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¢ <br />) FOR cITY VALIDATION MARION COUNTY BUILDING INSPECTION <br />IR~ceivcd By: . ~r ~ ~ COMMUNITY DEVELOPMENT CENTER ___~,,.~ <br /> 285 Church St. <br />[Zoning Validation: "ff~ Salem, Oreg~]~ <br /> 8:00~m4a0vm <br /> <br /> ONE & TWO FAMILY DWELLING PE~IT APPLICATION <br /> <br /> FOR CITY USE ONLY <br /> <br />At: ~ ! Rear: <br />I~ft Side: ~..~-- ' Right Side:~"/ <br /> <br /> *Includes electrical, mechanical, <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> BUILDING INSPEOTION <br />1. JOB DESCRIPTION <br /> (dNew Single Family Dwelling With Attached Garage ~'~'~'x <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br /> ( ) New Duplex <br /> <br />Ene~ Pa~: ~ No. Stories [ aK Detached Garage Height: I~Be~ooms: <br />Sq~F~t: B~ement:: Main rloor: ~ h [ S~ondVloor: Garage: <br /> <br />2. LOCATION OF INSTALLA{I~ <br /> <br />Crus~ S~t ~ *~ ~=~. ~o. <br /> <br /> Section a ~ Tomship ~ I ~nge ¢ ~ I Zone ~% M Water Supply: <br /> P vat W,. <br /> <br /> / <br />3. CONT~CTOR INFO~ATION ~ PLEASE INDICATE WHO IS D~NG THE WO~ <br /> / <br /> <br /> / <br />( ) I am the PROPERTY OWNER and own, reside in, or will reside in the completed stmcture~d 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 subcgfltractors, I will hire only subcontractors registered with the Construction Contractors Board. <br /> Ifa change my mind and do hire a general contractor who is registered with the Constructi~Contractors Board, I will immediately notify Marion County of the name'o~contractor. <br /> / <br />( ) I am a CONTRACTOR registered with the State of Oregon. / <br />Business Name <br />Mailine Address .' <br /> <br />( ) I am an AUTHORIZED REPRESENTATIVE of the property owner o/ontractor.., <br /> (please print) .~ Phone <br /> Mailing Address / <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on square footage: <br /> GrossSqFt \\~ x = $ t~X~_~'O~,q <br /> <br /> TOTALS: = $ ~%~% -- <br /> <br />1. PERMIT FEE: <br /> Gross Sq Ft $.345/sq ft <br /> * Building ~ ft <br /> Electrical .068 per sq ~ <br /> Mechanical .022 per sq ff <br /> Plumbing .070 per sq ff <br /> TOTAL $.345 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq I <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-1) <br /> <br />2. State Surcharge (5% of A-l) <br /> <br />3. Plan Review Fee (A-2) <br />4. .._.Z~3 urcharge t,zo. O0 if apl3hcame) ~ <br />5. Investigation Fee ($.345 per sq fi) <br /> <br />6. Reinspection Fee $25.00 <br /> <br />7. Other inspection $40.00/per hr (1 hr min.) <br /> <br />8. Overtime inspections $40.00/per hr (2 hr min.) <br /> <br /> TOTAL <br /> <br />Dwelling labels must be~utalneo at Marion County Building Inspection and must be placed at the johsite prior to inspection for plumbing, electrical and <br />mechanical work. Con,att 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 of Applicant (Please Print): ~' ~t.~a e~l~Nq~ ~' ~X~ Phone: <br /> <br />MC 15-80 Rev 1/96 <br /> <br /> <br />