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FOR CITY VALIDATION MARION COUNTY BUILDING~INSPI~CTION FOR CITY USE ONLY I <br /> ,/~ / COMMUNITY DEVELOPMENT CENTER <br />Received By' {~ ~/r~ 285 Church St NE - Room 13~.~ City Setback Requirements: I <br /> · ~ ~ ~ Salem, Oregon 97301 } ~N ~ - t , ~ ~ I <br />ZoningValida[ion: ~ (~, 8:~am.4:30~l~Phone588.5~/~~ Front: ~ ge~: ~ I <br />..... . ~ t ~ FAX 588-7948 dt}~~ <br /> ONE & TWO FAmLY DWELLING PE~T <br /> *Includes elec~cat mechanical, plumbin~ f,~ l 2 - ~ / I / i <br />COMPLE~ ALL SECTIONS, 1 THROUGH 4 /~/- 199 <br /> <br /> ( ) New Single Fa~ly Dwelling With At~ch~ G~age <br /> <br /> ( ) New Single Family Dwelling With Detached Garage <br /> ~t~New Duplex <br /> <br /> / [So. Stories / Detached Garage Height: <br /> <br />Square Feet: Basement:: [ Main Floor: 2/~ ISecOnd FlOOr: Garage: <br /> <br />Energy Path: <br /> <br />No. Bedrooms: <br /> <br />Section S~ ~- .,Q ~ Township ~ 5 Range <br /> <br />Lot Wid~ /~ ~, Oep~/~D Acres <br /> <br />Other: <br /> <br />2. LOCATIONOFINSTALLATION .,.~"4~14 ~art/ofO /l.~ff ~. ~. <br />~.~Own~ ffa/~/a ~. gar~fia// IMal'ingAd&~s ~r~ <br /> <br /> Lot <br /> <br /> .ap <br /> ~va~ Well ( ) Spring <br /> ~e~. Lot ~ ~om*~ ~o~u~ty <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> own, or completed structure my own general contractor. I understand that I must register as a consh-ucfion <br />I <br /> am <br /> the <br /> PROPERTY <br /> OWNER <br /> and <br /> reside <br /> in, <br /> will <br /> reside <br /> in <br /> the <br /> and <br /> will <br /> be <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 <br />Oregon. <br />Business Name Mar r4a// V . j/' ¢ 'O/7(pleasepfint) Registration No. ~}/2 <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 ~O&d& x 64.66 = $ 17l, OqO <br /> <br />1. PERMIT FEE: .~ 5~ <br /> o~osssqFt~ <br /> <br />* Building @ .1700 per sq fi <br />Electrical @ .0600 per sq fl <br />Mechanical @ .0200 per sq ft <br />Plumbing @ .0650 per sq fi <br /> <br />TOTAL $.315 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq Ft ~ <br /> <br />$ ~/7. <br /> <br />B. PERMIT FEES <br />,. Pe~nitFee~A-, =$ <br />2. State Surcharge (5% of A-l) = $ ~//'~. <br />3. Plan Review F~ (A-2) = $ <br /> <br />5. Investiga~on Fee ($.41 ~r sq ft) = $ <br />6. Reinsp~tion Fee $25.~ = $ <br />7. Other inspection M0.00/~r ~ (1 hr ~n.) = $ <br />8. Ove~ime ins~cfions $40.~/~r ~ (2 hr min.) = $ <br />9. Footin~oun~tion Only $25.~ - 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):~ /.~/~/'~ R. ~'~'~Z~// Phone: 7~ <br />Signature of Applicant: ~~ ~. ,~~~ Date: <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />