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COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />( ~)~ New Single Family Dwelling w/garag& <br />( ) New Single I:amily Dwelling w/o garage <br /> <br /> MARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY <br /> 220 lligh S@eet NE <br /> Salem, OR 97301 City Sell>ack R. equJrement~: <br /> 8:00am-4:30pm !~I~one 55 $-51 d7 From: <br /> ced~-A-P~o.e sgg-79o4 <br /> FAX 588-7948 <br /> <br />ONE & TwO FAMILY DWIgLLING PERMrr APPLICATI~ <br /> <br />( t,f< <br /> or Rafter ( > I No. globes I Detached Garage <br /> <br />Location of II ;tnllation ¢ 7~ <br /> <br />Contractor Information <br /> <br /> ) I own, Teeide in, or will reside in the completed structure. <br /> <br /> ) I will be my own gt:n~ral contra~or. <br /> <br /> If I hire subcontractors, I will hir~ only subcontractors registered with the Construction Conh-actom Board. If i change my mind and do hire a general COntractor <br /> who is registered with the Construction Contractor's Board, I w mmedia ely notify Marion County of the name of the eontra~or' ~ ~ ~j~.~ ~ ~Jt~ <br /> <br /> ~.,I am a reg,s~red builder OR tg~ authorized r*IX~entafive ~fa registered builder. ~,.- ~,',.~_ ~ <br /> <br />4. Fe Schedule ~- · ¢ <br />............................ , ;,, ~ 7~x ...... <br />A. New One-and-Two Fa~ly Dwelling C~e B- ~scellane~s Fees <br /> <br />(inleud~ El, Mo, Pi) <br /> <br /> Sq. Ft. / <br />(2) 5% Stele Surd~arge (.05 x Al) <br /> <br />(3) Plan Review <br /> <br />(4) ?xm ng gnrcharge (515 if appli~gable) <br /> <br />Valuation: <br /> <br />= ,$is5,0o <br /> <br /> (1) Driveway w/curb @ $7.50 <br /> (2) Driveway w/o curb @ $17.00 = __ <br /> (3) Additional Plan Reviews or Addendums = __ <br /> (4) Inve,qfigation Fee = __ <br /> (5) Reinspeedon Nee @ $25.00 = ___ <br /> (6) Other lnspe__ctioa$ not listed above <br /> <br />RECEIPT <br /> -~c, ,,'~ ,~. __ x $40 = <br /> / <br /> TOTAL 5 <br /> <br /> I hereby 5:enif~fl!al tile above informatJoll j$ correct and that have read and understalld the Info~ilmtion Notice to ~y Owners a~t (?onstn cfion Resins b &q on the <br /> <br /> Site evaluations, sepl.jc, elearical, plumbing and meal anical work req~re serrate ~r~. Check with M~on County Btfi d ng Ims~a on ~Iore s~bRfithng this ~plJcadon. <br />MC 15-80 Rev. 1~2 <br /> <br /> <br />