Laserfiche WebLink
.... '*' ........................... ~'x-]- /~ MARION COUNTY BUILDING INSPECTION i .......................................................... <br />~'FORCITYUS~.ONLY_ ..//.].~}~ .?~ /}~ICOMMUNITYDEVELOPMENTCENTER <br /> Pa:e~ed By: rq,.O~ Oate: ~f~ ~/~ [fi;,t_ -- 3150 Lancaster Dr, NE- Suite C <br /> I Zoi~ig '~y: a.~t4 City:~l~ ~.l~t~']//~ o Salem, Oregon 97305 <br /> <br /> - ';' ' ¥416~h~o~ : ' ~'"' ~' <br />.................. '-'---' .......... -O'~fi',% 24 ~a'i~lh~n Line 3?3-442? . <br /> : ' fl,~ ~/]'f~[X 5SS-?94S <br /> <br /> l)wemng labels must be obtained at Marion County Bu'~li~/~/ and must Im placed at the job site prior to inspeCtiOn for plumbing ele~¢~l aud m~h~mic~l <br /> ~ork. ContaetMarionCountyforimtruefiona. ] )Al ~1 <br /> Joe oEscmvnos " 7' <br /> <br />~- New Single Family Dwelling with Attached Garage <br />( ) New single Family Dv~lling with De-tached Oa~age <br /> <br />Number of Bedrooms:~ Existing: Proposed: ,,~ <br />2. LOCATION OF INSTALLATION <br /> <br />IP a reel Size: ~F ( ) <br /> 7 0tff- <br /> <br />( ) NewDuplexwithAttaehedGatage <br />( ) N~w Duplex with Detacl~d Garage <br /> <br />DweAling Height: Garage Height: <br /> <br />AC <br /> <br />Energy: <br /> <br /> Units: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />4. FEES <br /> <br />1 am tho PROPERTY OWNER and ow*~ reside ia, or will reside in the ~'nple~l structure and will be my own geaeal ~onm't~. I tmdarsa~ that 1 mst r~gist~ <br />as a construction contractor if the structure is sold ox offered for sal~ befo~ or upon completion, lfl hire sub~n~, I will hire only sulx~ontra~s l~ist~n~d with <br />the Cor, stmction Contractors Board. lfI change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will <br />immediately notify Marion County ofth~ nam~ of the contractor. <br /> <br />I am the AUTHORIZED REPRESE~NTATIVE of the oroperty oWeer ~lr the contractor. <br /> <br /> Street Cify Zip % Phol~ <br /> <br />I am a CONTRACTOR registered with the_..~ate of Oregon. t . <br /> S~t Ci~ Zip' <br /> <br />VALUATION (See Valuation Schedule to determine the valuation based on square <br />footage) <br />LivingArea SquamF~t ~LT.~x $64.66 = $~'$"~ <br /> Garage Square Feet ~'?.~ x $16.27 $ <br /> <br /> Building ~ $0.185 p~r square foot <br /> El~a'icat ~ $0.0~0 per square <br /> M~hanieal ~ $0.040 per squar~ foot <br /> Plumbing ~ ~0.090 per square fc~t <br /> <br /> Gross Square F~t x $O.120/sq. <br /> <br />B. Fee Summary <br /> <br /> (~) state Surcharge (.0~% x ^-0 <br /> (3) PI~ R~i~w F~ (A-2) <br /> (4) ~ifi~ P~ Revi~/~m ~ $50~, <br /> m~ ~lfh~r. <br /> (4) Z~ing Su~, if a~l~Mc ($30.00) <br /> (5) Inv~i~ti~ F~ ($.4050 ~ ~. R.) <br /> (6) ~in~ F~, $50.00 <br /> (7) ~s~s ~e outs~e of~ <br /> ~si~$ ~m, $50~, ~ ~o h~rs <br /> (8) l~i~ f~ which no ~ is ~ifi~lly <br /> indi~t~ $50.00~, ~ ~ ~ur <br /> (10) Fou~tion ~ Au~, $25.00 <br /> <br />( 11 ) Addifionni Sots of Plans $10.00 per set <br /> <br /> / U TOTAL <br /> <br />I hm~oy certify that the above information is correct, po~ts?~, non-transferrable and expire if wq[k is not sauted within 180 days of issuance or if wo~k is sas~d th~ 180 days. <br /> Name of A~licant~Please Print]: D ~ ~.~A/~.~;4-v~Lt..a4.'~ ~ <br /> <br />SignatereofApplicam:~,~,~7~'~'ntn.~'~.t~, ,,0.~' D~" ~--~'tt,,~'~"~-'t~t,n./-~ Date: 20'-/,.~'--~' <br /> <br /> <br />