Laserfiche WebLink
FOR {~ITY VALIDATION] <br />l~ec~eived By: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> $:00am..4:30pm Phone 585-$147 <br /> 24 HR Inspection Line $88-7904 <br /> FAX $88-7948 <br /> <br /> MANUFACTURED DWELLING <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requirements: <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 PERMIT APPLICATION <br /> <br />1. JOaB DESCRIPTION~ <br />(,~) New Placement G~r~ <br />( ) Replacement ( ~ Attac~ <br />( ) Addifion~ Unit Add-on ( ) Detached <br />~alers~ Y~of NO. of Lengthg¢ -" ' <br />Ty~ of Si~ng: Ty~ of Roofing: Squ~e Footage: <br />(~o~ ( ~omp <br /> ( ) Metal ( ) Steel Pit Set: En~gy: <br /> ( )Vinyl ( )Met~ ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Lot Width: ,~,~g' Lot Depth: <br /> <br />Uth~l Growth Soundaly? ( ~es ( ) No <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING TIlE WORK <br /> <br />Water Supply: ( ) Private Weil ( ) Community WelI <br /> <br />I m tM PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that 1 <br />must rng~ster as a construction contractor if the structure is sold or offered for sale before or upoa completion. If I him subcontractors, I will hire only <br />subcontractors reglst~red with the Construction Contractors Board. If I change my mind and do hire a general conffaetor who is registered with the <br />Construction Contractors Board, I will immediately notify Marion County of the name of the contractor, <br /> <br />l am a CONTRACTOR registered with lira Slag of Oregon. <br /> <br /> Magi d ' <br /> <br />( ~ I am an AUTHORIZED g~ePRE$ENTATIVE of the property owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactmed Phicemen~Connecfions $245.00 <br />(includes F~L, PL, ME connections) <br />State Sumharge $12.25 <br />State Fee $20,00 <br />Zoning Surcharge (if applicable) <br /> <br /> RECEIPT #: <br /> <br />B, Additional Inspection/ <br /> (beyond third inspection) <br /> Reinngecfion 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. <br />NAMEOFAPPLICANT(please~ ~i~-¢--~L~ PHON~:7bf-Zg~t-)t_ <br />SIGNATUREOFAPPLICANT: ~-~ DATE: I~I ~}/~ ~1~ <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />