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, MARION COUNTY BUILDING iNSPECTION <br />]"FOg OFFICE USE ONLY F~_Qg OFFICE USE ONLY] <br />/ ~t~f'eiYed bY:' ~ ? [220 High Street NE <br /> Salem, OR 97301 ~~-'~-'~ - ~ <br />/ Zoning Validation ~.~,----:--~ I a:OO,m-~:~O~o~ sss.sm L~. R,,r: , / <br /> 1. Job ~p~n <br /> <br /> Garage or Carport <br />Newt ) ~ ) ( )Det~e~ <br /> <br />3, Contractor InfOrmation <br /> <br />( ) I mtd~rstmd that I must ~ister es a ¢onnmctio~t contmotor ff the s~m~um If sold or offer=d for file hafor~ or upoia completion. <br />( ) I will ho my owll g~eral commctol', <br /> <br />If I hire ~ub~mtmcla-s, I will him only subcontractors reshtored with the Coll~tructlon C2mtmctom Board, <br />If I change my mind and do ~ a general co~tractor, ! will contract with St ccnrmctor who Il re$istered with the Constmctloz Conttactox'~ BO~ ~, and will <br /> <br />CoatoK~r Bufine~l Hame & #: ...... Maili~ lddml~: [ Phone: <br />( ) I am a r~i~tereg butkl~r OR the aithodaad mp~sant~tive'~f a rali~t~l hollaar. <br /> <br />Auth0dzed mzen~,, or ieasee: , <br />4 Fee ~hedale <br />A. (1) Mamffmurcd Home ~q~oo. <br /> <br />C, Addttirmal Lnspe~tton <br /> or R~t~sp~ction <br /> <br />D, Iaves~a~io~ Fee <br /> <br /> ~ 40,00 per hotlr (2 hour mlrllmmm) <br /> <br />@ $60.00=~ <br /> <br />TOTAL ~ $ ..... <br />RBCEIFT: <br /> <br /> hereby ¢~'tlfy that the above information is correct and that I have mad and undellt,~d the Inforr~tion Notice to Property Owners abont Construction Respmslbillties <br /> the ~eve~ si~ ~ ~s form. <br /> <br />T~, fee covel'~ th~ manufacto~d srmcturc placement, plum~8 cotmectlon, electrical conneaion and mechanical oomicc~ion, Site evaluation, septic permit, ,lectficaI <br />service o~ plumbing water/sewer ltne~ a~ aopara~e required permit~, MC 1 ~-64 Rev 11-91 <br /> <br /> <br />