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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> ~:00am - 4:$0¢m phon~ 5g$-5147 <br /> ~e-A-~ $88-7904 <br /> F~ 588-7948 <br /> BU~D~G PERM~ APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />I. Job Description <br /> <br />.}'OR OFFICE USE. ONLY <br />City Set .~, ek Reqair~nents: .... <br /> <br />KESIDILNTtAL COMMERCIAL ( >New <br />( ) Ad(ii.on ( ) Relocation ( ) Addition ( ) Sign <br />(L4rAveesao~y ( )Other ( )~ang~ofOccnpancy ( )Other <br /> <br />rmss('~ orRafter< ) [N°'$toxig~/ t {OccutxaIltL°ad°rNumb'~r°£Empl°yees <br /> <br />2. Locationoflnstallation ,J~,/e~ ff/~ q 7o2d~ <br /> <br />JobAddmss /J.~ ~f~4qe / ,~)v', T~xA¢¢t. No, CrossStmet <br />~r6 ~ ~3a*~ <br />Su~lvidon Lm Bilk <br /> Pfivam Well ( <br />~Wid~ ~5t L~De~ ~ g A~z ~cg,~/ ~ Comer ~ C~u~tyW~( ) City <br /> <br />Contractor Information <br /> <br /> ) I own, mslde ~, ~ ~ msld~ M ~e completod stm~um. <br /> <br /> ) I undanmnd ~it I must m~s~t ag a oomtmefi~ ~ntmet~ if ~e s~ctum is so~ or ~emd for sale before or u~ <br /> <br /> ) I wi~ ~ my own gmeml e~im~. <br /> <br />If I kite mbeontraetora, I will hire only sub¢o~tractol~ registered with the ConstrueLion Cont. ractor~ Board. If 2[ cI~nge my mind and do hire a general <br />with a eonmletor who iS registered withe Construction Conkeaetor's B ua ~,~a[d~ ~ill immediately notify Marion County of the naree of th, contractor. <br /> <br /> ( ~I are a registered b~ilder OR the authori~d mpmscn~ive of a regi~md builder. /M~ #g{ t~d O I I ~- I / <br /> <br />4. Fee Schedule ~t~bo~a/ ~/3.th{,~9/~* ¢gVO! <br /> <br />A, VALUA%XON ($¢e "Valuation Schedule" <br /> <br /> square footage,) <br /> <br /> (1) ?crmit Fm <br /> (2) 5% Scum Surcharge (,05 x Al) <br /> <br /> (3) StmctutaI Plan Rcvlew (,65% x Al) <br /> <br /> (4) Fire & Life Safety Plan R~v£ew (.40% x Al) <br /> <br /> ' 5 <br /> <br />B. Misee. llanecals Fees <br /> (1) Driveway w/curb @ $"/,50 <br /> <br /> (2) Driveway w/o curb@ $17.00 <br /> <br /> (3) Site Plan Rexdew (ecanre~mial only) @ $79.00 <br /> <br /> (4) Additional Plan Reviews or Addendum$ <br /> <br /> (5) Investigation Fca <br /> <br /> (6) Reinspe~,~on Fe~ @ $25.00 <br /> <br /> (7) Other Inspections ~ot listed above <br /> <br /> $' ' , h,a~om:, ~,:pu~;, electrical, plumb, ng and mechat~cal work t~quire sepcmte permits. Check with Mafioa County 8uil4ing Inspection before ~ubraittingthi~ appl/catlot~. <br /> <br />MC 15.73 Rev, 11/91 <br /> <br /> <br />