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IFOR CITY VALIDATION J <br />Received By: <br />Zoning Validation: ·/",t'_~'~ [ <br />Da,e: / <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:0Oam-4:3Opm Phone 588-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588~7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requirements: <br /> <br />F~nt: ,~0 ' J~'~: Il ~ <br />ua side: ~ 'J Pa~t side: 8 ' <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *In, <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIFFION <br /> <br />(b~NewSingleFamilyDwelli~gWithAtta~hedOarage ~ APR 2 .~ 1995 -- <br />New Single Family Dwelling With Detached CrarageMARION COUNTY <br />New O.plex BUILDING INSPECTION <br /> <br /> ,-am-,=: I <br /> <br /> No. Bedrooms: <br />Square Feet: Other:. <br />il. LOCATION OF INSTALLATION ~.3r ~'~Zff <br /> <br />Lot Width ~. d6 Lot Depth 1~,~. ~/q ¢ Acres In'eg. Lot met ~ <br /> <br />W~r 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 contra~or. I tmderstand that I must register as a consimction <br />contractor if the structure is sold or offered for sale before or upon completion. If I hir~ subcontractors, I will hire only subcontractors registered with the Construction Conh'actors Board. <br />If I change my mind and do hire a genamral conlractor who is r~gistered with the Colxstmction Conlxactors Board, I will immediately nolify Marion County of thc name of thc contractor, <br />I am,a CONTRACTOR registered with the Sta~ of Oregon. <br />Business Name / -- ~ Registration No. <br />I am ~n AUTHORIZI~I) REPRESENTATIVE of the propeay owner or contractor, <br /> <br /> Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on square footage: <br /> <br /> TOT~: 1~6 7 <br /> 1. PR~ ~E: <br /> <br /> El~l ~ .~8 <br /> M~i~l ~ .022 <br /> Pl~b~g ~ .070 <br /> TOTAL 5345 PER <br /> <br /> 2. P~ ~EW ~E: <br /> <br /> ~ Sq Ft <br /> <br />s wgK. <br /> <br /> I <br />B. PERMIT FEES <br />I. Permit Fee (n- 1) <br /> <br />2. State Surcharge (5% ofA. l) <br /> <br />3. Plan Review Fe~ (A-2) <br /> <br />7. ~her i~fion ~.~/~r ~ (1 M m~.) = $ <br />8. ~ime i~fio~ ~.~/per ~ (2 ~ ~n.) = $ <br /> <br /> , woo. o,/ q,O'i/ <br />Dwelling labels must be obtained at Marion Coun~ Building Insp~tion and must be placed at the jobsite pflor to inspection for plumbing, electrical and <br />m~hanical wor~ Con.ct Ma~on Coun~ for ~s~cfions. <br /> <br />I hewby e~ ~at ~e a~ve informant..Pe~i~ ~e non-~sfe~ble ~d expire if wo~ is not p~ed wigan ! 80 ~ys of issu~ce or if work is s~ended for <br /> <br /> / .......... <br /> <br />MC I~-~0 ~cv1/96 <br /> <br /> <br />