MANF - 1594095 - Laserfiche WebLink

Home Browse Search

FOR CIT.Y USE ONLY Received By: Date: Zoning By:__ _City:_ Receipt#:____ Amount: $ MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00 am - 4:30 pm 24 hr. Inspection Line 373-4427 FAX 588-7948 FOR CITY USE ONLY City Setbacks: Front: Rear: Left: Right: Special: MANUFACTURED DWELLING PERMIT APPLICATION 1. JOB DESCRIPTION *FLOOR PLAN REQUIRED* RESIDENTIAL Garage or Carport ( )New Placement (l~eplacement ( ) Additional Unit Add-on ( )Attached ( )Detached Height: Dealer's Name: O?~/~D htOOtL ~ TypeofSiding: ,(,,,~rWood ( )Metal ( )Vinyl Super Good Cents Home { I Yes ~No (Provide Documentation) 2. LOCATION OF INSTALLATION No. Of Sections: ,,~ Length: Width: ~.L.~ Height: 1 ~l~ Typ~ofRoofing: (/~Comp ( )Steel ( )Metal PitSet ~)Y ( )Iq Number of Bedrooms:,.~ Existing: Proposed: StaAddress City: ~L6 Zip' q-~ ~" CrossStreer 60, $7'~ '~.~/ Parcel Owner: r a Mailing Address:// ~ 'ty: Zip: Phone- PropertyLocator: Parcel#:, - I Water Supply: (~PrivateWell ( ) Community Well ( )City 3. CONTRACTOR INFORMATION --- PLEASE INDICX~E WHO IS DOING THE WORK ( ) I am ~e PROPERTY OWNER and own. reside in. or will reside in the completed structure and roll be my own general contractor. I understand that I must register as a construction contractor tf the structure is sold or offered for sale before or upon completion If 1 hire subcontractors, I will hire only, subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor who is registered with the Conslmetion Contractors Boar& l will immediately notify Marion Counr~ of the name of the contractor. I am the AUTHORIZED REPRESENTATIVE of the property owner or the contractor. Bosiness Name (please print)_ Mailing Address: Street: City: Zip: Phone: () [ am a CONTRACTOR registeJ~[wRh the State of Oregon. __ ~ Business Name (please print): -: - - -i _~, _- -'_ t - - - ' ~ · - -- Registration g:~7___ MallingAddress: ] Street 2 - ~- '~City:- -: ~- ~ ZOip:. i -_ Phone:-' ~-' Fax:' 4. FEES A. (1) Manufactured Placement / Connections (includ. es E.L, PL~ IV l/. connections & 30 feet each of sewer ~nd water lines): $ 305.00 (2) State Surcharge 15.25 (3) State Administrative Fee 30.00 (4) Zoning Surcharge, if applicable 30.00 B. (1) *Earthquake-Resistant Bracing System (ERR) $ 85.00 (2) State Surcharge 4.25 (3) State Administrative Fee 30.00 * This fee is only charged when the ERB system is not part of the original manufactured dwelling installation. C. Miscellaneous Fees (1) Additional Inspection or Reinspection ~ $60/per inspection [Assessed for inspections beyond the third Inspection] (2) Investigation Fee @ $305.00 (4) Other Inspections ~ $50 per inspection TOTAL $ $ $ $ I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. Name ofApplicant [Please Print]: ~ ~'5 ~ O~qleer~ '~, ~[e~ M~ling Add~ss~t'~ _am~ ~ ' ' Date: