Laserfiche WebLink
FOR CITY-VALIDATION <br />Received By: __ I <br />Zoning Validation: <br /> <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 /> FO__~R CITY USE.___~ONLY <br />City S~tback R~quir~ments: <br /> <br /> ~::t Sid~: <br /> <br /> RESIDENTIAL ' COMMERCIAL Use of Structure: <br /> ( )Addition ~1~ ~)Relocation ( )Addition ( )New <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> ( ) Accessory ( ) Change of Occupancy ( ) Other <br />D~cfiptionofWork [ Is thia ahJstofiealbdildnig? Yes ~ <br />~.ergy~: I No.S d ] NO. of Employees: Existing - New- I No. Bedrooms: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision Lot Block <br />Mobile Home Park Sp~e # <br />S~ction Township Range Zone Map Water Supply: <br /> Privat~W~ll ( ) Spdng ( ) <br />LotWidth LotDepth Acres Itr~g. Lot Comer CommunltyWell ( ) City ( ) <br /> <br />3. CON~JL~CTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br /> ( ) I am aa Al~r~ HORIZED REPRESENTA~TIVE of tbd property owner o~ contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />VALUATION (See "Valuation Schedule" to dctc~nin¢ valuation based <br /> <br />on square footage of project,) Valuation: $ <br />(1) P~mit Fee <br />(2) 5% Stat~ Surcharge (.05 x Al) <br />(3) Structural Plan Review {.65% x A 1 ) <br />(4) Fire & Life Safety Plan Review (.40% x Al) <br />(5) Zoning Surcharge, if applicable (.05% x Al) <br />(6) Seismic Surcharge <br /> <br />Miscellaneous Fees <br /> (1) Additional Plan Reviews or Add~edums <br /> <br /> (2) Investigation <br /> <br /> (3) P,~inspeetion Fee @ $25.00 <br /> <br />=$ <br /> <br />TOTAL -- $ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-trans fercable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br />NameofApplicant(PleasePrind~ d- ~/~ ~--~ Phone: <br />SignatureofApplicam: ~ _~t~/,~/~[,~ ~, Date: <br /> <br /> <br />