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FOR CITY VALIDATION <br />Received. By: ~/,~ ~ <br />~oning Validation:ff ~/,~. <br />Date: / -~- ~,~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301-,. <br /> <br /> 24 hr. Inspection Line ~[1t~9tl8 FAX 588-7948i 11 I <br />ONE & TWO FAMILY DWELLIN~[~ ~,PPLICATI~ <br /> *Includes electrica~ mechanical, plurnbth~e~s <br /> <br /> MARION COUNTy <br /> BUILDIN~ <br /> <br />~New Single Family Dwelling With Attached Garage <br />( ) New Single Family Dwelling With Detached Garage <br /> <br />( ) New Duplex <br /> <br /> FOR CITY USE ONLY <br /> <br />Uity Setback Requirements: <br /> <br />:ront: ~ / Rear: <br />~: ~/ Right Side: <br /> <br />al <br /> <br />Square Feet: Basement:: JM~in~oor:/,~Q ~ JSecondnoor: ~ <br /> <br />I Garage: t.~ ~,~ <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner ~[ {..~/-~ ~[~..}q,.. <br />Job Address ~ ~ ~" ll~ ,,,,~b,~, <br /> <br />] Mailing Address 6 I <br /> <br />IPh°neN°- ~ "} 'I~ C~. O ~q <br /> <br />Cross Strut ~ S T <br /> <br />Section ~" Township ~.~ I Range <br />Lot Width 7 ~ ' Lot Depth /t ~', I q} Acres <br /> <br />Tax Acct. No. p 00/~ --~/ <br /> <br /> , Lot ~ Comer <br />Zone LOt~S I Map Water Supply: <br /> Private Well ( ) Spring <br />Irreg. NO A//o 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 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 Constmcfon 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 />Business Name Registration No. <br /><.-.~t_,.,.-'~ %~ co,-.-T~'-~,~.,) Id> ~"'oo / <br />()t~ I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />Mailing Address ~ ~ Phone <br /> <br />4. FEE SCHEDULE <br /> VALUATION: <br /> Gross Sq Ft /a~a~ x 64.66 = <br /> <br />1. PERMIT FEE: <br /> GrossSqFt 1~ x $.315/sqft <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 $.315 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> <br /> Gross Sq Ft <br /> <br />$/o,a <br /> <br />/ q,~L~ x $.0950/sq ft $ /~ Ca~, (Oq <br /> <br />.B. PERMIT FEES <br />1. Permit Fee (A-I) <br /> <br />2. State Surcharge (5% of A-l) <br /> <br />3. <br /> Plan Review Fee (A-2) <br /> Z,:,,,;,/~ SmCharge tSzo.oo ii appl~camc) ('~ <br />5. Investigation Fee ($.41 per scl ft) <br /> <br />6. Reinspection Fee $25.00 <br /> <br />7. Other inspection $40.00/per hr (1 hr min.) <br /> <br />8. Overtime inspections $40.00/per hr (2 hr min.) <br /> <br />9. Footing/Foundation Only $25.00 - ~ounty Use Only <br /> <br />=$ baS'. 7.-s" <br /> <br />=$ 9o. t9 ~ <br />=$ <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 /> <br />Name of Applicant (Please Print): <br /> <br /> <br />