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FOR CITY VALIDATION I <br />Received By: d,6Z~_ q <br />Zoning Validation': <br />Date: /":/o2 '-~:' <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 /> FOR CITY USE ONLY <br /> <br />City Setback Requirements: <br /> <br />Front: ~ Rear: ~ / <br />Left Side: ~ [ Right Side: 5 t <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />*Includes electrical, mechanical, plumbing fees <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> (~New Single Family Dwelling With Attached Garage <br /> ( ) New Single Family Dwelling With Detached Garage <br /> ( ) New Duplex <br /> <br />Detached Garage Height: <br />[ Secondnoor: Oarage: qL6 ~ <br /> <br />Square Feet: Basement:: Main Floor: <br /> <br />[ MailingAddress~(~ ~ ~ ~.[ PhoneSo. Zq[)-6 <br /> <br />ITaxAcct. No. ~/.~-o2--o / <br /> Lot 7 <br /> <br />Irreg. Lot <br /> <br />Map <br /> <br />Comer ~/O <br /> <br />Block x~ <br />Water Supply: <br />Private Well ( ) Spring ((/~ <br />Community Well ( ) City <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Job Address ~ q0~/ f~ ~ '- <br /> <br /> Section c:~.~"' I Township ~j~ Range o,~{.~J <br /> Lot Width 7~- tS 7 I Lot Depth ~ 7. ~-~ 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 />Business Name ~ t/~ ' } Registration No. <br />I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />(please ptSnt) <br /> Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> Gross Sq Ft /tf]~ -~x 64.66 <br /> 1. PE~IT FEE: <br /> GrossSqFt /~ x *.315/sqft <br /> <br /> * Building @ .1700 per sq fi <br /> Elec~cal @ .0600 per sq fi <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 />/~ ~ x $.0950/sq ft $ / 7~. ~ q <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-I) =$ <br />2. State Surcharge (5% of A-l) =$ o~. <br />3. 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 />9. Footing/Foundation Only $25.00 - County Use Only = $ <br /> TOTAL ~ <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): ~ Phone: <br />Signature of Applicant: ,~'- ~, ~__ ?/~}~dX~'~~ Date: <br />MC 15-80 Rev 1/95 <br /> <br /> <br />