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[F~OR C,ITY VALIDATION <br />Received By: __ <br /> <br />IZoning Validation: <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 588-7904 <br /> FAX 588.7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />IiFOR CITY US~E _ONLY <br /> <br />RESIDENTIAL COMMERCIAL Um of Slmcmr¢: <br />( )Alteration ( )Other ( )Alteration ( )Sign <br />( )Accesso~ ( )~geofOccupancy ( )~her <br /> <br />2. LOCATION OF INSTALLATION <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 ~side in the completed structure and will b~ my own gene, nd conlra~r. I tmd~rstund that I must rngistur as a conatn~tlon <br /> contractor if the structure is sold or offered for sale before or upon completion. If I hir~ subcontractors. I will hire only suhcontta~tors mglstcred with the Construction Conh'actors Board. <br /> If I change my mind and do hire a general contractor who is registered with the Con s'auction Contractors Board, 1 will hn~ediatuly notify Marion County of the name of the conltac~or. <br /> <br /> ( ) [ am a CONTRACTOR registered with thc State of Oregon, <br /> <br />MailingAddrcss lt g~! E.~o..t~ ~ ~ <br /> <br />4. FEE SCHEDULE <br /> <br />A. VALUATION (See "Valuation Schedule" to ~termine valuation based <br /> <br />on square footage of project.) Valuation: $ <br />(I) Permlt Fee <br />(2) 5% State Surcharge (.05 x Al) <br />(3) Structural Plan Review (.65% x Al) = <br />(4) Fir~ & Life Safety Plan Review (.40% x Al) = <br />(5) Zoning Surcharge, if applicable (.05 c,% x Al) = <br />(6) Seismic Surcharge <br /> <br />I hereby certify that the above information is correct. <br /> <br />(2) Investigation <br /> <br />(3) Reinspection F~ <br /> <br />(4) Other Inspections not listed abov~ <br /> <br />=$ <br /> <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is susl~nded for 180 days. <br />Signature of Applicant: ~ <br /> <br /> <br />