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I FOR CIT~ VALIDATION I MARION COUNTY BUILDING INSPECTION <br /> -~ ' ~/'-~-' -~'v~ ' I ] COMMUNITY DEVELOPMENT CENTER <br /> Received By: ~ ~ ~ 285 Church St. NE- Room 132 <br /> - bt // ,~n I Salem, Oregon 97301 <br />Zoning Validation: . ,6'~- I 8:00am-4:30pmPhone588-$147 <br /> Da[ - ~--~r~"~ I 24 HR Inspecfion Line 588.7904 <br /> ___e. ~_ ~ .__ ~ FAX 588-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />2ity Setback Requirements: <br /> <br />g <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 <br /> <br /> L JOB DESCRIPTION <br /> ~IoN r, OllNTY <br /> <br />()~ New Placement Garage C <br /> BUILDING <br /> INSPECTION <br />( ) Additional Unit Add-on ( ) Detached <br />Deal Year of ~, No. of Length6 Width <br />N2e:~fi~ ~ i. Manufacture~ Sections 2 t 27' <br />Ty eof Siding:wood Square Footage: 1500 to. of Bedrooms: <br />) T,y~e of Roofing: <br /> (~) Comp <br />( ) Metal ( ) Steel Pit Set: Energy: <br />( ) Vinyl <br /> <br />2. LOCATION OF INSTALLATION .~fl~:~:7~/_ <br /> <br /> Occu~nt: ] roiling Address: I ~one No.: <br /> Im Lot: ~ <br /> <br />Lot Width: I' <br /> <br />UrbanGmwthBoundary7 ( )Yes ( )No <br /> <br />Water Supply: ( ) Private Well ( ) Community Well ~t~) Ci~ <br /> <br />3. CONTRACTOR INFORMATION I PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I ara 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 <br />must register as a construction eontractox if the structure is sold or offered for sale before or upon completion. If 1 hire subcontractors, I will hire only <br />subcontractors registered with the Construction Contractors Board. If l change my mind and do hire a general contractor who is registered with the <br />Construction Contractors Board, I will imn~tiately notify Marion County of the name of the contractor. <br /> <br />l am a CONTRAC'~OR registered with [be State of Oregon. <br /> <br />I am an AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br /> one: 7 Iq -7?qq <br /> <br />A. ~annfactured Pt ..... gCounections $245.00 <br /> (includes EL, ?L, ME connections) <br /> State S~char~ $12.~ <br /> State Fee $20.~ <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reinspeedon Fee <br /> <br />$60.00 = <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 <br />or if work is suspended for 180 days. ~/x~ <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />