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F..~.I~]T~Y VALIDATION <br />Received By: __ <br />Zoning Validation: <br /> <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 /> <br /> City Setback Requirements: ~ <br /> Front: <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT.4gPP-I~IC-~ATION- <br /> *Includes electrical, mechanical, pl~l~ing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br />('~)) New Single Family Dwelling With Attached Garage <br /> <br />CAr~ui'4 GOUNTY <br /> <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br /> ( ) New Duplex <br />Energy Path: j I No. Stories / Detached Garage Height: <br />Square Feet:t~/4~ Basement:: ~ }Main Floor: ,~ ~,~/ ] Second Floor: ,,._.,. <br /> <br />Garage: <br /> <br />BUILDING INSPECTION <br /> <br />No. Bedrooms: <br />Other: <br /> <br /> LOCATION OF INSTALLATION <br />2~m Owner Mailin Ad re <br /> <br /> Section Township <br /> ) , [ O ~ ~ ~ P ] 0~ 0~[ ~vate Well ( ) Spring <br /> Lot Wid~ ~ Lot Depth <br /> <br />3. CONT~CTOR INFO~TION ~ PLEASE INDICATE WHO IS DOING THE WO~ <br /> <br />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, 1 will immediately notify Marion County of the name of the contractor. <br />am a CONTRACTOR registered with the State of Oregon. <br /> B~s~e~` ~ ~f~ ~fint'~) Registration No. <br /> am an AUTHORIZED REPRESENTATIVE of the property owner or contrac[or. <br /> Name <br /> (please print) <br /> Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br /> VALUATION - Based on square footage: <br /> <br />Ao <br /> <br />Gross Sq Ft x 64.66 <br />Garage Sq ii x 16.27 <br />TOTALS: = <br /> <br />1. PERMIT FEE: <br /> Gross SqFt x $.345/sq ii $ <br /> * Building ~ .185 per sq fl <br /> Electrical ~ .068 per sq fl <br /> Mechanical ~ .022 per sq fl <br /> Plumbing C~, .070 per sq ii <br /> TOTAL $.345 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br />Gross Sq Ft x $.12/sq ~ $ <br /> <br />B. PERMIT FEES _ I <br />1. Permit Fee (A-I) =$$ ~/~~=.~~ <br />2. State Surcharge (5% of A-1) <br /> <br />3. Plan Review Fee (A-2) = $ <br />4. Zoning Surcharge ($20.00 if applicable) = $ <br />5. Investigation Fee ($.345 per sq ft) = $ <br />6. Reinspection Fee $25.00 = $ <br />7. Other inspection $40.00/per hr (1 hr min.) = $ <br />8. 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 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): ~"-I~-~/e~'~ ('~~ Phone: ,~3 ~ff('~ <br />SignatureofApplicant: Date: /~'-' /e'7 ~ ~ <br /> <br />MC 15~80 Rev 1/96 <br /> <br /> <br />