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FOR CITY V~LIDAyION <br />Receivld By: /~e.4- <br />Zoning Validation: <br />Date: / - ~-~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> 8:00am-4:30pm Phone 588.5147 <br /> 24 hr. Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br />IFOR CITY USE ONLY <br />City Setback Requirements: <br /> <br /> Front: ~ Rear: ~- <br /> Left Side: ~ t Right Side: <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electric~l~qnic.~al, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br /> 'New Sm'gle Farml'y Dwelhn'g With' Attached Garage <br /> (~) New Single Family Dwelling With Detached Garage <br /> <br />No. Bedrooms: <br /> <br />Other: ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />I Mailing Addres~a _~/t~/,_~ ~ 9R~I Phone No. <br /> <br />Subdivision ~'t/'L/r//~' ~')~,r~l ~ <br />s ction l °wnshi - t -g <br />Lot Width ~5! I Lot Depth i/~o ~ ~ I Acres <br /> <br />Tax Acct. No. ~Ogg/oqO <br />Lot ~MM~p <br /> Corner <br /> <br />Zone ~ <br />Irreg. Lot /~0 <br /> <br />Block t~ <br />Water Supply: <br />Private Well ( ) Spring <br />Community Well ( ) City <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 undemtand 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 />Busilless Nan~ Registration No. <br />I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />(please print) <br />Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />VALUATION: <br /> Gross Sq Ft ~ x 64.66 = <br /> <br />1. PERMIT FEE: <br /> Gross Sq Ft ~ x $.315/sq ft <br /> <br /> * Building @ .1700 per sq ft <br /> Electrical @ .0600 per sq ft <br /> Mechanical @ .0200 per sq ft <br /> Plumbing @ .0650 per sq ft <br /> <br /> TOTAL $.315 PER SQ 1~ <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq Ft / 7~"~' x $.0950/sq ft <br /> <br />$ .5-.5'3. <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) <br /> <br />2. State Sumharge (5% of A-l ) <br /> <br />3. Plan Review Fee (A-2) <br /> <br />4. <br /> <br />5. Investigmion Fee ($.41 ~r sq ft) <br /> <br />6. Reinsp~tion F~ $25.~ <br /> <br />7. O~er ins~tion $40.~/~r ~ (1 hr ~n.) <br /> <br />8. Oveffime ins~tions $40.~/~r ~ (2 ~ ~n.) <br />9. F~tin~oundation Only $25.~ - County Use O~y <br /> <br />=s <br />=$ <br />=$ <br />=$ <br />=$ <br />=$ <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 of Applicant (Please Print): Phone: 3 <br />Signature of Applicant: Date: <br />MC 15-80 Rev 1/95 <br /> <br /> <br />