Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br /> 3150 La.n~ 150 Laacas~r Dr. WE - Suit~ C <br /> ~ Oregon 97305 <br />8.00 am - 4'30 pm 24 hr. Inspection Linc 373..4427 FAX ~88o7948 <br /> <br /> I$ NOT STdlRTF. D PfII~IIN 1,~0 DAYS OFiSSU.4NCE OR IF <br /> ~o~ /s SUSP~D~ ~a ~ ~o D~ YX <br /> <br />2~ CO~OR ~FO~TION <br /> <br /> ~ili.~A~ P. O. ~X 417 <br /> <br /> C~tySTA~ Sine: OR Zip: 97383 <br /> <br /> ~: 1-503-769-7124 <br /> F~: 1-503-769-6114 <br /> C~=~ ~rd NO: ~4344 <br /> C~ t~ NO: 24-365C <br /> 5~ L~ Ne: 1336S <br /> <br /> 2~ FOR O~ER ~TION / <br /> ~ ~: ~leaae print) <br /> <br />City State: Zip: <br /> <br />I am the PROPERTY OWNER and own, relide in, or wilt re,Me in the <br />completed structure and will be my own general contractor. I <br /> <br />structure is sold or offered for sale before or upon completion. Iii <br />hire subcontractors, I will bite on& subcontractors registered witfi the <br />Consrructwn Contractor$ Board. Iii change my mind and do hire a <br /> <br />Contractors Board. I will immediatel~ noti~ Marion Count~ of the <br />ha/ne of the contractor: <br /> <br />Signature: <br /> <br />3. PLAN REVIEWSECTION <br />IMarion County does not rcquh-c a plan review. We will p~ovid¢ <br />plan r~view service if yOU comple~ Section 5B and submit two(l) <br />s~ o f pl~u~s and specifications with this applicatkm, <br /> <br />==~rE E SCHEDULE (eomldete and enter total in Al) <br /> Numb~ of lml~ctiom per p~rmit allov~--- <br /> Residential Per Unit, Service Included <br /> <br />1000 St. Ft. oc le~ <br /> <br />L~ r~ <br />Ea Manu fa~tured Home m <br /> Modular l:~:lliag Se'x'/c~ ~ F~ler <br /> <br />Im,,z Cost (~ch) Sum <br /> x S110.00 =$ 4 <br /> x S 20.00 =S <br /> x S 30.00 =$ 1 <br /> <br /> $ ~2.00 -- $ 2 <br /> <br />B, ~-rvltes or Ytt,~er$ {Does not <br />Ins~flo~ ~ndon, or Rel~aflon <br />2~ x $65.~ = $ 2 <br />201 ~4~ x $80.~ <br />~1 ~to~ x $130.~ = $ 2 <br />~1~1~ x $170.~ = $, ,2 <br />~ I~vol~ x $3~.~= $ 2 <br /> <br />201 ~ x $ 55.~ ~ $ 2 <br />D, B~nch Ci~ul~ <br />ofS~ F~F~ ~ Br C~ x $ 3.~ <br /> <br /> ~1B~ C~it <br /> ~~fi~c x $55.~ = S 2 <br /> Si~ C~i<s) ~ ~ L~ ~ ~1, <br /> <br /> F, ~ch Additional lu~cflou, over the allo~ble <br /> In any of the a~ve, ~r ~c~n x <br /> <br /> ~ oil0 h~ Sl0.~ ~ x SI~.~ $ <br /> <br /> On~ Fim~ Mlllm8 F~ <br /> <br /> ~llln8 Pemit ~b (For Sidle Fam~y D~l~a~ One) <br /> <br />TOTAL $~'~&'~ <br /> <br />5. FEES <br />Al. Enter Total Fees ~,i0~ $ <br /> <br /> ~ SUBTOT~: $ <br /> <br />B. En~ 30% of~c Al for P~ ~w <br />C. ~v~i~n F~, ff~u~d <br />D. ~¢~n F~ ($50.00) $ <br />E. ~d~bn~ P~ Rev~ (62.50~, <br />mM~ on~ h~) $ <br />F. ~oa for ~hi~ no f~ ~ s~ifi~y ~d~ <br />($62.50~, mM~um OhO ho~) $ <br />G. Ms~n OuBi~ N~ B~ Hou~ <br /> <br />H. Mdu~ P~t ($62.50~r) TOT~ ~O~ D~ $ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />