Laserfiche WebLink
IFOR CITY VALIDATION <br /> <br />Zoning Validation: I <br />Date: ..~--/0"- -q <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St. NE - Room 132 City Setback Requirements: <br />Salem, Oregon 97301 . <br /> <br /> 24 hr. Inspecflo Side' <br /> FAXI;~~'~l ~ ~I~Y ' IRightSide:/t~ ! <br /> <br />1. JOB DESCRIPTION <br /> <br /> RESIDENTIAL <br /> ( ) Addition ( ) Relocation <br /> ( ) Alteration ( ) Other <br /> <br />Squa~ Footage -Basomont: <br /> <br />COMMERCIAL <br /> ( ) Addition <br /> <br /> ( ) Alteration <br /> <br /> ( ) Change of Occupancy <br /> <br /> ployees: Existing - <br /> <br />MARION COUNTY <br /> <br />( ) New <br /> <br />( ) Sign <br /> <br />( ) Other <br /> <br />Is this a historical b~ilding? Yes - ~ <br /> <br />New - <br /> <br />No. Bedrooms: <br /> <br />L LOCATION OF INSTALLATION <br /> <br />Subdivision <br /> <br />IMailing Address <br /> <br />Lot Block <br />Space# <br /> <br />Wate~ Supply: <br />Priva~ Well ( ) Spring ( ) <br />Community Well ( ) City (*.Y~' <br /> <br />LotWidth ~! LotDq~h lO0 e Acres Ineg. Lot fro Comer NO <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />am rite PROPERTY OWNER and own, reside in, or will reside in the completed ~ and will be my own general contractor. I understand that I must register as a construction <br />cona'actor if the stmctore is sold or offered for sale before or upon completion, ff I hire subcon~ctors, I will hire only subconWactors registcned with the ConsU~qion Contractors Board. <br />ff I change my mind and do hire a general contractor who is regimred with the Construction Contractors Board, I will immediately notify Marion County of the name of the conWactor. <br />am a CONTRACTOR registered with the State of Oregon. <br />Business N.ame ~ ] RegisUation No. <br />am an AUTHORIZED REPRESENTATIVE of the propew/owner or contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION (See "Valuation Schedule" to determine valuation based <br /> <br />on square footage of project.) Valuation: $ <br />( 1 ) Permit Fee <br />(2) 5% State Surcharge (.05 x Al) = <br />(3) Smactural Plan Review (.65% x Al) = <br /> <br /> / <br />(5) Zoning Suwharge, if applicable (.05% x Al) = <br /> <br />(6) Seismic Surcharge = <br /> <br />Miscellaneous Fees <br /> (1) Additional Plan Reviews or Addeadums <br /> <br /> (2) Investigation Fee <br /> <br /> (3) Reiuspoction Fee ~ $25.00 <br /> <br /> (4) O~her Inspections not listed above <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not stat~ed within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Signature of Applicant: ~~ ~ Date: <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />