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.................................... ] .MARION COUNTY BUILDING INSPECTION ~l CITY U~E ONLY - . -- I COMMUNITY DEVELOPMENT CENTER FOR CITY USE ONLY P-.~4vedBy~Da~:/~t-~'~/ I 3150 Lancaster Dr. NE-SuiteC City Setbacks _ Zeath~?y: dso - City:~ I Salem, Oregon 97305 Front: ~_Rear: Receipl~: ._q'7.~, Amount:$~ ] 8:00am-4:30pm L~R~Right:___.q~_~ ;. ................................... 2 24 hr. Inspection Line 3734427 Special: FAX 588-7948 -~ ....................... ONE AND TWO FAMILY DWELLING PERMIT APPLICATION (r(-/~f Hwelllag labels must be ob~thed #t Marion Co,uty Building lusgeetio, and mast be plae~d at ~he job site prior to lmspeefioll fo'~/~tl~. work Colltact Marioll Cou.ty for instrllctions. ~ff-- ~"~'~ --~x% ~' ~. ~' New Single Family Dwelling with Astached Garage () N~v Duphix with Attached Garage ( ) New single Family Dwelling with De-tacbed Garage ( ) New Duplex with Detachnd Garage Number of Bedrooms: ~ Existing: Prop~l: ~ Drilling Halght: /~gt Garage Halghi: 2. LOCATION OF INSTALLATION Site Add~: City: Zip: I Cross Stin~et: ..~ ()N Parcel#: WatarSupply: ( ) PrlvateWell ( ) Community Wall CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK ( ) I am the PROPERTY OV~NE R and own, r~side in, or will r~ide in thc ~ompleted structure and will be my own g~ne~al conlractor. 1 undemand that I mug as a cons~a'ucfion con~xactor if the stmctave is sold or offered for sale befo~ or upon compk~ion. If I hire subcontrac~wm, I ~ hire only subaon~aotom regist~'ed with the Construction Contraeto~ Board. lfI change my mind and do hire a general conWactor who is regist~ed with the Cons~uotion Contraotc~ Board, I will inur~intely notify Marion County of the name of tho co~Wactor. ~ I am the AUTHORIZED REPRESENaTAT1VE of tke'l~rop~rq( OWl~r or the Business Name (please prim) ~ ~t'. (~/'n~. _~ Ma~higAdd~: ~D 4'~'~ I Z~A, ~T_( ~:~ a3.1,,--? ~[ 7~9~ Street City Zip Phone I am a CONTRACTOR registered wi~ t¥ Business Nan~ (please print): Street City Zip 4. FEES VALUATION (See Valuation Schedule to dctarmin¢ thc valuation based on square f°°tage)LivingA~t SquarcFeet_~ x $64.66 = $ ~A/~/~/d'~'~ Gro~$SqnareFeet t/'~ x $0.4050 ~ $ ~/& Building ~ $0.1 $5 per square foot Electrical ~ 20.090 per square foot Mechanical ~ 20.040 per square foot Plumbing (~ 20.090 per square fix~ Gross Square Feet x B. Fee Summary (l) P~rm~ Fee (A-l) (2) State Surcharge (.05% x A-1 ) (3) Plan Review Fee (A-2) (4) Additional Plan Review/Addendum ~ mimmum on~-balf hour. ~ (5) Investigation Fee (2.4050 per sq. ~.) (6) Reinspection Fee, $50.00 (7) lnspeotiom made outside of normal business hours, $50/hr, minimum two hears (8) lnspeotions l~r which no fee is sPe~fically indicated, $50~00/hr, minimum one hour (10) Foundatiea Only Authorization, $25.00 (11) Additional Sets of Pinna $10.00 per set TOTAL $ $ $ $ $ $ I hereby certify that the above information is eorrcot. Permits ar~ ~non-t~ansf~le and exp~work is not started within 180 days of ~ance or if work is suspended fx~ 180 days. Name of Applig.'ff~t [Please Pr/ot ]: ~lraA/. Phone: ( / f-ff .... '~z~5~- Z-~l~t4 - - -- , t · Si~latar~ of Aoplicant: ~ ~"~-~-~'~ ~-~L - ' Date: