Laserfiche WebLink
]?OR OFFICE USE ONLY <br />Received by:~ - <br />Zoning Validation: <br />Date: <br /> <br />MARION COUNTY BUILDING iNSPECTION <br />220 High Street NE FOR OFFIC~E US.__~E _ONLY_ <br /> Salem, OR 97301 ~ity Sell~aek Requircvnems: ] <br /> $:00 amM:30pln Phone 588-5147 Fmllt: I Rear: , <br /> Code-A-mo~ 588-7904 } f}eft Side: [Right ~ide: / <br /> FAX 588-7948 <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br />cOMPLETE ALL SECTIONS. 1 THROUGH 4 PERMIT APPLICATION , <br /> <br /> New( ~ Gara or Carpor[ <br />Residential( ~'~ Replaeemem( ) ( ~tm~ed <br />Com~em~al( ) N~w( ) R~cem~t( ) ( ) Detached <br /> <br />Manufa*tUmfa Year of Color of l~g~; 'Wi <br /> <br />2. Location of Installation <br /> <br />,'~0~ 0~ ~ ~oo~ s~o, <br />Subdlvid~ t ~t 'l Bl~k Urban Gmwth"Bounda~? <br />Mob~e Home Pa~ S~ce ~ Y( ) N( ) <br /> <br />Serum ~ Tow~hip ~ ~ Range ] ~ ~e Map WaterSu~ly'. <br />,, Private Well (~pri~g ( ) <br />L~Wid~ i~De~ Ae~ %,~1 ~,~t Comer ~ C?mmu~tyW~( ) Cit~ ( ~ <br /> <br />3, Contractor In/rbrmation <br /> <br />Property Owner [ Mailing Address I'Phone No, <br /> <br />( ) I oM, reside ia, or will reside hi the completed structure. <br /> <br />If I hire subcontractors, I will hire only sub*ontmcto~ registered with the Construction Contractors Board. <br /> <br />If I change my mind and do hire a general contractor. I will contract with a co~traetor who it: feglstemd with thc Construction Contractor's Board, and will <br />ixmncdla~ly nofffy Marion County of the hame of the contractor. <br /> <br />ContractOr Bus~cs~ Name & #: [ Mailing Address: I Phone: <br />( ) I am a registered buildor OR the authorized representative of a iegistel~d builder, <br /> <br />Authosized agent or lessee: [Mail/ns Adages*: ] Phone: <br />4. Fee Schedule <br /> <br />A, (1) Manufagured I'Iouc <br />o~' Modular Unil Plaevmel}t/Connecfion @ $182.~ = ~ <br />~) State Fee ~ 20.00 = ~ <br /> ~ 9.10=~ <br />O) State Surcha~e ~ ] 5.00 = ~ <br />(4) ~fing Surcha~e (15.~ if applicable) <br /> <br />g. (1) Mfg.'d Structure Storage Fee <br /> @ $ 25,00 <br /> (2) ,Mfg,'d Structure Storage Renewal @ 25.00 <br /> (3) Zoning Surehaxge (15,00 if applicable) @ I5,00 <br /> <br />C, Additional Inspection <br /> or Reinspection <br /> <br />D- Investigation Fee <br /> <br />E. Other inspections not hst~d <br /> @ 40,00 per hour (2 Inmr minimum) <br /> <br />(q $60,00: <br /> <br /> @ $40.00 =__~ <br /> <br />TOTAL= $~_ <br />RECEIPT: <br /> <br />ze~ice or plumbing wamr/sewer ~cs are ~e~ra~ r~uimd ~it~. MC 15-64 Rev 11-91 <br /> <br /> <br />