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MARION COUNTY BUILDING INSPECTION <br /> 20 High Street NE <br /> alem, OR 97301 <br /> <br /> g:00am - 4:30pm Phone 555-5147 <br /> ¢.o~e-A.Phone 5884904 <br /> FAX $88-7948 <br /> <br /> BUll,DING <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1, Job Descrlptlon <br /> <br />COMMERCIAL <br /> <br />( )Addition <br />(~Almm6on <br />( ) Change of Occupancy <br /> <br />Addltlon ( )Relocation <br />Alteration ( )Demolition <br />Accessory ( )Other <br /> <br />( ) <br /> <br />( ) Other <br /> <br />FOR OFFICE USE ONLY <br /> <br />3Z>e~-+,~;+-, F~(~-. q~ ~ s~,~o. ' .... <br />Mo~c H~o Pa~ S~ ~ <br />............ PdvateWcll ( )Spdng ( ) <br />L~ Wid~ Lot Dc~ A~s I~g. ~t Comer CommuMB,,~a ( ) City ~--' <br /> <br />3. Contractor Information <br /> <br />Prol~ny Own*r '[ MailMg Add~¢ss ,J Phone No: <br /> <br />own, ~.skle in, or will reside in thc eomplete, d s[ru,aure. <br /> <br />understand that I must register as a constmcticaa contra~or ff thc stratum is sold or offra~l for sale before or utxm completion. <br />will be my own gmcral contraator <br /> <br />If I him subcon~xaemr% I will hire only sub~ontraaors registered w~th thc Construction Contractors Board. If I change my mind and do him a general contractor, 1 will contra¢l <br />with a ecaltm¢Ior who i~ m~tered withe Construction Contractors Boar~, and will/mmediate, ly notify ~arion Courgfhof t ~0al0.tt Oflke contractor <br /> <br /> ( ) I am a reglsmmd builder OR the authorized rep~senonlv¢ of a registered builder, <br /> <br />Archi*ce[ name: } MuLling AddreR~: [ Phone: <br />4. Fee Schedule <br />[ A. VALUATION ($e¢ "Vzluation Schgdule" B, Miscellaneous Fees <br /> <br />to determlne valuation based on <br /> <br />square footage.) <br /> <br />(1) Permit Fcc <br /> <br />(2) 5% Smt~ Surcharge (,05 × Al) <br />(3) Structural Pian Review (.65% x Al) <br />(4) Fire & Life Safety Plan Review (.40% x Al) <br />(5) Yxming Sureharge, if applieable (.O5 % x A1) <br /> <br />Wluation: $..~OOO. ~ <br /> <br />(1) Driveway w/curb@ $7,50 <br /> <br />(2) Driveway w/o *neb @ $17.00 <br /> <br />(3) Site Plan Review (commercial only) @ $79.00 <br /> <br />(4) Additional Plan Reviews or Addendoxns <br /> <br />(5) Investigation Fee <br /> <br />(6) Rcin~pectlon Fee @ $25,00 <br /> <br />(7) Othcrlmpectlonsnotllztedabove ~4e~'-O-Q~ <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />