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.FOR OFHCE USE ONLY
<br />· Receiw,i· By: ______
<br />- Zoning '7:didaIiun: __
<br />] Date:
<br />
<br /> COMPLETE ALL SECTIONS, 1 TI-IROLTGH 4
<br /> I. Job Description
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<br />MARION COUNTY BUILDING INSPECTION
<br /> 220 High Strcet NE
<br /> Salem. OR 97301
<br />
<br /> 8:00am - 4:30pm Phone 588-5147
<br /> Code-A-Phone 588-7904
<br /> FAX 588-7948
<br /> BU".DINO A] L CATi C,EIVED
<br />
<br />DEC 2 0 1994
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<br /> FOR OFFICE USE ONLY
<br />[City Sgt}~¢g ~equir~msnts:
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<br />RI-'-SID I :w'['IA L COMMERCIAL ( )New Use of Structure:
<br />
<br /> ( );~tdidon ( )Relocation (X)Addition ( )s~llifl~l COU:['~ed Manufacturing
<br /> ( )Al,c,aLion ( )Demo[[dm ( )^,e~,"o. (E}UII~i}J}{~ INSPICTIOM
<br /> ( ) Accesso~ ( )Other ( )~afl~eOf~Cu~C~ ( )~er
<br />[~cfip0onofWo~: ExpansLon a['~""'u'pgrade [o an exLscLng feedmLf'[ ......
<br />..... -I ....... 7',"' I .....
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<br />2. Locationoflngtallation 5/49 South Second Street
<br />
<br />wner FOSTER >fI:LLS / DEL '~'ESA FARMS,,,,,,l,Mail/ngAddz~ss Hi'i'll'bore, Or'egon "~hm~eNo, 503L¢~-0549 .....
<br />; I L6~"]"'/";hlcn Road TaxAcct, No. CrossS[~et
<br />Aurpra, O[,qgon 970~ ..... ,,,, SlmNo. . ........ - ...........
<br />
<br /> .... 8 Zowns~p 45 Range l'""~" ~e Map W~;~I~:
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<br />............. C~u~tyWell ( ) City ( ) ....
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<br />3, Cotdractorlnf0rmation 549 South Second Street
<br />I'rop~r~vOwner "OSTER HILLS DEL MESA FAlhq$MainngAddmss Hillsboro, Oregon [PhoneNo: 503-648-0549
<br />
<br />own. reside Ln, Ot will rusiilc in the completed s£mclu~.
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<br />,nderstand that I ilion[ register a~ a con~tmct~c~l cofltt~¢,.or if the structure i~ *old or off¢~:d for sale b~fore or Ul=On ¢oeapl¢ilon.
<br />will b~. my own general contractor,
<br />
<br />Il 1 hire ~aln.ontvaCtOrS. I will him only subeonteaetors mgi~Lere~d with the Construction CO~[racLom Board. If I change my mind and do hire a general ¢ontraClor I will 'contract
<br />with a c~.m~cior who i~ mgiitm'ed with, Con~tr~¢ilon Ce~tramoFi Board. and will flnmediamly nmify Motion County of the name of th* COntractor.
<br />
<br />C[,.ua~..,llu~in~ssnam~&#,. THE KEN BtATNEY COMPANY IMail~gAdams': 3100 - 101St Street ]Phone: 515-270-2417
<br />la,rlategistcmilbuilderORtheauthot{~:.drcpmscn[ailvcofamgi,t¢o3dboilil~r. ~)eS Moine~, Iowa 50322
<br /> THE KEN BRATNEY CONPANY [MaR~gAdd~ss: 3100 - lOlst 5treat [pho.~: 515-270-2417
<br /> Das Noi~s, 1.6wa 50422
<br />
<br /> ALt. TI: t-LaRK }5. VERHEER, P.E.
<br />4. Fee Schedule
<br />
<br />A. VAI,UATION (See "Valuation
<br />
<br /> (1) Pl:nnil Fcc
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<br /> (2) 5~ State Surcha~¢ (,05 x Al)
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<br /> (3) Stm,:mral Phm Review (.65% x Al)
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<br /> (,t) [:~re & llfe Safety Phm Review (.40% x A I)
<br /> (5) Ti;fling Sa/charge, if ~ppllcable (.05% X Al)
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<br />Valuation;
<br />
<br /> (1) Driveway w/curb@ $7,50
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<br /> (2) Ddvaway w/o curb @ $17,(:0
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<br /> (3) Site Plan Review (commercial o~ly) @ $79,00
<br /> (4) Additional Plan Reviews or Addendums
<br /> (5) Investigation Fee
<br />
<br /> (fl) Reinsf~¢tion Fee @ $25.00
<br />
<br /> (7) Other Inspections no~ l/sLed above
<br />RgCLq~F:.
<br />
<br />TOT\I,$
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<br />Naln~of pplicam(llcas~lrint): FOSTER MILLS / D~,L MESA FAIhMS Phoner 503-648-0549
<br />MC 15./~ Rev. 11/91
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