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FOR CITY VALIDATION <br /> <br />Zoning Vhlidation:/ ~',~ff · <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br /> 'New Single Family Dwelling With Attached Garage <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br /> ( ) New Duplex <br /> <br />Energy Path: ase~me [ No. Stories/ <br />Square Feet: B at:: IMain lq°°r: <br /> <br />IiFO____~R CITY US___~_E ONLY <br /> ity Setback Requirements: <br /> <br /> font: oaO ' [Rear: <br /> <br />ONE & TWO FAMILY DWELLING P~M~IhA4~T_/ON /~'_~,.f <br /> *lncludeselectrical, tnechanical~-~~~ <br /> <br />MARION COUNTy <br />BUILDING INSPECTION <br /> <br /> Detached Garage Height: No. Bedrooms: <br />ilSec°nd Fl°°r: ~ IGarage: .~6 Other: ..__._ <br /> <br />Tax Acct. No. 9~tt~ --106/ <br /> <br />Zone ~ g [ Map Water Supply: <br /> Private Well ( ) Spring <br />Irreg. Lot ~//) Comer N& Community Well ( ) City <br /> <br />2. LOCATION OF INSTALLATION <br /> PropertyOwner[~g~ ~ ~'~tl~ ~ <br />'°bAd'ss <br /> <br /> S<,ion ~C ] Township. <br /> ~t Wid~ ~ I ~t Dep~ //~, I ~ Acres <br /> <br />3. CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I must register as a construction <br />contractor if the structure is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. <br />If I change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately notify Marion County of the name of the contractor. <br />I am a CONTRACTOR registered with the State of Oregon, <br /> <br />ness Na~e Registration No. <br />I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />(pleas~ print) <br /> Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> Gross Sq Ft / 7~--~x 64.66 <br /> <br />1. PERMIT FEE: <br /> <br /> Gross Sq Ft <br /> <br /> * Building <br /> Electrical <br /> Mechanical <br /> Plumbing <br /> <br /> TOTAL <br /> <br />2. PLAN REVIEW FEE: <br /> <br /> Gross Sq Ft <br /> <br />/7~'t~ x $.315/sq ft <br /> @ .1700 per sq ft <br /> @ .0600 per sq ft <br /> @ .0200 per sq fi <br /> @ ,0650 per sq ft <br /> $.315 PER SQFT <br /> <br />/7.~'o~/ x $.0950/sqft $ /~{~-4/'~ <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) =$ 8~ <br />2. State Surcharge (5% of A-l) =$ t~Z,i~ <br /> 4.3. ~ ff ~' -- =$~ $ <br /> Plan Review Fee (A-2) <br /> <br />5. Investigation Fee ($.41 per sq ft) = $ <br />6. Reinspection Fee $25.00 = $ <br />7. Other inspection $40.00/per hr (1 hr min.) = $ <br />8. Overtime inspections $40.00/per hr (2 hr min.) = $ <br /> <br />9. Footing/Foundation Only $25.00 - County Use Only = $ <br /> TOTAL &/.~ ~ff'/// =$ ~ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. ~ <br />Name . _ <br /> of Applicant (Please Print): Phone: <br /> Applicant: Date: ~ , <br /> 15-80 Rev 1/95 <br /> <br /> <br />