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MARION COUNTY BUILDING INSPECTION <br />[Fo . OmCyy.eSt;pNL¥l FOR OmC <br /> <br /> MANUFACTURED SI~ ~g~ <br /> <br /> CO~LETg ALL SEC~ONS, 1T~OUOH 4 P~RmT A~JC~5 ~ <br /> <br /> ~E~.ClOl~t (~a~.g~ ~ Carport <br /> ( ) Attached <br />Commercial( ) N~w( ) R~plaee-m~atr( ) --' ~ ( ) Detached <br /> <br />ManttfactureFs Year of Color eS /~__ Lealgth: / Width <br />....... Manufaetm'~: ~ <br /> <br />2. Location of Installation ~Ooff bUr~, OI~ q 7D '7/ <br /> <br />Owner ~ <br />SuMMsion L~ ] Bl~k Urban Growth Bounda~9 <br /> <br />L~Wiflth ~W/ ~tDepm ~/ Aems I,eg.~ ~O Comer ~O l'riva~Wen ( ) Sp~g ( ) <br /> Commu~tyWe~( ) Cily (~ <br /> <br />Contractor Information <br /> <br />) I o~, ~sido ~. or w~ ~slde ~ ~e c~ple~d s~. <br /> <br />) I unders~nd ~at I must ~ster as a c~stmcfim e~etor ff ~e s~m ~ ~old or offered for $~e bffom or <br />) l w~ ~ my own gmerfl <br /> <br />ff I him subcontractors, I will hh'e only subcontraetor~ registered with the Construction Contractors Board, <br /> <br />If I change my mind and do him a g~neral contractor, i wffi contract with a contractor who ia registered w~th the Constmetlon Contractor's Boagl, and will <br />immediately notify Marion County of the name of the contractor. /._~. ~ ..l_ ~- <br /> <br />(~-) I am a registered builder OR the authorized mpre~entativ~ of a <br /> <br />4. Fee Schedule <br /> <br />A. (1) Manufactured Home <br /> <br /> or Modular Unit l'qacemfnlt/Corl~ection <br /> <br /> (2) State Fee <br /> <br /> O) St~t~ Sur~h~ ~ ~-~-4..~ <br /> <br />@ 20,0o =._oT~t'~ <br />@ .,..w,,o-_- /~..~' <br /> <br />TOTAL: <br /> <br />/3. (I) Mfg.'d Structure Storage Fee <br /> @ <br />(2) Mfg,'d Structure Storage Renewal @ 25.1)0 <br />(3) Zoning Surcharge (15,00 if applicable) @ 15,00 <br /> <br />C. Additional Inspcctlon <br /> or Reimpecllon <br /> <br />D. Investigation Fee <br /> <br />@ $60. tX)::__. <br /> <br />rt. Other Jaspectlons not llged <br /> <br /> @ 40.00 per hour (2 hour minimum) <br /> <br />I hereby certify that thc ahovc information is correct and that I have read and understand thc Information Noliee to Property Owners ahout Ccostruction Responsibilities <br />m~ thc reverse side of this form. <br /> <br />This fee covers the manufactured structure placement, plumbing connection, electrical connection and mechanical connection, Sile evaluation, septic permit, electrical <br />service or plumNng water/sewer lines ave separate required permits. MC I564 Rev 11-9I <br /> <br /> <br />