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MARION COUNTY BUILD~G._~SPECTION <br />FOR OFFICE USE~ONLY] 220 m,,h stree,]~I~'~.~,~T~,-~'R'OFFICE USE ONLY` <br />R~ceive~y:~I /.. Salem, OR 97~$~' ?~t~ ~& Reqmmenta: <br />Zoni? Validatign~ /o~. ,V' 8'~ m4'3~e ' ~e-~-~ 588~147 ~/" --~/ I : /_~ear ~ t <br /> <br /> MANUFACTURRDSTRUCTURE PL~MENT <br /> CO~ ALL SECtOrS, l TI~OUGI-I 4 P~R~TAPPLICA~O~ASION COUNTY <br /> 1. Job Description 8UILDIN INSPECTION <br /> <br />Residenfial(~/~' New~..~ Replacement( ) Garage or Ca.on <br /> ( ) Attached <br />Commercial( ) New( ) Replacement( ) ( ) Detached <br /> <br />Manufacturers Year of ~olor of Length: [ Widthl <br /> <br />2. Location of Installation <br /> <br />Su~i~si~ ~ I gl~k Urban Omw~l~ Bounda~? <br /> <br />LotWid~ ~$-¢ L~De~. ~¢' A~s ~g.~t ~d ................ b;mer ~ Commualty W~ Phva~ Well ()() Sphng ( )City <br /> <br />3. Conuactor Information <br /> <br /> ) I own, reside m, or will reside m the completed structure, <br /> <br /> ) I understand that I must reglst~r as a constmcOon contractor if the stm<gttm is sold or offgred for sale before or upon completion. <br /> <br /> ) I will be my own general contractor, <br /> <br />~ I change my mind and do hirg a general contractor, I will contract with a contractor who is reglstegd with the Construction Contractor's lloard, and will <br />imm~dlamly notify Marion County of tl~ name of th~ contractor, <br /> <br />( ~ a registered builder OR the authorized representative of a registered bu/kler, ~, <br /> <br />4. Fee Schedule <br /> <br />A, (1) ManufactumdHomo <br /> <br /> or Modular Unit I~acem~t,/Conn¢¢gion <br /> <br /> (2) State Fee <br /> <br /> (3) S~ate Sumharge <br /> ~g-)~applicablej~ <br />11~ (1) Mfg.'d Structure Storage Fee <br /> (2) Mfg,'d Stmem~ Storage Renewal <br /> <br /> O) Zoning Surcha~e (15.00 if appl~cablo) <br /> <br />C, Additional Inspe~tlon <br /> <br />D. Inve~tigat/on Fe~ <br /> <br />E. Other i~spectloas not l~st~d <br /> @ 40~00 per hour (2 hour <br /> <br />$ 25.00=__ <br /> 25,00 -~ __ <br /> 15.00-~__ <br /> <br />@ $60,00 :-% ,, <br /> <br /> @ $40.00 = ....... <br /> <br /> g.,23',¢ ¢0 <br />RECEIPT: / 7'~'5~ <br /> <br />'I'11i$ fee COvers the manufactured structure placement, plmalbJ~g ¢O~lleetico, ~lectrieal connection and mechanical connection. Site evaluat[otL si:pile permit, electrical <br />service or plumbing water/sewer [~ges am separate required permits. MC 15-64 Rev 11-91 <br /> <br /> <br />