Laserfiche WebLink
IFOR C.I. TY VALIDATION <br />R~e~'6ived By: __ <br /> <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 /> FOR CITY USE _ONLY <br />City Setback Requirements: <br /> <br />Front: Rear: <br />Lept Side: I Right Side: <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB D~_EffRIPTION <br /> ~%)~New Single Family Dwelling With Attached Garage <br /> <br />( ) New Single Family Dwelling With Detached Garage <br /> <br />( ) New Duplex <br /> <br />iEnergy Path: I No. Stories <br />Square Feet: Basement:: { Main Floor: [ r'~ {O ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Detached Garage Height: <br /> <br />No. Bedrooms: <br /> <br />Other: <br /> <br />Pr°perry Owner ~[.) ~ ~ Ok~'k ~ ~-~ ~C-L. <br />JobAddress 11~..~I~3 "~O,~t~..'~ ~O,..~ ~C <br />Cross Street <br /> <br />Subdivision <br />Section <br /> <br />Lot Width <br /> <br />Township <br />Lot Depth <br /> <br />Mailing Address t4 "} 2}'I ~% ~S[_{' ~.~ ~ ~ <br /> <br /> I T <br /> ax Acct. No. <br /> <br /> Lot <br /> <br />Range Zone <br />Acres Irreg. Lot <br /> <br />IMap <br />Comer <br /> <br />Block <br /> <br />Water Supply: <br />Private Well ( ) Spring ( ) <br />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 />I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />VALUATION- Based on square footage: <br />Gross Sq Ft x 64.66 = $ <br />Garage Sq ~ x 16.27 = $ <br />TOTALS: = $ <br /> <br />1. PERMIT FEE: <br /> Gross Sq Ft x $.345/sq ft $ <br /> * Building ~ .185 per sq fi <br /> Electrical ~ .068 per sq Pt <br /> Mechanical ~ .022 per sq Pt <br /> Plumbing ~ .070 per sq Pt <br /> TOTAL $.345 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> <br /> Gross Sq Ft x $.12/sq Pt $ <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) = $ <br />2. State Surcharge (5% of A-l) = $ <br />3. Plan Review Fee (A-2) = $ <br />4. Zoning Surcharge ($20.00 if applicable) = $ <br />5. Investigation Fee ($.345 per sq fi) = $ <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 />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): CC~' 0 \ ~¥N. ~00 ['~ Phone: ~' ~ I, -- q'Xo-~'[ <br /> <br />Signature of Applicant: ~~n_f ~ Date: L.[-- ][--~ ~ <br />MC 15-80 Rev 1/96 <br /> <br /> <br />