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FOR @ITY VALIDATION Zoning Validation: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 Salem, Oregon 97301 8:00am-4:30pm Phone 588-5147 24 hr. Inspection Line 373-4427 FAX 588-7948 FOR CITY USE ONLY City Setback Requirements: Front: ~0t Rear: ~Y/ Lea Side8 ~" ' Right Side: ~/ ONE & TWO FAMILY DWELLING PERMIT APPLICATION *Includes electrical, mechanical, plumbing fees COMPLETE ALL SECTIONS,, THROUGH 4 P%-o3 t l)J I 1. JOB DESCRIPTION r- .. -" '- 2r ( ¢¢New Single Family Dwelling With Attached Garage t~,~1 ( ) New Single Family Dwelling With Detached Garage MARION ( )NewDuple× It. IJILDING No. Bedrooms: Other: -1 'T15" .-OO Tax Acct. No. ~ I Irreg. Lot N~ ~.~ J Comer I~C) ' Subdivision Lin,.oln ~I~O. doWS Section ~::~5 Township (~' S. J Range t.otWidtb qO'~ ~°tDeP*l'~¢--Iqq~I Acr= 3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK Pho.e o. '-/qfl 035 1'-5g Water Supply: Private Well ( ) Spring (). Community Well ( ) City 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 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. If I change my mind and do hire a general conh'actor who is registered with the Construction Contractors Board, I will immediately notify Marion County of the name of the contractor. I am a CONTRACTOR registered with the State of Oregon. Business Name C~¢ ~ ri 5,~1_1[~0..~ i 0 g,~ Registration No. I am an AIJTHORIZEI) REPRESENTATIVE of the property owner or contractor. ~ame (please print) Mailing Address Phone 4. FEE SCHEDULE Ao VALUATION - Based on square footage: OrossSqVt [9 03 x 64.66 GamgeSq f~ .~O {o x 16.27 1. PERMIT FEE: GrossSqFt ~.?'/g20C~ x $,345/sqa $ ~/~'/' // * Building ~ .185 per sq R Electrical ~ .068 per sq ff Mechanical ~ .022 per sq ft Plumbing ~ .070 per sq ff TOTAL $.345 PER SQ FT 2. PLAN REVIEW FEE: GrossSqFt ~_/.~-O ~ x $.12/sqfl $ 2.-~'~, O g B. PERMIT FEES 1. Permit Fee (A-I) 2. State Surcharge (5% of A-l) 3. Plan Review Fee (A-2) ............................ ~e_.~ 5. Investigation Fee ($.345 per sq fl) 6. Reinspection Fee $25.00 7. Other inspection $40.00/per hr (1 hr min.) 8. Overtime inspections $40.00/per hr (2 hr min.) TOTAL g3t.ll z~/ , /~¥.69 /z ge. Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and mechanical work. Contact Marion County for instructions. 1 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 i£ work is suspended for 180 days. Name ofApplicant (Please Print):Lissa B /e s ho.e: ']qg--DO,33 Signature of Applicant: ~t~74 ~J~¢'l~ ~ Date: q,//°~ ,/q ~ MC 15-80 Rev 1/96