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RF?ROFFIC~E USE ONLY MARION COUNTY BUILDING INSPECTION <br /> ceived'By. /)~_~ ~ ~z~ 220 High Street~E <br /> · ! ff Salem, OR 97]~h <br />Izoning Validation:,, P~ $:00am:4:S0pm <br /> <br /> :: : s,gg- l / <br /> <br /> COMPLETE M~L SECTIONS, 1 THROUGH 4 ~10~ COUnTy <br /> 1. Job Description ~l lll ~ .... <br /> <br /> (~New Single F~y Dweaing w/g~ ( ~G~ge, at~ched <br /> ( ) New S~gle F~fly Dwelling w/o g~ge ( ) G~ge, ~hed <br /> <br />FOR OFFICE USE ONLY <br /> <br />ko.t: d0 ' Rea~; 0-" <br /> <br />I D~taehM Garage H¢igth: <br /> <br />2. Location of Installation ,~.,q/~t~- q '/30 ~ <br /> <br />Job Ad'ss 600 q,~ ............ <br />Mobile Home P~k S~ee <br /> ~vateW~ll ( ) Spring ( <br /> <br />3. Contractor Information <br /> <br />~ropertyOwne~me~ ~£ fi'0 ~.a/~'~L'' IMaillngAdd~$ [,PhoneN*. <br /> <br /> own. reside in. o~ will reside in the completed <br /> <br /> understand that I must register a~ a eoRgttuetion eontraetoe ff the su'u/:ture is sold or offered for sale before or upOn completion, <br />(~ I will b~ my own general <br /> <br />If I hire subcontractors, [ will hire only subcontractors reglstc, r cd with the Construction Contractors Board, If I change my mind and do lfite a general contractor <br />who is registered with the Constru~ion Contractor's Board, I will immediay~l y notify Marion County of the name of the ¢ontracor: <br /> <br /> ( ) I am a registered builder OR the authorized representative of a registered build,m <br /> <br />4, Fee Schedule <br /> <br />A. New One-and-Two Family Dwelling Code <br /> (jnleuden El, Me, <br /> <br />(2) 5%State Surchaege (.05 xAl) <br /> <br />(3) Plan Review <br /> <br />(4) Zoning Surcharge ($15 if applicable) <br /> <br />B. Ivliscellano~.s F~s (1) Driveway w/crab @ $7,50 <br /> <br /> (2) Driveway w/o curb @ $17.~ <br /> <br /> (3) AddMoaal ~a R*qews or Addendu~q <br /> <br /> (~) Invesfigafi~ F~ <br /> <br /> (5) Relus~ Fee ~ $25.~ <br /> <br /> (6) ~er Ins~cfions not listed ~w <br /> / F <br /> <br /> x $40 <br /> <br />TOTAL <br /> <br /> rever~e ~ide of this form. <br /> <br /> Site evaluation& septic, ele~rica], plumbing ~d mechanical work reqmre serrate ~r~. Check wi~ M~ion County B~Iding Iron.ion ~fore sub. thug ~is applica~on, <br />MC 15-80 Rev. 1~2 <br /> <br /> <br />