc above infonnafion i~ correct and thal I have read and understand the Information Notice IO Property Owners about Conat orion Rcsp nsibiliticz <br />.n~hemvcr,efid. o[thi,£o.n,-- Cq <br />N me of Appl/cant (please print): ~,, ~L..' ' t ) Phone: ~ 6 ~ ~ 7 ~ V{ ~/ <br /> <br />TMs fcc covers thc manufactured structure i~sccmcnt, plurnbin~ connection, clc~L~cul cormcction mrd mechanicM connection, Ske cwduadon, septic permiL el~cttical <br />servil;e or plumbing water/sewer ].ine s an~ separate required ~its. MC 15-64 Rev I 1-91 <br /> <br /> <br />