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~ ................................... ] MARION COUNTY BUILDING INSPECTION i ........................................................... I _~CITYUSE_QI~LY ./ / COMMUN1TY DEVELOPMENT CENTER ! FOR CITY USE ONLY Rec~tved BY:~]l[~c''~'' Date: ~.-~- 3150 Lancaster Dr NE - Sui~t/'~ ~ i ...... i Zoning By' - ' Ci ' ' '% ~..lIy ~ett>acKs · I . . _ ty, ~ Salem Oregon 97305 : · ....................... - ............. z~ hr. mspecuon Line 373-442'~ ~ial:__ FAx 588-7948 one Am) TWO FAMILY DW LL Na p mvaT Dw~ng~be~amus~b~bta~n~datMar~C~``tyB~ding~ape`~n~ndm~thap~d~ha~;t~a~lr`/~.~'e~a~f~r~`~`tri¢~`d~h~`~a~ ~ork. Contact Marion County for instractions. NewSm cFamfl ~ Ih . ) ' gl 'yr.,we 'ngwithAtt~hedOarage )~ New Duplex with Atlachad Galt~/ ) New single Family Dwelling with De-tachad Garage ) New Duplex with Detachad Garage SquareFootage: Basement: /d/A Istmoor:2/[~ zddVloor: N/,~C Numhar of Bedrooms: ,~ Existing: Proposed: 2. LOCATION OF INSTALLATION site Address:/tgt~9 t Parcel Owner: ~e/'~ · Su~vision: Oc~upency: Const. Type: A/ca/ Other: Garage: ~'#Siofies! ] Units: Dwelling Height: /~ ! Garage HeightI /~, t Mailing Address: Pamel S/ze: ¢ SF () Ac Cross Strut: zip: UGB: ~Y () N Block: City Se~r Septic System WaterSuppfy: ( ) Private Well ( ) ConmauintyWell 0~City 3. CONTRACTOR INFORMATION -- PLEASE 1NDICATE WHO IS DOING THE WORK () () I am the PROPERTY OWNER and ow~ reside in, or will reside in the completed structure and will be my own general contractor. I undemtand that I mus~ register as a cons'~uction contractor if the structure is sold or offered for sale before or upon completion. IfI hire suhaontractors, I will hire only suhaontraetors registered with the Consimction Contractors Board. Ifl change my mind and do hire a general conU'actot who is registered with the Constzuction Contractors Board, I will immediately notify Marion County of the name of the contractor. I am the AUTHORIZED REPRESENTATIVE of the property owner or the contractor. Business Name (please print) Mailing Address: Street City Zip Phone I am a CONTRACTOR registered with the State of O~gon. Business Name (please print): '7~/*-- ~.~.~ ~.. ~..~, RD. gox 47 Mar/on q7. ffcl Street City Zip Regisa'afion#: ~ 74 7dq-_Kffc/7 7d?-4/37 Phono Fax 4. FEES VALUATION (See Valuation Schedule to determine the valuation based on square ~118 Living Area Square Feet~2~"x $64.66 = Garage Square Feet ..~7~ x $16.27 Building ~ $0.185 per square foot Electrical ~ $0.090 per square foot Mechanical @ $0.040 po'square foot Plumbing ~ $0.090 per square foot 2. Plan Review Fee B. Fee Summary (I) Permit Fee (A-I) $$~7~ (2) State Surcharge (.05% x A-I ) (3) Plan Review Fee (A-2) $ ~ (4) Additional Plan P,~vi~v/Add~dum ~ $50f!lr, minimum oho-half houL $ (4) Zoning Surcharge, if applicable ($30.00) $ (5) Investigation Fee ($.4050 ~ sq. fi.) $ (6) Rei--tion Fee, $50.00 $ (7) Inspections nnde outside of normal business hours, $50/hr, minimum two hours $ (8) Inspections for which no fee is specifically indieatdd, $50.00/ht. minimum on~ hour $ (10) Foundation Only Authorization, $25.00 $ TOXAL $ t ~;o~l. 6t4 I hereby certify that tha. a, bove ~ ~f~rma.. tion i_s ~o~reci.. V?m ~,.~_e.n on:~, ns fe~?le ~ ,exo~ge if work is~no,arsm~i.wit hth~0 dayj0]f issuanc~ or if, vlorkis suspended for 180 days. Signature of Applicant: _/'~/~o'~,~ ~'~. f/'~U,~:2brt~.. Date: ~ - ..~ - ~ MC ,s-~o 9m