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FOR CITY yALIDATION <br />Received By: ~-/ 7 ~ <br />Zoning Validation: <br /> <br />Date: /-/O.. -.~ ~, <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 />reFOR CITY USE ONLY <br /> <br />I~asi~:~3- / RightSide: .~r <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT <br /> *Includes electrical, mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> ( t~NNew Single Family Dwelling With Attached Garage <br /> <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br /> ( ) New Duplex <br /> <br /> Path: ~ ] No. Stories ~ Detached <br />Energy <br /> Garage <br /> Height: <br /> <br />Square Feet: Basement:: I Main Floor: ]~. ~:~ O Second Floor: Garage: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner <br /> <br /> MARION COUNT1( <br />BUILDING INSPECTION <br /> <br />No. Bedrooms: <br />Other: <br /> <br />I ~ailing Add'ss ~-~/O C~,~- IPh°ne N°' ~0-~ <br /> <br />Tax Acct. NO. q EgO ! o~ -- ~ .,2- / <br /> <br /> Lot / <br />Zone ~5 Map <br /> <br />Block ~.ft/ <br />Water Supply: <br />Private Well ( ) Spring <br />Community Well ( ) City <br /> <br />Irreg. Lot /~/t~ Comer ~/0 <br /> <br />Section ~'- Township ~:>5 ] Range <br />Lot Width q6, ~ r Lot Depth q Z t.~ ~[ 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 /> <br /> Business Name ~ ~-~ ' Registration ~o. <br /> <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 ffzoE~ x 64.66 <br /> <br />1. PERMIT FEE: <br /> GrossSqFt / 7t9~ 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 Fl' <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq Ft / 70 ~ x $.0950/sq ft <br /> <br />$ S38. o,~ <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. _ Z~nin~, Surcharge ($20.00 if applleahh..3.- <br />5. Investigation Fee ($.41 per sq fi) <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 /> <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 ' : ~ 7~.}~~ Phone: <br />Signature of Applicant: .Pri~ ~ ._ _ Date: /" .~2'" _~ff' <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />