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~r~- ......... , ....................... OUNTY BUILDING INSPECTION <br />I FOR CITY USFo~,~I/~ .... f$1m~ ~)~ DEVELOPMENT CENTER <br /> <br /> ~g h~b mu~ ~ obtained tt Marion Coun~ B~ing Inaction and must ~ placed at tho job site prior to ins~c~n for ~umMng, ekc~c~ and ~ha~al <br /> <br />~ork Contact Marion County for instruclion~ <br />1. JOB DESCRIPTION <br />~ New Single Family Dwelling with ^Rached Garage i ~ <br />New single Family Dv~lting ~ <br /> . <br /> Squar~Footage: Basement: lstFloor.~{9~" 2ndFIoo¥! 5"o~ ~ <br /> <br />1. LOCATION OF IN.STALLATION <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br />r~o~: ~0 R~: /~" <br /> <br /> Lcit: <br />Special: <br /> <br /> ) New Duplex with Attached Garage <br /> ) New Duplex with Detached Garage <br /> <br />Occupancy: Const. Type' Ener~' <br />Oceupency~2onst. Type: Ener~: <br /> <br />Other: Oatage: ~ Stories: ~ Units: <br /> <br />Cross Strut: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> I am the PROPERTY OWNER and own, r~ide in, or will ~e~ida in the completed ~xuct~re and will bu my own ~1 ~. 1 undetsland tbat I must register <br /> as a construc6on contractor if the stracture is sold ~ offexed fi~r sale bafo~ or upon completion, ffI hire subcontractors, I will hire only sulx:on~raetors r~gistered with <br /> the Construction Contractors Board. lfI change my mind and do hire a general ~trac~or who is registered with the C o~an~ion Contracto~ Board, I will <br /> immedintefy notify Marion County of the name of tho contractor, <br /> <br /> ( ) I am the AUTHORIZED REPRESENTATIVE of the property owaer or the contractor. <br /> Business Name (please print)__ <br /> <br /> Mai~ing Address: <br /> <br />() <br /> <br />Su'eet City Zip <br /> <br />I am a CONTRACTOR registered with the State of Oregon. <br />Business Name (please print): __ <br /> <br />Mailing Address: <br /> <br /> Pholg~ <br /> <br />__Registration #: <br /> <br />Street City Zip Phone Fax <br /> <br />4. FEES <br /> <br />VALUATION (Ss Valuation Schedule to determine th~ valuation based on square <br />footage) <br /> <br /> LivnigA~a Square Feet ~ x $64.66 = $ <br /> Garag©SquareFeet -- x $16.27 = $ <br /> <br />A. 1. Permit Fee: <br /> Gross 8qaare Feet <br /> <br /> Building ~ $0.185 l~r square fcot <br /> Electrical ~ $0.090 per square foot <br /> Mechanical ~ $0.040 per square foot <br /> Plumbing ~ $0.090 per square foot <br /> <br /> 2. Plan Review Fee <br /> Gross Square Feet~ x $0.120/sq. Ft <br /> <br />B. Fee Summary <br /> (1) Permit Fee (A-l) <br /> (2) State Surcharge (.05% x A-I ) <br /> (3) Plan Review Fee (A-2) <br /> (4) Additional Plan Reviem/Addaddum ~ $50Par, <br /> minimum one-balf hour. <br /> (4) ' ~ <br /> (5) lnv~figation Fee ($.4050 per sq. <br /> (6) Reinspection F~, $50.00 <br /> (7) Inspections mada outside of normal <br /> business hours, $50/hr, minimum two hours <br /> (8) Inspections for which no f~ is specifi~lly <br /> indicated, $$0.00/la', minimum o1~ hour <br /> (10) Foundalion Only Authorization, $25.00 <br /> (I 1 ) Additional Sets of Plans $10.00 p~r set <br /> <br />TOTAL <br /> <br />$ <br />$ <br />$ <br /> <br />I hoveby ee~ify that the above information is correct. Pemfits ~.~_,non-tnmsfefrabte and e~i#re ifw,~ is n~ start~l wifl~th 180 days of issuan~ or ifva~ is suspended for 180 days. <br /> Nan~ of Apptieam [Please Print]: ' ~ <br /> Mailing Address: ..~, ~'~,~.~ ('~-~ ~'' ~ in ~ _<' .... ~'~ . <br /> <br />Signature of Applicant: ~ ~c t~-a0~m <br /> <br /> <br />