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FOR OFFICI~ U+_S~ O.z~LY <br />R~ceived By: ~ <br />[ Zoning Validation: . <br /> <br /> COMPLETE ALL SECTIONS, 1 THROIJGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street N'E <br /> Salem, OR 97301 <br /> <br /> Il:IX)am - 4:3{¥m Phone 588-514~ ~ ,;:. <br /> Code-A-Phone 555-790~~.~_~;';~ ;2~- _' ' '?>.7~ '; <br /> <br />1. Job Description , <br /> <br />2. Location otInstallatlon <br /> <br />H I hire subcontractors. I will him only subcontractors registered with [he Construction Cmtraetors Board. If i change my mind and do hire a general contractor. I will <br />with a contractor who is registered with* Construction ContractOr's Board. and will immediately notify Mafio~ County of [he name of the contractor. <br />Con,ra¢lor Business name a #. ¢ / h ] Mailing Address:.d~-/,q <br /> (I/)'Q am a registered builder OR'the authorized relxeSc~allve of a r~gistered builder. / -~, ~- ~' ~'2c°tl'~, t~,"& q 73B~ <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Valuation $Oledule" <br /> <br /> aquae footage.) <br /> <br /> (I) PennR Fee <br /> (2) 5% State Surcharge (.05 x A I) <br /> <br /> (3) Structural Plan Review (.65% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (.40% x Al) <br /> <br /> if-m.'.Z2.1,. ~,05% ^ ~1) <br /> <br />= <br /> <br /> (1) Driveway w/curb @ 57.50 <br /> <br /> (2) Driveway w/o curb @ 517,00 <br /> <br /> (3) Site Plan Review (eexnmemial only) @ $79,00 <br /> <br />(4) Additional Plan Reviews or Addendams <br /> <br />(5) Investigation Fee <br /> <br />(6) Re, inspection Fee @ 525.00 <br /> <br />G) Other Inspections not listed above <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />