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oalng Validation: ,,, /r I <br />ate: /~-o~,' ~ ' ] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Stxeet NE <br /> Salem, OR 97301 <br /> g:00am - 4:30~m Phone 555-$147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />US~E ONLY <br /> <br /> /o ' <br /> <br />1, Job De.ri )tion <br /> <br />RESIDENTIAL ~)~ViERCIAL ( )New Usc of Swocture: <br />( )Ad~i6< ( )R~fion ( )Addi~ ( )Sign <br />(~Accca:~ , . ( ) ~cr ( ) ~angc of Occupancy (, ? ~et ...... <br /> <br />2. LocationofInstallafion ..~£. ,f,~/.e~, ~r q73~a~ <br /> <br />3. Contractor Information <br /> <br />Phone No: <br /> <br />) I own, reside ~, or will mddc in the e. ompleteA stmaum. <br /> <br />) I understand that I must register as a ¢ons~mcedon contractor ff the strac~um is sold or offered for sale before or upon completion. <br /> <br />) I wig be my own general ¢omra~or. <br /> <br />If I hire subcontractors. ! will hire only sube. ontracto~ registerexl with the Construction Crmtractors Board. I,f I change my mind and do hire a general contraclor. 1 will contract <br />with a contractor who is rcgdstercd withe Construction Contractor's Board, and will immediately notify Marion County of the name of the contractor, <br /> <br /> (-~ I am a t~gigtcl~d builder O~ thc authotized representative of a rcgistcr~t builder. ~4 O / & I/~ t ~r~- ~/ 70 ,~ ~ <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (S~ "Valuation Schedule" <br /> to dcte;0~ J~l¢ valuation based on <br /> ~qua~ footage.) <br /> (I) Pem~it Fee <br /> (2) 5% State Stlrcha~ge (,05 x Al) <br /> <br /> C3) Structural Flan Review (.6~% x Al) <br /> (4) l'ire & 1 ifc Safety Plan Review ( 40% x Al) <br /> <br /> (~ Zonin~ SllfC- ' , . . <br /> <br />V-~.ation: S J*~ ~ / <br /> <br />B. Miscellaneous Fees <br /> (1) Driveway w/curb@ $730 <br /> <br /> (2) Driveway w/o curb@ $17,C~2 <br /> <br /> O) Site Plan Review (commercial coly) @ $79.00 <br /> <br /> (4) Additional Plan Re'dews or Addendumx <br /> <br /> (5) Investigation Fee <br /> <br /> (6) R¢in~pocfion Fee @ $25.00 <br /> <br /> (7) Other Inspections not listed above <br /> <br />hereby certify that the above information is correct and that I have read and understand the Information Notica to ProperLy Ow-acm about Constmctinn Rcsponalbi[ities on thc <br />reverse side of this form. <br /> <br /> Sile cvah,afions~eet~ieal, plumbing and mechanical work require scpomtc permits. Check with Marion County Buildieg Inspection ~xffote ~ub~Jlt~g this application. <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />