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FOU OFFIg ys5 o LY I, <br /> Received By: ~ <br />I Zoning Vah~dati,on] ~ I <br /> <br />MARION COUNTY BUI.LDING iNSPECTiON <br /> <br />FOR OFFICE USE ONLY <br /> <br />220 High Street NE ~ c-;:a .--~__ <br />Salem. OR 97301 <br /> <br />COM_PLETE ALL SECTIONS, 1 THROUGH 4 MJ~RI0~ OOUNTY <br />L Job Description BUILDING <br /> <br />RESLDENTIAL COMMERCIAL ( )New U~e of ~mctum: <br />()Addition ( ) Relocation ( ) Ad~/ilion ()Sign ~¢~ <br />( ) Almmtiot~ ( )Demolition ( )Al~a-ation ( )DemoUtion <br />( ) Aceesso~ (, ' o~cr ( )ChangeofOogxl[~ney (,~/Other ~ ' <br /> <br />Tress( ) ot Rafmr( ) tg~ l~No. Stodes O~eup~ntLoadorNumberofgmployees~' F'~o. Bedro°ms: <br />Sq,a~ ~!~ Ua~,~e,;' ' I M~n ~or: .......... ' I S,~o,~'~: I O~; ..: .............. '"l ~gh~: '" <br /> <br />2, Location of Installation <br /> <br />Mo~e H~e Park ~ $~ ~ <br /> <br /> ............... PfivateWell ( ) Spring ( ) <br />LotWld~ /~ L~p~ /5~ Ac~s I~g.~t ~0 ~mer~e5 CommnnilyWeU( > Oty <br /> <br />3, Contractor Information <br /> <br />, [ Mailing Addms~ I Phone No: <br /> <br />) I own. reticle in, or will mslde/n the complex/structure. <br /> <br />) I tmder~tand that I ramt ~eg~ster as a construction contraem, if the straemre ia ~old or off, red for sale before or upon completie¢~. <br /> <br />) Iwlllbcmyowng~e~falcontmetor. <br /> <br />I~ I lfire subcon[ractors. I will hire only subcont raetoi~ registered with the Construction Contractors Board. If I change my mind and do hire a general contractor, I will contract <br />with a contractor who Js registered withe Constraetion Comraetot's Beard, a~d willimmediately notify Marion County of the name of the contractor <br /> <br /> (~ I am a regiatemd builder OR the authorized representative of a regidemd builder, ~F~ d g fid. '-~'(_,,t~ 16/.~ .~t,~/~ ~ V ~ <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Val~atlon Schedule'+ <br /> to d~termine valuation based on <br /> square fmtage.) <br /> (1) Permit Fee <br /> <br /> (2) 5% State Sumharge (.05 x A 1 ) <br /> <br /> 0) Structural Plan Review (.65% x Al) <br /> (4) Fire & L/lc Safety Plan Review (.40% x A 1 ) <br /> <br />B. Miseelhneoas Fee~ <br /> (1) Driveway w/curb@ $7,50 <br /> <br /> (2) Driveway w/o curb @ $17.00 <br /> <br /> (3) Site Plan Review (commercial ally) @ $79,00 <br /> <br /> (4) Addli/onalPlan Reviews or Addendums <br /> <br /> (5) Investigation Fee <br /> <br /> (6) Re/nspectaon Fee @ $25.00 <br /> <br /> (7) Other InspeCtionS not listed above <br /> <br /> hereby ~ertify that the above informaQon is correct and that I bavc icao and understand the Information Notice to Pw, nerty Owners about Construct/on Res~onsib/l/d~s on th- <br /> <br />SJ~o, naill~OfAppHcant, ~'~L~~ ' ¢1{~ ,,, Phone: 9qa~- <br /> - .,D.te: <br />Site evalualions, septic, electrical, plumbing and mechanical work require seperate permits. Check with Marion Comlly Building Inspection before mbmilfing this application, <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />