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FOR CITY V/~ .LIDAT/.ION [ <br />Received By: ~ 0.-- ~ <br />Izoning Validation: /~'.I <br />]Date: ~9_~ ' ~ <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 />faFOR CITY USE ONLY <br /> <br /> ity Setback Requirements: <br /> <br /> ront: 20 Rear: 3~ <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Inclu~q, lr4tt~anical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 41. JOB DESCRIPTION <br /> <br /> ( ) New Single Family Dwelling With Attached Garage ] 2 ]996 <br /> ( ) New Single Family Dwelling With Detached Garage MARIOI~ <br /> )New Duplex <br /> ~UILD/NG INSPECT!ON <br />Square Feet: <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />2. LOCATION OF INSTALLATION <br />Property Owner ]t~ ~,~ ~ C,~~ ~//~ 14~, ailing Addressf-~. . Phone No. <br /> <br /> SuMivisi°n ~ ~ rOO~ ~ l~3 Lot <br /> S~fion~~ Township ~ ~ R~ge ~ ~ ~ne ~ ~ ~ Map Water Supply: <br /> ~vate Well ( ) Spring <br /> ~, Wid~ '~ ~t Dep~ J~, ~ Ac,s I~eg. Lot ~e; Coreer <br /> <br />3. CONT~CTOR INFO~ATION ~ 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 Registration No. <br />(please print) <br />Mailing Address Phone <br />/~/I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name ~ <br /> <br /> Mailing Address O , ~ Phone 79 ? ,.zoff"7 <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> GrossSqFt 2 x 64;66 = ,/ 7/,t t(y <br />1. PERMIT FEE: : Jd/ff"' ] <br /> Gross Sq Ft <br /> <br /> · Bulling ~ .17~ per sq fl <br /> Elecffical ~ .~ ~r sq ft <br /> <br /> Mechanicfl <br /> Plumbing ~ .0650 per sq ft <br /> TOTAL <br /> <br /> Gross Sq Ft~ x~ $ <br /> <br />B. PERMIT FEES <br />I. Permit Fee (A-l) =$ <br />2. State Surcharge (5% of A- 1) =$ ~~, <br />3. Plan Review F~ (A-2) = $ ~ / 7. ~ <br /> <br />5. Investigation Fee ($.41 ~r sq ft) = $ <br />6. Reinspection F~ $25.~ = $ <br />7. Other ins~ction ~0.~/per ~ (1 hr min.) = $ <br />8. Ove~ime inspections $40.~/~r ~ (2 hr ~n.) = $ <br />9. Footin~oundation OnLy $25.00 - County Use Offiy = $ <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): /~ ~f~ /~ t~," ~1~] ~j~ ,,'t..~'~ Phone: ~/~ //~Z <br />S'~gnature of Applicant: ~"~-"~/q~ ,,- ~'/ "~/~...~.~- ~' ~ ~..~.~_ ~ _ _ Date: ~l~ <br />MC 15-80 Rev 1/95 ~ <br /> <br /> <br />