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FOR CITY VALIDATION[ <br />Received By: ~ :~ <br />]Zoning Validation: /~ ] <br />]Date: ' /'-/~ -~ I <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: O~q9 t IRear: ~ ! <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT <br /> Includes electrical, tnechamcal, plumb~tlg=fe, e~--~ <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESC~ION <br /> (~New Single F~ly Dwelling Wi~ Attached G~age <br /> ( ) New Single Fa~ly Dwelling With Detached G~age <br /> <br />Energy Path: 8 [ No. Stories / Detached Garage Height: <br />Square Feet: Basement:: MainFloo,://,/$ Isecond.oor: I Oarage: Z/'/O <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> . yOwner <br /> <br />Mailing Address¢! D <br /> <br />IPh°neN°' ~,~O --~ 7/~:~ <br /> <br /> Section ~.~ )Township ~.~ Range <br />, Lot Width /~. V 7 ti Lot Depth ~ '7. -"'""%-~" Acres <br /> <br />Tax Acct. No. qZg~)/o~--- <br /> <br />Lot ~) <br /> <br />Map <br /> <br />Comer <br /> <br />Block <br /> <br />Water Supply: <br />Private Well ( ) Spring ( ) <br />Community Well ( ) City (/,..L..'~' <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 ,n' t ~' . 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 />VALUATION: <br /> GrossSqFt /~,<-~:~ x 64.66 = $ ~/d.,~.--"~ <br />1. PERMIT FEE: <br /> <br /> GrossSqFt /'~ x $.315/sqft $ <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 Er <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq Ft /S~ x $.0950/sq ft $ <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) <br /> <br />2. State Surcharge (5% of A-l) <br /> <br />3. Plan Review Fee (A-2) <br />4. - Z6n~a~ S..,.ho~ ($20.00 if appltcaole) ~.~ <br />5. Investigation Fee ($.41 per sq 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 - 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 />Name of Applicant (Please Print):~ ,~ iL ~ 7LL/~-t/~~~'"'~ ~ Phone: <br /> <br />Signature of Applicant: .... ~ _ Date: <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />