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MAR:ION COUNTY
<br />DEPT. OF BUILDING INSPECTION
<br />Senator Buil¢;ling #225
<br />220 High St,, N.E. 2nd Floor
<br /> Salem, Oregon 97301
<br />
<br />588-5147 -- 588-5148
<br />
<br /> 1~/~/86 5:00 P.M ....................... CODE-A-Phone ...................... 8:00 A,M.
<br />Date, ~-~--/21 uu Date:
<br />
<br /> Mo~3~e h~e R~7..d.C~'4,~ & '~TLec se~/' & cozt~ ~. ~lep~;ic eva.].uat'lon
<br />Type of Permit:~ __Tax LOt NO,:_
<br />
<br /> 86-i2S7
<br />Permit NO:~
<br />
<br />By;, ~
<br /> 12-11-86
<br />
<br />Address: ., 11351[i, L,~¥9~maz~ ,~a.,d,~,,,,,,~ A~,m-~'~'l 19 _ Sec,: ~ Tweshp-: 8 Rge.: _
<br />
<br />Owner'
<br />
<br />Phone:,,, ~5'78-509~ Wk_ Address' ~e
<br />
<br />Bldr & NO,: ~me~ea~ Nble Eotae Phone;~, Address: ,,, Pol-%la~d ..........
<br />
<br />Plans by __ ~ Phone: ~&ddress: ,,
<br />
<br />t : ....... 6lk. No.: Sub, dv:
<br />Area of Bldg. 2nd Rase- Total ~_~,~
<br />Main Fir. Fir,: ,~...~.~,~.~ment' Area:
<br />
<br />Roof Type:~ Truss/Stick.' Height' ,, ,
<br />Heating Wood Water
<br />System: ....... Stove; .Supply:
<br />Septic Tank New
<br />Site Eval.; ~.~,808 Instal_:
<br />Exist No.
<br />System: ........ yes , Gals,: ~ a.o.(t,
<br />
<br />VALIDATIONS:
<br />Zonlngj ..~// ~ , Mechanical'
<br />
<br />I agree to build a¢cord~ng to the submitted plans end ~pecifioaffons, the laws of the
<br />State of Oregon a~d the Ordinances of Marion Count. PERMIT EXPIRE~ IF WORK
<br />NO T COMMENCED WI THIN 180 DA Y3. I further expressly warrant that I ¢omply wlt~
<br />the ProWsions Of OR~ 701,005 fo 701,125 because:
<br />
<br />I am performing work on a property I Own
<br />or occupy
<br />I am a registered builder OR ( ) the
<br />authorized representative of a
<br />registered builder
<br />
<br />( ) The work w#/be performed
<br /> by a registered buildsr
<br />( ) Other (please specify)
<br />
<br />Lot $ize-~- RR A~'Te~;orner?~
<br />
<br />Valuation:
<br />Bldg, Permit
<br />Fee: (+
<br />
<br />Elect Fee;
<br />
<br />Mech. Fee:
<br />
<br />Plumb, Fee;
<br />State '~o~0 --
<br />Surcharge: (4%) ~
<br />
<br /> 7.68 fleet
<br />Plans Chk, Fee: , -~/'~
<br />8eptlcTank ,..~ ~
<br />Permit Fee: ............
<br />
<br />DEQ Surcharge
<br />
<br />TOTAL FEE,
<br />BLDG.
<br />RECEIPT NO
<br />Or,veway
<br />Permit F~:
<br />
<br />Review Fee:
<br />Public Works
<br />Receipt No.'
<br />
<br />I have react this application in it~ entirety and certify that the stated ll~formatloll is true a~lcl correct tO the best of my ktlowledgs.
<br />
<br /> · PLEASE NOT~: Driveway and sidewalk inspection a~ required by Public WorKs. 588-5036
<br />~ 15-6
<br /> Plumbin El ElectriCal [] Meghanisal L"I
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