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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> $:00~uzl-4:30pm ~lone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 58g-7945 <br /> <br />ONE & TWO FAMILY DWELLING PERMrr APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. job Description <br /> <br />(.R') New Single Family Dwelling w/garage <br />( ) New Single Family Dwelling w/o garage <br /> <br />( v~arage, attached <br />( ) Garage, detached <br /> <br /> MAI~!ON OOUNTY <br />BUILDiN~ INSPECTION <br /> <br />'IYus~ (~c) or Rafter ( ) t No. Stories i I Detaoh~d Garag, Height: No, Iledroorm~: '~l,. --'i <br />SquareFe~t; lh~emen,: {MainFioor, i~{.. ] Second Floor: [Garage: .2. HO (~ther: ........ 2 <br /> <br />2. Location of Installation <br /> <br />"~tWidth~. ~1. ~' ~ ..... PdvateWell ( ) Spring <br />~&Z ':l~O'~m~h lq~, Aeren l~eg.l~t Corner [~ CommuMtyWell( ) City <br /> <br /> ,4 <br /> Contractor Information L/ <br /> <br />(~*) I own, reside in, or ~i]l re~i~ in the completed s~racture. ~) ...... ) I uoderstaad that I lllu~t register ~_q a construction ¢ontractc~ if the structure is sold or offered for sale before or upon completion, <br /> <br /> ) I wilI be my own general contractor, <br /> <br />who iz register~ with die Con.~ruct ion Contractor's Board, I will immediately notify Marion County of the name of the contracor: <br /> <br />Contractor Business name & ~: [ Mailing Address: ] Phone: <br /> ( ) I am a registered builder OR the authorized representative of a registered builder <br />Arcl~tect natne: [ Mailing Address: I Phone: <br /> <br />4, l~'ee Schedule <br /> ll~lll IlI l~lI l~l <br /> <br />A, New One-and-Two Family Dwelling Code <br /> (inlcudes El, Me; PI) <br /> <br />Valuation: <br /> <br />(2) 5% State Surcharge (,OS z ^l) = <br />(3) Iqan Review $185,00 <br /> <br />B. IVfi$cellaneous Fee* <br /> (1) Driveway w/curb 49 $7,50 <br /> <br /> (2) Driveway w/o curb ~ $17.00 <br /> <br /> (3) Additional Plan Roviews or Addendums <br /> <br /> (4) Investigation <br /> <br /> (5) Relnspection Fee @ $25.00 <br /> <br /> (6) Other ?~l~cfions not listed above <br />RECEIPT :_~ <br /> <br />TOTAL <br /> <br />I hereby certify 0,at the above information is coffee a d ti a ave read and understand the Info, nm oa Notice to Propony Owners about Constlll¢fion ResponsibJl[0cs on the <br />MC 15.80 Rev. 1/92 <br /> <br /> <br />