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'~?OR 0FFICg USE O~NLY~ <br /> <br />Zorang Validation: ~ <br />iD?: / <br /> <br /> COMPI.ETIi ALL SECTIONS, 1 THROUGH 4 <br /> job Description <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> 220 High Strut NE <br /> Salom, OR 97301 <br /> <br /> 8:00am - 4:30om Phono 5gg-5147 <br /> ~Tq-c~.flu~9~¢ .... <br /> <br />FOR OFFICE USE ONLY' <br /> <br />2. LoeatioaofInstallation $,~,~c. /q t4/icc;iOd]g Dre 9732s- <br /> <br />3. Contractor Information <br /> <br />Mailing Address [ Phone NO: <br /> <br />) I own. reside in. or will reside in the completed structure. <br />) I unde~gand that I must r~glster as a constmetioa ~ontm~tor ff the straaur¢ is sold or off. md tot sale before or upon ¢omplefon. <br /> will b~ my ow~ general <br /> <br />ContractorBusincssnam~&#:~ ~/ ~¢..tfft'~l~ <tiff 0 Ma~gAdd~ss: <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Valuation SehcduI¢" <br /> to det~nnlne valuation based <br /> {quam footage.) <br /> (1) Permit <br /> <br /> (2) ~% Sta~e Surcharge $05 x Al) <br /> <br /> (3) Structural Plan Review (,65% a Al) <br /> (4) Fire & Life Safety Plan R~view (-~o x Al) <br /> <br />Valuation: <br /> <br />B, MisceLlaneous Fees <br /> (1) Driveway w/curb @ $7,50 <br /> <br /> ~) Driveway w/o curb @ $17.00 <br /> <br /> (3) Site Plan Review (commercial only) @ $79.00 <br /> <br /> (4) Additional Plan Reviews or Adgendum~ <br /> <br /> (5) ~nvcstigafion Fee <br /> <br /> (6) Rethspeerion Fee @ $25,00 <br /> <br /> (5 '~ ' , ,J,.,~L4c. (:0$'D'X"K1) (7) Other hspecfions nqt h~ted above = <br /> <br />I hereby c~[& ~at the above i~o~ation is ~ct ~d ~at ~ have read and under.nd ~e In fo~afi~ Notice to Property Owners ab~t C~stmc0on Responsib~fies on the <br /> <br /> Site evaluations, septic, electrical, plumbing and mc~anlcal work require se~mte ~it5. Check wi~ Ma~on Cotmty Bdldlng inspz~ion ~fote ~u~itt~g ~Js a~caaon, <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />