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MARION COUNTY BUILDING INSPECTION <br /> FOR'OFFICF USE OJ LYI, <br /> Received by: /):7;~, 4//~ <br />j Zoning Vahd~tion~ I <br /> <br />COMPLETE ALL SEC'lIONS. 1TFI~OUGFI 4 BUILDING <br />1. Job Description <br /> <br /> 220 High Street ~.j <br /> FICE <br /> USE <br /> ONLY <br /> i~ ~ ~= lotySe~.L~dRequiremmts: <br /> 8:00 mm4:30pm Ph°ne 5881~111~Salem, OR 9730~ <br /> <br /> F~ 588-7948 <br />MANUFACTURED STRUCTURE <br /> PER~T APPLICATION <br /> <br />Residential(~) New(~() Replacement( ) Garage or tarpon <br /> ( )Attached <br />Commer~al( ) New( ) Replacement( ) ( ) Detached <br /> <br />2, Location of Installation <br /> <br />3. Contractor Information <br />Property Owner <br />( ~ ) I om, miide <br /> <br />ff I him subcontractors, I will him only subcontractors registered with the ¢onstmctlon Contractors Board, <br /> <br />~ 1 change my m~nd and aD hire a general contractor, I will contract with a contractor who J~ t~giste~d with the Construction Contractors Board, and will <br />immediately notify Marion County of the name of the contractor. <br /> <br />(X) I am a registered builder OR the authorized mlxes~ntatlve of a registered buiMer. <br /> <br /> I <br />4. Fee Schedule <br /> <br />A. (1) Man,factored Home <br />~ ~oad~r Unit ma~¢m~,~Co~nmlo~ @ *~S2 00 = ,,/~ ~ <br /> (2) State Fee ~ 20.~ = ~. ~ <br /> ~ 0.me ~/~ <br /> (3) State S~rcha~e ~ 15.~ = ~* <br /> <br />B, (l) Mfg.'d Structure Storage Fcc <br />¢) Mfg,'d Stmcm~ Storage Ren*wal ~ 25.~= ~ <br />(3) ~ng Sugha~e (15,~ if up.cable) ~ 15,~ = ~ <br /> <br />C. Additional Inspection @ $60.00 = <br /> or Relnspection <br /> <br />D. Investigation Fee <br /> <br />@ 40.00 per hour (2 hour minimum) <br /> <br />@ $40,00 = __ <br /> <br /> I .................. <br /> ! <br />T}ds/eec~er~eman~actumditm um lamment, plumblng~nnecfion, el~t~calco~Beaioa~dmechanicalc~ecfion, Sit~evaluation,~cEtlepe~it, clectdcal <br /> <br /> MC 15-64 Rev 11-91 <br /> <br /> <br />