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[ goa o gic us . oNLv[ <br />I <br /> Date: I-I$-q$ [ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> , 220 High Street NE <br /> Salem, OR 97301 <br /> ~) ) ~/ 8:00am-4:30pm I~ 588-5147 <br /> Code-A-Ph~ 588-7904 <br /> FAX 588-7948 <br /> <br />ONE & TWO FAMILY DWELLING <br /> <br />COMPLETE ALL S~ONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />(bO/New Single Family Dwelling w/garag~ <br />( ) New Single Fmnily Dwelling w/o garage <br /> <br />( I~a~age, attached <br />( ) Garage, detached <br /> <br />FOR OFFICE USE ONLY <br />City Setback l~uir~m~nt~: <br /> <br />Re~: ~5 <br />Right Side: <br /> <br />Tmss( jor .ar erC ) I ao-Sto es ! ID a h Oaragomi . o. oorns: <br />Square F~et: Basement: ] Main He,c: /~'-~ [ Second H~: Garage: Other: <br /> <br />2. Locationoflnstallation '~tZ~.~', 9r~. q7,~12 <br /> <br />3. Contrae~r Information <br /> <br /> ) I own, ~e~ide in, ~ will re.~ide in the completed s~mcmr*. <br /> <br /> ) I undersland that I must register as a coasUuction contractor ff the structure is sold or offered for sale before or upon completioa. <br /> <br /> ) I will be my own general contractcc <br /> <br />If I hire subcontractors, I will hire only $ub~ontractc~ registered with die Construction Contractors Board. If I change my mind and do hire a general ¢ontract~ <br />who is registered with the Construction Contractor's Board, I will~ai~ ~t '~t ely notify Marion County of the name of the eontracor: <br />C°ntract'l~rBusinessname&#:2/bt"~iJS dOt'l'~le~t~s~'tn~- IMalU'gAdd'*":~--~,y~'_~ a.~ ,t-da~_-_< [Phone: <br /> (l,~ 1 ,am a regist*rnd builder OR the auth~rizod representativ, of a regiat~red builder /i/, ~'. ~n-/e ~ q 7 3 o / <br /> <br />4. Fee Schedule <br />A. New One-and-Two Family Dwelling Code <br /> (inlcude$ El, Me, PI) <br /> <br />(1) Cross Sq. Ft. ]OtlO <br /> <br />(2) 5% State Surcharge (.05 xA1) <br /> <br />(3) Ham Review <br /> <br />(4) Z~i~g Surcharge ($15 if applicable) <br /> <br />B. Miscellaneous Fees <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb ~ $17.00 <br /> <br /> (3) Additional Plan Reviews or Addendum$ <br /> <br /> (4) Investigation Fe~ <br /> <br /> (5) Reinspeefion Fe~ ~ $25.00 <br /> <br /> (6) Olher Inspections not listed above <br /> 176 7 <br /> <br />x$40= __ <br /> <br />McSli;~;;aluReav~n/~,2septic, ~mbing and mechanical w~xk requir~ seperate ,ruff,. Check with Marion County Building Inspection beg s:~"'idng/ fltis application. <br /> <br /> <br />