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MARiON COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:00am-4:30pm Paone 588.5147 <br /> C,:de.A.Phou~, 58g-7904 <br /> FAX 588-7948 <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />COMPLETE Al.I. SECTIONS, I THROUGH 4 <br /> <br />1. Job Description <br /> <br />( t~ New S~ngle' l'*amfly' Dwelhng' w/garag& <br />( ) New Single Family Dwelling w/o garage <br /> <br />( ~"~Garage, attached <br />( ) Garage, dclached <br /> <br />IFOR OFFICE USE ONLY <br /> <br />1994 <br /> <br />2. Lacationoflnstallatlon ~L~ ~ ~ ¢~',~ <br /> <br />Seaion ~ lbwgship ~ ' Wa., Su~ly: <br /> LotWldth ~d.~ ' ~' ~/ ~ Acres ~g.~t ~d .... ~'ner ~S Priva~Wdl ( ) Spring <br /> <br />........................... Commm~,W~ll ( ) Cily <br /> <br />3. Coltltlraetor Information <br /> <br /> ) I own/reside in, ce will reside in tla¢ completed structure. <br /> <br /> ) I understand that ! must register as a construction contractor if the structur~ is sold or offered for sale before or upon completion, <br /> <br /> ) I will be my own general contractor. <br /> <br />who is r;,gister~.l wid, the Construct on Coati'ac ot's Boa~d, I wi m~.e~. ~l.}e~ ~i I~ hoary M~ion County of the name <br /> <br /> ( ) I am a r*gister~d builder OR ~e ~hori~d r*~eseatafive of a ~gis~r~ ~ld~. <br /> <br />4. Fee Schednle <br /> <br />A. New One-and. Two Family Dwelling Code <br /> (inlcades EI, Me~ PI) <br /> <br /> (l) <~ro~,~ Sq. l:t,/~ 9/~ x $.28 <br /> (2) 5% State Surcharge (.05 x Al) <br /> (3) Plan Review <br /> (47 ............ ~ ) <br /> <br />= $185,130 <br /> <br />B. Miseellaneeas Fees <br />(I) Driveway w/curb @ $7,50 <br />(2) Driveway w/o curb @ $17,00 = .... <br />(3) Additional Plan Raviews or Addendums <br />(4) Investigation Fee = __ <br />(5) R¢inspection Fee @ $25,00 <br />(6) Other Inspections not listed above = <br /> <br /> I hct'¢by certify' d:at the atx~ve information is correct and d~at I have read and nder$ and ti e I for la on Notice o Proper{y @whets about Conslructkm Responsibilities on tile <br /> reverse side of lhls l'ornL · <br /> <br /> Site evatea~iona, septic, electrical,~mbing ~d mechanical work req~re serrate ~rmit.q. Cheek with Marion Comgy B~lding Ins~ion ~~s applicafiq, n. <br />MC 15-80 Rev, 1/92 <br /> <br /> <br />