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FOR CITY VALIDATION <br /> <br />Zoning Validation:.' <br />Date: eLY.' 02. &, <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 />[FO____~R CIT_____~Y USE ONLY <br />City Setback Requirements: <br /> <br /> Front: O~) Rear: .~ <br /> Left Side:~ IRight Side: ~ / <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrica~ mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br /> New Single Family Dwelling With Attached Garage <br /> <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br />( ) New Duplex <br /> <br />Energy Path: / } No. Stories / [ Detached Garage Height: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />I Second Floor: ~ I Garage: ~d~O <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />Property Owner C/Ot/~ C~/V~ ~'~a0~_$ IMailingAddresspa~f.~Jd~g// ~/~,, ~4^~.~Ph°neN°' <br />Cross Street ~-" Jg'~ S ~'"' ] Tax Acct. No. 9¢Oj c~ ~ ,..~ / <br /> <br />Map <br /> <br />Comer <br /> <br />3. CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Block / <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 /> <br /> (y I am a CONTRACTOR registered with the State of Oregon. <br /> Business Nan~ Registration No. <br /> ( ) I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. ~ e~ C~k~N~ <br /> Name (please print) ~n~J~~''~ ~I <br /> <br />4. FEE SCHEDULE <br /> <br /> VALUATION: a. PERMIT FEES <br /> GrossSqFt ~'J~ x 64.66 = $ ~ 1. Permit Fee (A-l) <br /> <br />1. PERMIT FEE: , ~ htr"' <br /> Gross Sq Ft / q~-'O x $.~2r/~q ft $ ~ ~ qO <br /> * Building ~ .17~ por sq ~ <br /> Electrical ~ .~ ~r sq ft <br /> M~h~ic~ ~ .0200 ~r sq ~ <br /> HumMng ~ .0650 ~r sq ff <br /> <br /> TOTAL $.315 PER SQ ~ <br /> <br />2. PLAN ~EW FEE: · I ~ <br /> ~ sq vt /q~ ~q ~ ~~-~_ <br /> <br />3. Plan Review Fee (A-2) A/ <br /> <br />5. Investigation Fee ($.41 per sclft) <br /> <br />6. Reinsp~tion Fee $25.~ <br /> <br />7. O~er inspection ~0.00/~r ~ (I hr ~n.) <br /> <br />8. Oveffime ins~tions $40.~/~r ~ (2 ~ ~n.) <br />9. Foofin~oundation 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. / ~,'-x. ~ ~. <br />Name of Applicant (Please Print): /~d~ &'~l ,...~ ~'~d~/ Phone: ~>~//~ ~r~: ~.~¢.-7 <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />