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.FOR CITY VALIDATION <br />Rgceived ~y:. _//~_.i~z~_ ~ ~ <br />Zoning. Validatiori: / ,~ <br />Date: ~.~'-~Zg- ~, <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 373-4427 <br /> FAX 588-7948 <br /> <br />CIT___ _V ONLy <br /> <br /> merits: <br /> <br /> ONE & T~I/~-~L~'~b,IIT APPLICATION -~/ ./~.~ <br /> <br />I. JOB DESCRIPTION FEB 2 O <br /> ~ew Single Family DweH~g With A~ached Gauge <br /> MARION COON i'~( <br /> ( ) New Single Family Dwelling With De~ched <br /> o~iLDiN6 INSPE~?~7-~ <br /> ( ) New Duplex <br /> <br />Ene~ Pa~: ~ ]No. Stories ~ I Demch~ Gauge Height: ['~' No. BeSoms: 3 <br />Sq~ Fee, aW B~ent:: } Main Flor: [~Z* ISec°nd Fl°°r: [ Garage: "~V Other; <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner <br /> <br />I Mailing Address PO ~(~ <br /> <br />Job Address <br /> <br />Cross Street <br /> <br />Subdivision <br /> <br />S~tion <br /> <br />Lot W d~ <br /> <br /> Tax Acct. No. <br /> ~ ~ '~,&d.~ Lot <br /> <br />Acres Irreg. Lot l(xO Q~ <br /> <br />t <br /> / city <br /> <br />qOOl2- %~31 <br /> <br />Map <br /> <br />Comer <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <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 />IfI 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 />MailingAdd~s0 /~0~:~ /. C~/ ~,a(t' t~-~.,-,'l~ C2I /~_ Phone <br />I am an AUTHORIZED REPRESENT?TIV~E of the property owner or contractor. <br />' ~ ~.~------~-~'~--- t~ · (please print) <br />'mnin~ ~ % ~ ff Phone <br /> <br />4. FEE SCHEDULE <br /> <br /> B. <br /> <br />VALUATION - Based on square footage: <br /> Gross Sq Ft ff'~ ~' O x 64.66 <br /> Garage Sq fl ~4~1~'9 x 16.27 <br /> TOTALS: I 7~ q = <br /> <br />1. PERMIT FEE: <br /> Gross SqFt ) 71 q ,~ $.345/sqfl <br /> * Building ~ .185 per sq t~ <br /> Electrical ~ .068 per sq fl <br /> Mechanical ~ .022 per sq ff <br /> Plumbing ~ .070 per sq ~ <br /> TOTAL $.345 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> GrossSqFt / 7t ? x $.12/sqt~ <br /> <br />$. d,-¢3. 06, <br /> <br />$~ <br /> <br /> PERMIT FEES <br />I. Permit Fee (A-I) <br />2. State Surcharge (5% of A-1) <br />3. Plan Review Fee (A-2) <br />4. Zoning Sumh~ge ($20.00 if applicable) <br />5. Investigation Fee ($.345 per sq ~) <br />6. Reinspection Fee $25.00 <br />7. Other inspection $40.00/per ~ (I ~ min.) <br />8. Oveflime inspections $40.00/per hr (2 hr min.) <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. e Print)~c.~ )' <br />Name of Applicant (Pleas ~ ~ ~ Z W {/~ 1'~7....~%' ~-'x~l Phone: % "~ ~ C 0 3 7 <br />Signature of Applicant: ~.~~~~ Date: "~ ' ~ ~ ~'q ~" <br />MC 15-80 Rev 1/96 <br /> <br /> <br />