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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT C.E~/TER <br /> 285 Church St. NE - ~Room 132 <br /> Sale, In, Oregon.97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> <br />Received ,By: 4 /Aaa. x~ <br />Z°ning X)alidati°n: /' ~ I <br /> 24 hr. Inspection~e~588-7904 <br /> <br /> · FAX 58p~~~; <br /> ONE & TWO FAM~Y DWE~5~*~I Y e~N <br /> *Includes elec~cal, mfitO~ P~e~s i ~ % ) <br />COMPLE~ ~L SECTIONS, 1 THROUGH 4 ~ ~ ~/~ <br />1. JOB DESC~ION ~O~ ~ <br /> <br /> M/IR/ON <br />£UILOiN ,.,_OUNT <br /> <br /> ( ) New Single Family Dwelling With Attached Garage <br /> ( ) New Single Family Dwelling With Detached Garage <br /> (~ New Duplex <br /> <br />'Energy Path: / I No. Stories / Detached Garage Height: <br /> <br />SquarcFeet: Basement:: I 'ain oor: 2/tOt: ; IS ond oor: <br /> <br /> FOIl CIT____~Y USE, ONLY <br />City Setback Requirements: <br /> <br /> m.t: 2d9' <br /> <br />Garage: <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />2. LOCATION OF INSTALLATION --'~'q4 ~r'/~n ~///~- <br />I ~o~ Owner ~ Mmhng Ad.ess Phone No <br /> <br />' Su~ivision 5ha~~ ~5~~ ]Lot ~q Bilk <br /> <br />' Section Township Rage Zone ~ Map Water Supply: <br /> <br /> ' t I .. [ _', ' I , ~vateWdl ( ) Spring <br /> ~t Wid~ /O3 I ~t Dep~!01' Acres [ I.eg. Lot Ye5 I Comer NO Co=un,~ Well ( ) e,~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> am 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 />I <br /> the <br /> PROPERTY <br /> OWNER <br />contractor if the structure is sold or offered for sale before or upon completion. If 1 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 * No. <br />~a~Aa/I ~, nS/r~//0~ Registration <br /> ,p.... print) --. q/~ 74 <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 />Ao <br /> <br />VALUATION: <br /> GrossSqFt °~9~{//~''~ x 64.66 = $ /7l, 090 <br /> <br />1. PERMIT FEE: <br /> GrossSqFt O~'t'~' x $.315/sq ft <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 ~ <br /> <br />2. PLAN REVIEW FEE: . J,.,~..A~ O <br /> Gross Sq Ft a~. ~' q~:~ x $.0950/sq ft <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) =$ 9/a.B 7 <br />2. State Surcharge (5% of A-l) = $ ttt~ 6 ~ <br />3. Plan Review Fee (A-2) = $ ~ / ~/. ,~ '~' <br /> <br />5. Investigation Fee ($.41 per sq ft) = $ <br />6. Reinspection Fee $25.00 = $ <br />7. Other inspection $40.00/per hr (1 hr min.) = $ <br />8. Overtime inspections $40.00/per hr (2 hr min.) = $ <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 />180days. ~ / . <br />Name of Applicant (Please Prat):. _, _n~ / ~/~'"~ J~o Phone: <br />g,gnature of Applicant: ~ ~., /~__~ Date: <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />