Laserfiche WebLink
MARION COUNTY BUILDElgG RflSP~ECT ON .~FOR OFFICE USE ONLY <br /> <br /> Salem, OR973~il~ ' -~F.~2JJ ~ / 'a~ /~' <br /> 8~ 40 ~8~47 ~f R~ ' <br /> <br /> F~ <br /> BU~D~G PERMW APPLI~0U NTY <br /> <br />COMPLETE ALL SECTIONS, ] TH~OUOH 4 BUILDING iNSP£CTION <br />L ~ob Descr,ptmn <br /> <br />RE$1I)~L COMMF. R~IAL ( )New Use of Stmetug: <br />)Addition ( )Reloe~6on ( )Ad~fi~ ( )Sign <br />(~essoW ( )~er ( )~8eof~u~ ( )O~er <br /> <br />z~(ff or~r( ) I~°'s~ ~ t ,l~"t~a°~°f~V~~ <br /> <br />2. Location of Installation /o~, .~. ~. ///m£1/i//e ~ 7].2, <br /> <br />3. Contractor Information <br /> <br /> ) Iown.~esideha, <br /> <br /> ) I un~nd ~at I must m~smr as ~ c~stmc~ con~c~r ff ~e s~u~ is ~d or offered for sale ~om or u~ c~plefi~, <br /> <br /> ) l~R~myo~gme~ <br /> <br />with a ¢onw~cmr who is registered withe Consgmcfioa ConLmetof s Board, and will immediately notify Marion County of thc mg~e <br />.... !~ ~,~ - <br /> <br /> (~m a regis~md bander OR ~e au&od~d representative of~ ~gis~d b~d~, ' / <br /> <br />4. Fee Schedule <br /> <br />A. VALUATfON (See *'Valuation Schedule" <br />go determ/ne valuation based on <br />~qua~ root.ge.) V. lUaUOn; s <br /> <br /> (2) 5% Star~ Surcharge (.05 x A 1 ) -- /*~ <br /> (3) Structural Plan Review (.65% x Al) ~-~/~tt..~ = <br /> <br /> 6q) Zordng Surcharge, if applicable (.05% x A 1 ) <br /> <br />B, Miscellaneous <br /> <br /> (2) Driveway w/o cu~ $I7.~ <br /> <br /> ~) Sl~ ~n Re~ew {c~mer~ mly)~ $79,~ <br /> <br /> (4) Addifionel Plan Renews or Adflend~s <br /> <br /> (5) ~ves~gafi~ <br /> <br /> (6) R~s~c~ Fe~ ~ $25,00 <br /> ~) ~erhs~efi~s not l~s~ above <br /> <br />I he'by cerLify that the above infom~'ffon i~ coS~o~and that I have read and understand lac Inforrfmtic~ Notice to Property Owners about Construction Rcsponsib Ii es on the <br /> <br />MC ~5-~3 R~v, 11/91 <br /> <br /> <br />