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IFOR CITY VALIDATION MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br /> . '~ -ff COMMUNITY DEVELOPMENT CENTER I <br />iR¢celved' By.' /t~_z ~ ~ 285 Church St. NE - Room 132 [ City Setback Requirements'. <br />I - ~'/,~. ~/ Salem, Oregon 97301 I . i <br />IZoning Validation: Z~r 8:00am-4:30pm Phone 588-5147 [Front: OtqO ' [Rear: <br /> Date' / - ~- -~ 24 ' ' - 4 Left Side: / Right Side: <br /> <br /> ONE & TWO FAMII~[}~-~~ I~Eil/vlI~A~I~I~ICATION <br /> *'~n,tudes ,~, m, echanical, elum~l <br />COMPLE~ ALL SECTIONS, 1 THROUGH 4 JA ~ - 5 ~,~S ~ <br />1. JOB OESCmPTXON MARION COUNTY <br /> ~New Single F~ly Dwelling Wi~ A~ched G~age BUILDING INSPECTION <br /> ( ) New Single Fmily Dwelling With Detached G~age ~~/~ <br /> <br />Energy Path: 4~i~ 1 IN°' St°ries t IDetached Garage Height: IN°'B~°°m~: ~ <br />Square Fee,: Basement:: IMainF~°°r:/~tt,,q.ISec°n""°°r: }Garage: ~S7 I Other: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner <br /> <br />Job Address ,~ irs <br /> <br />[ Mailing Address e'~O~ l~.~.~ ~ It..g,'g"~.~ PhoneNo. ~"~ <br /> <br />CrossSt~t / O ~ ~'t.~-~ <br />Su ivision <br />Section ~.~"' ~ ~ Township ~ ~ Range ~} <br />Lot Width ~ff. Lot Depth ir~ ~ / Acres <br /> <br /> Tax Acct. No. ~O/o~ <br /> Lot 6t <br />Zone ~'£ [Map <br />Irreg. Lot ~5 Comer <br /> <br />Block ~ <br />Water Supply: <br /> <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 sh"ucture and will be my own general contractor. I understand that I must register as a construction <br />contxactor 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 />Business Name Registration No. <br />( ) I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> Gross Sq Ft tq~ 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 FT <br /> <br />2. PLAN REVIEW FEE: <br /> <br /> Gross Sq Ft <br /> <br />Iq;aB x $.ooso/~qft $ jgaO.&~ <br /> <br />.B. PERMIT FEES <br />i. Pe~t Fee (A-l) = $ ¢O$". 7'O~ <br />2. State Surcharge (5% of A-l) = $ .L~.~ <br />3. Plan Review Fee (A-2) = $ 1/~,~. 0 q <br /> <br />5. Investigation F~ ($.41 ~r ~ A) = $ <br />6. Reins~tion Fee $25.~ = $ <br />7. O~er ins~ction ~0.00/~r ~ (1 hr ~n.) = $ <br />8. OveRime ins~ctions $~.~/per ~ (2 ~ min.) = $ <br />9. Footin~oundation Only $25.~ - County Use ~y = $ <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 (PleasePrint):~~ ]'~ ~ Phone: ~'~'~% O ~ ~}' <br />Signature of Applicant: --~ Date: {/ ' ~' "*~1~ ~'~ <br />MC 15-80 Rev 1/95 <br /> <br /> <br />