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II*OR OF. FIC~ USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, OR 97301 <br /> $:00am-4;30pm Phono 588-5147 <br /> Code. A-Hmne 588-7904 <br /> FAX 588-7948 <br /> <br />F.~R OFFICE USE ONL, Y: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1..lob Description <br /> <br />( ) New Single Family Dwelling w/o garage ( ) Garage, detached <br /> <br />or Rafter ( ) I No. S'OriZS / }'~)¢'aehed Garag~ Height: <br /> <br />Othe. r: <br /> <br />2. Locatio, 'Installation <br /> <br />3. Contractor Information <br /> <br /> ( ) l own, reside in, or will re-qid0 in the completed strllcture. <br /> <br /> ( ) ~und~rstand~hat~mu-~tr~g~$t~rasa¢~n~traetj~n¢~tra¢t~r~fthestru~t~i~s~d~r~redf~rsa~ebef~reoru~¢~mp~e~n. <br /> <br /> ( ) I will be my own generai comraclor, <br /> <br />4. Fee Schedule <br /> <br />A. New One-and,Two Family Dwo]]ing Code <br /> '(inlcude$ El. Mc, PI) <br /> <br />If I hire stthcontractor~, I will hire only ~ubeontfaetor~ registered with rite Conswaation Contraotors Board. If I change my mind and do ]fire a general ¢oatracior <br /> <br />who i~ registered with the Con~tmction Contractor's Board, I will immediately notify Marion County of the nam* of the cone-acer: <br />Con recto; Business nam* & #' ' .... ~q .... K/9}~# 'li~' Addr~' . o* ~.~ .~;" '~2~- <br /> ( ) I am a registered builder OR t~tauthori.'.ed, relxesentmiv~a registered builder, , d .,, <br />Architect ~ame: . Mailing Addres~:~.~ ~ Phon¢: <br /> <br />7¢ <br /> <br />(l) Gross Gq, <br /> <br />(2) 5% State Surcharge ¢05 x Al) <br /> <br />(3) Plan Review <br /> <br />(4) Zen/nd Surahargo ($15 if applicable) <br /> <br />B, Miscellanecam Fees <br />(1) Driveway w/c~b ¢ $7,50 <br />(2) Drlveway w/o curb @ $17.00 = _. <br />(3) Additional Plan Rev}*ws or Addcndums = <br />(4) Inve~llgation Foe = ~ <br />(5) R~ns~etion Fee ~ $25.~ <br />(6) ~er Ins~cfio~s not listed ~ <br /> <br />MC 1540 Rev, 1/92 <br /> <br /> <br />