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IFOR CITY VALIDATION <br />Received By:. ~ ~) ~.~.,e <br />Zoning Validation: <br />Date: o~-,~~ <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 />IiFOR CITY USE ONLY <br /> <br /> ity Setback Requirements: <br /> <br /> mat: c~ t Rear: ~'r <br /> eR Side:q:~ Right Side:5 t <br /> <br /> ONE & TWO FAMILY DWELLING <br /> *Includes electrical, tnechanica <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCmPTION <br /> <br /> (,~ew Single Family Dwelling Wi~ Aaached Gmge <br /> <br />) New Single Family Dwelling With Detached Garage <br /> <br />Detached Garage Height: <br /> <br />Isecond F'oor: IGamge: <br /> I MailingAddress ~r/t9 <br /> <br /> MAR;(;;~ ' ........ ' <br /> : "d Y <br />']]UILDI~3 <br /> <br /> No. Bedrooms: <br /> <br /> Other: <br /> <br /> PhoneNo. <br /> City ~ i~1]/~ <br /> <br /> ( <br /> ( ) New Duplex <br />Energ~ Path: g [ No. Stories / <br />Square Feet~ Basement:: ]Main Floor:/d/,.~ <br /> <br />2. LOCATION OF INSTALLATION <br /> Property Owner~ d/j.4./gl ~ ~ /~~ <br /> <br /> Cross Sueet ~ ~ <br />Su ivision <br /> <br /> ,a3- ownship b'3 ;32 Range <br /> Lot Width ~ ,w%Z 3/ Lot Depth q 7, ~ Acres <br /> <br />Lot <br />Zone ~.(~ ] Map Water Supply: <br /> Private Well <br />Irreg. Lot Y'~ I Comer y~_~ Community Well ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- 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 /> <br />· ""/C Phone <br />( ) I am an AUTHORIZED REPRESENTATIVE of thc property owner or contractor. <br />Name <br /> <br /> Mailing Address_..,q, Phone .~,~d' t~ ?Jt~ <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />VALUATION - Based on square footage: <br /> GrossSqrt /,~/,~ x 64.66 : <br /> Garage Sq ft '~/~O x 16.27 <br /> TOTALS: <br /> <br />1. PERMIT FEE: <br /> Gross Sq Ft / 7~'~ x $.345/sq ft <br /> * Building ~ .185 per sq fl <br /> Electrical ~ .068 per sq ft <br /> Mechanical ~ .022 per sq <br /> Plumbing ~ .070 per sq <br /> TOTAL $.345 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq Ft ~ 7-.~ x $.12/sq <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) <br /> <br />2. State Surcharge (5% of A-l) <br /> <br />3. Plan Review Fee (A-2) <br /> ............ ~ <br />4. · ....... ~_~wk ~_,~ ...... ~ ;7~vvi~ble) <br /> <br />5. Investigation Fee ($.345 per sq ~) <br /> <br />6. Reinspcction Fee $25.00 <br /> <br />7. Other inspection $40.00/per hr (1 hr min.) <br /> <br />8. Ove~ime inspections $40.00/per hr (2 ~ 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 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 ofApplicant (Please Print): ,,~,//~t ~: .~"~..~.~'_.~',~,7/.~ ~.4.e~ Phone: <br />Signature of Applicant: ~ .~/~ *..~,~ ~ ~ , _~~ ~ Date: <br />MC 15-80 Rev 1/96 <br /> <br /> <br />