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IRFOR CITY VALIDATION <br />iZoning Valid0;tion: c~7-.~c' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNiTY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am4:30pm Phone 588-5147 / <br /> 24 hr. Inspection Lin'e 588-7904 <br /> FAX 588-7948 <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 <br /> <br /> FOR CITY USE ONLY <br />City Seth~ck Re4u kement~: <br /> <br />Front: <br /> <br />LeftSde.: ~ RightSide: ~ <br /> <br />1. JOB DESCRIPTION APR 20 t993 <br /> <br /> RESIDENTIAL COMMERCIAL MARION C )l ~T~ use otst~ct~r=: <br /> ( )Addition ( )Relocation ( )Addition BUiLDiNG IN!~[,ION ,_.~,~--~ <br /> ( ) Alteration ( ) Other ( ) Alteration I <br /> ( )Accessory ( )ChangeofOccupancy ( )Other ~/~/4'-7~ ~ I/O?~LOO. O <br />Energy Path: I No. sm.. I NO. of Emphiyees: Existing - New - [ No. Bedrooms: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />~6Vm~s~ ~ q~z~ A'~?-''. '~' . <br />Mobile Home P~k ' ~ ' ' ~. ~ - <br /> ~va~ We~ ( ) Spring <br />~d~ ~o ~v,p~ /~O A.~, .~ ~,~.~ c~, ~ co~,~w~, () city <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 reside in the completed structure and will beamy own general contractor. I unde~t that I must register as a coasmiefion <br /> contractor if the structure is .sold or offered for sale before or upon completion. If I hire subcontractors. I will hire qnly subcontractors registered with the Construction Contractors Board. <br /> IfI change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will inunedlately 9o~?t Marion County of the name of the contractor. <br /> /~' 1 am a CONTRACTOR reglstered with the State o f Oregon. <br /> Business Name Registration No. <br /> <br /> ( I I am an AUTHORIZED RIr~PRES£NTATIVE of the proporty owner or contraetoc. <br /> <br />4. FEE SCHEDULE' <br /> <br />A. VALUATION (See "Valuation Schedule" to determine valuation based <br /> <br />MARION COUNTY <br />B_U!L_OING <br /> <br />on square footage ofpruject.) <br />(II Permlt Fee <br /> <br />(2) 5% State Surehaxge (.05 x Al) <br /> <br />(3) Structural Plan Review (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan Review (.40% x A ;') <br /> <br />B. Miscellaneous Fees <br /> <br /> (I) Additional Pla~ R~views or Addendums <br /> (2) Investigation Fee <br /> (3) Reinspection Fee ~ $25.00 <br /> (4) Other Inspections not listed above <br />~cm~: ,.~'~C O <br /> <br />=$ <br /> <br />TOTAL <br /> <br />1 hereby certify that the above information is correct. <br />Permits ace non-transfercable and expire if work is not started within 180 days of issuance or if work is :suspended for 180 days. <br /> <br />Name of Applieant (Please Pdnt): 6~,,~ "-~lO.,'r~,l~f~ Phone: <br /> <br /> <br />