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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> $:00am - 4:30pm Phone 588-.5147 <br /> Code-A-Phon~ 588-7904 <br /> FAX .588-7948 <br /> <br />FOR OFFICE USE ONLY <br />CiW S~b~c,k Requi~nntmts; <br /> <br />BUILDING PERMIT. APPLICATION <br /> <br />RESIDENTIAL <br />( ) ^ddJ~on ( ) Rdo~a6on <br /> <br />~scfip~ of Wo~: <br />Tmss~' or ~ftet( ) .[. No. S~es., <br /> <br />I Occupant Load or Number ef Fallployees <br /> <br />No, Bedrooms: <br /> <br />2. Location ofl~atallation .~/~n~ ff~ ~73o'~/ <br /> <br />Semi,sion L~ Bl~k <br /> ........ ......... ' ........ <br /> <br /> ..... CmmaNty W2U ( ) City <br /> <br />3. Contractor Information <br /> <br /> (~ I und~ ~at I must ~gs~er aa a eonstm~ ~c~ ff ~e stm~ ~ sold or ~e~ for are before or u~ ~ple~. <br /> <br />If ! hi~ subcontractors, I will hire only ,ub*ontraetors fegiste, t~d with the Con,truction Contractors Board. ff I change my mind and do I~e a general contractor, I will ~ontra~ <br />w/th a contractor who is ~gistered withe Construction Contractors Board, and will immeddatoly no~ffy Marion County of the name & tho contractor. <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION ISee "Valuation Schedule" <br /> m detexmine valuation ba~¢d c~ <br /> <br /> (1) Permit Fcc <br /> <br /> (2) .5% Stat~ Surcharge (.05 x Al) <br /> <br /> O) Stracmnd Plan Review (,6.5% x A 1 ) <br /> <br />Val~ati~: $ ~0 <br /> ,..q'~, <br /> = <br /> <br />(1) Driveway w/curb~ $7.50 <br /> <br />(2) Driveway w/o curb @ $17.00 <br /> <br />(3) Site Plan Re,Aew (commercial only) @ $79,00 <br /> <br />(4) Additional Plan Reviews or Addendums <br /> <br />(5) InvesUgation Fee <br /> <br /> (4~ Fire & Life Safety Plan Review (.40% x Al) (6) Relnspeet/eo Fee @ $25.00 = <br /> <br />I hereby certify that the above information is con'~¢t and that I have mad and understand the Information Not[ce to Property Own~ about Construction Responsibilities on the <br /> <br /> s, / / <br /> Site 2valuations, septic, ¢l~¢meal, plumbing and m2~hanieal work ri=quire ~elp~rate permits. Cheok with M~rion County Building Insp2¢t[on b~fo~ ~ub~nitting this appli~atlon. <br /> <br />MC 1S-73 Rev, 11/91 <br /> <br /> <br />