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IFOR CITY VALIDATION <br />Received By: O/~.., <br />Zoning Validation: j <br />Date: --~ - ~'~ ' <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 373-4427 <br /> FAX 588-7948 <br /> <br />IFOR CITY USE ONLY <br />City Setback Requirements: <br /> <br /> Front: ~y Rear: ~ / <br /> Left Side: ~ / Right Side: o,~ / <br /> <br /> ONE & TWO FAMILY DWELLING~EF ~fA!~~ <br /> Includes electrical, tnechantc~ilurnbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> (~ew Single Family Dwelling With Attached Garage MARION COUNTY <br /> <br />( ) New Single Family Dwelling With Detached Garage BUILDING INSPECTION <br />( ) New Duplex <br /> <br />Square Feet: Basement:: IMain F'°°r: /o~60 [ Sacond Floor: Garage: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Cross Street ~ ~ ~ <br /> <br />Subdivision/r~/~ l,~.3" t~l <br />Section :~ [Township <br />LOt Width ¢ ~, ~3 ] Lot Depth <br /> <br /> Range <br /> <br />.7 7. /5- Acres <br /> <br /> I Tax Acct. No. ~')d') <br /> <br /> ~t4Z <br />Zone /'~,.5 I Map <br />Irreg. Lot ~[~.~,~ [ Comer <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />IPhoneNo. ~t9 '- ~__~ 7,/ ~ <br /> <br />Block <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 /> <br />M~iiing-Add~es~" '~ ~:~',/~'°r Phone ~-~r ~ ~, <br />( ) I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />M~iliag ^da~ss..~2 Phone ~-.,~, ¢ q r l; <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />VALUATION - Based on square footage: <br /> Gross Sq Vt /*,'~. ~.~ O x 64.66 <br /> Garage Sq fl ,4~q~ x 16.27 <br /> TOTALS: <br /> <br />1. PERMIT FEE: <br /> GrossSqFt i 70~ x $.345/sqfl <br /> * Building ~ .185 per sq fl <br /> Electrical ~ .068 per sq ft <br /> Mechanical ~ .022 per sq t~ <br /> Plumbing ~ .070 per sq at <br /> TOTAL $.345 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> GrossSqFt / 70~3 x $.12/sqtt <br /> <br />PERMIT FEES <br /> <br /> Permit Fee (A-l) <br /> <br /> State Surcharge (5% of A-l) <br /> <br /> Plan Review Fee (A-2) <br /> <br /> Investigation Fee ($.345 per sq f~) <br /> <br /> Reinspccfion Fee 325.00 <br /> <br /> Other inspection $40.00/per hr (I hr min.) <br /> Overtime inspections $40.00/per hr (2 hr min.) <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 arc non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. <br /> <br />Name of Applicant (Please Print): <br /> <br />Signature of Applicant: <br /> <br />MC 15-80 Rev 1/96 <br /> <br /> <br />