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IFOR CITY VALIDATION I <br />Red,iv'ed dZ,. I <br />[Zoning Vandation: /~. [ <br />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 /> FOR CITY USE ONLY <br /> <br />City Setback Requirements: <br /> <br />F,out: ko ,ear: <br />Left Side: ~ Right Side: <br /> <br /> ONE & TWO~I~i~Y-~~ PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> ( ) New Single Family Dwelling With Attached Garage MARION COUNTy New Single Family Dwelling With Detached gar~ILDING INSPEGTlOfiI <br /> New Duplex <br /> <br />Square Feet: Basement:: IMain~°°r: _t~,t 0 6 SecondFloor:~, Garage: <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner <br /> <br />Job Address <br /> <br />Cross St~t ~ <br /> <br /> T°wnship I Range <br />Lot Width gllt~[ I Lot Depth I~t ~ [ Acres <br /> <br />"A I"hone,o. 7q' <br /> <br /> Acct. No. <br /> <br /> Lot <br /> <br />I Zone ~/b~ Map <br />I~eg. L~ ~) Comer <br /> <br />3. CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Water Supply: <br />Private Well ( ) Spring <br />Community Well ( ) City <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 Registration No. <br />(please print) <br />Mailing Address Phone <br />I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Nam~4~ y~' 6'~ ~a~rint) <br /> MailingAddress FO / la O ~ Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> arossSqVt_~6q 6 x 64.66 = $ /"TI/.O~O <br />1. PE~T ~E: <br /> <br /> * Building ~ .17~ per sq fl <br /> Elec~c~ ~ .0~ per sq ft <br /> Mechanicfl ~ .02~ ~r sq ft <br /> Plumbing ~ .~50 per sq ft <br /> <br /> TOTAL $.315 PER SQ ~ <br /> <br /> 2. PLAN ~EW FEE: . / ~ C <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) <br />2. State Surcharge (5% of Ad) <br />3. Plan Review Fee (A~2) <br /> <br />4. - 7,'";"Z 5'_'::~:.:;: ($20.~,; ;; ,vpik,~ble)~ ~,~ <br />5. Investigation Fee ($.41 ~r sq ft) <br />6. Reinsp~fion Fee $25.~ <br />7. O~er inspection ~0.00/per ~ (1 hr ~n.) <br />8. Overtime inspections $40.~/~r ~ (2 ~ m~.) <br />9. Footin~oundation Only $25.00 - County Use Only <br /> <br />=$ <br /> <br />=$ <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 />Name of Applicant (Please Print): '~. Y~ (,/~,~ ~4'~'/ Phone: 7~/~ ""//,~'~ <br />Signature of Applicant: ~X.q,,,q~(~ ?~_~e'?~_~n~,~/~ Date: <br />MC 15-80 Rev 1/95 <br /> <br /> <br />