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FO,R OFEICE USE ONLY] ,MARION COUNTY BUILDING INSPECTION F~R OFFICE USE ONLY <br />IZoai.g Vanaati a: I :','i/'' ,:~' Salem, OR 97301 '~e~. '~ ,~ <br /> <br /> BU~D~G PERM~ APPLICAT[~ <br /> COMPLETE ~L SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Job Description BDILDIN~ ;i0N <br /> <br />RESIDENTIAl. COMMERCIAL ( ) New Use of Structure; <br />(.~:,n ( ) Relocation ( ) Addition ( ) Sign <br /> <br />(.~lteration ( )Demolition ( )Alterat,on <br />( )Ac¢:ossor7 ( )Other ( )ChangeofOecupaney <br />'l'mss(oS"~'~-or I~t. aft=r( ) ] No, Slotigs <br /> <br />Location of Installation <br /> <br /> ,,i, ' Ca_La_- <br />Mo~e llome Pa~ Spa¢~ ~ <br />gotten ~*~ Tow. sNO /~ Rang~ ~ Zone .~ Map WamrSupply: <br />.............. PtivateWcll ( ) S~ring ( ) <br />LotWid~ gO LotOgpth ~, AcTs i.eg.l~t ...................... Co,',mr ~ Com,,m.it, W,dJ( ) Ci,y (~ <br /> <br />3. Contractor information <br /> <br /> ( ) I own. reside in, or will reside in thc completed st~ctllte. ' O <br /> ( )~.~rstand that I must mglster as a construction contractor ff the structure is sold or offered for sale before or ~pOn completion. <br /> (-~) ! will be my own general contractor. <br /> <br />Contramo~ Busines~ name & #: J Mailing Address: j Phone: <br /> ( ~]: am a registered builder OR tho anthorl?~-d l~ptes 'entative of a mgistcmd builder, <br />Architect name: J Mailing Address: I Phone: <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> <br /> square footage.) <br /> <br /> (1) Fermit Fee <br /> <br /> (2) 5% State Surchal~ge (.05 x Al) <br /> (3) Structural Plan RevJt;w (,65% x Al) <br /> <br /> (4) Iqre & Life Safety PLan Review (,40% x Al) <br /> (5) 7xming Sufcha,gc, if applicable (,05% x Al) <br /> <br />Valuation: <br /> <br /> = <br /> <br />B, Miscellaneous Fees <br />(1) Dtiveway w/curb (o~ $7.$0 <br />(2) Driveway w/o ctlrb@ $17.00 = _ <br />O) Si[e Plan Review (commercial only) ~3 $79,00 <br />(4) Additional Plan Reviews or Addcndumg <br />(5) ~lvcstigation Foe = , .......... <br />(6) Reinspection Fee ~ $25.00 <br /> <br /> / <br /> <br />MC I5-73 Rev. 11/91 <br /> <br /> <br />