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.................................... MARION COUNTY BUI~ ]INSPECTION <br /> '}'OR CITY USE ONLY __ COMMUNITY DE V E~t~II~'F/C~I~N TE R <br /> R~iv~l By: "~ Date: ~ <br /> <br /> D~mng ,al~ls must be obtained., Marion Cou.~ Bnildin, II~pection .nd <br />work. Contact Madon Coun~ for instructions, l/~ <br /> <br />( ) New Single Family Dwelling with Attaehed Garage <br />( ) New single Family Dwelling with De-tached Garag¢ <br /> <br />SquamFootage: Basement: Mt/R lstFIoor: 2//~'2naS]oo~: A//,'~ <br /> <br />Number of Bedroe~m: 3 Existing: Proposed: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />New Duplex with Attached Garage <br />New Duplex with l~ached Oarag~ <br /> <br />Occupancy: Coast. Type: A/~g,ot Energy: t~J~ / <br />Dwelling Halght: /t~" Garage Halght: /~t <br /> <br /> Zip: <br /> <br />Lot: Bl~ek: <br /> <br />AC <br /> <br />UGB: ~ () N CitySew~r ~ <br /> Septic System <br /> <br />Water Supply: ( ) Private Well ( ) Cm'mnunityWell ~City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE 1NDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />() <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in the completed slracture and will be my own general contractor. I understand that I must regist~ <br />as a construction contractor if the stracture is sold ~ offered for sale before or upon completion. Ifl hire subcontractors, I will hire only subeontraettns register~ with <br />the Construction ContraOors Board. lfI change my mind and do hire a general contractor who is registered with the Constraetion Contractors Board, I will <br />immedintely notify Mar/on County of the name of the contractor. <br /> <br />I am the AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br />Business Name (please print) <br /> <br />MailingAddress: <br /> <br /> Street City <br /> <br />I am a CONTRACTOR registered with the State of Oregon......--. <br />Busmess Name (please print): <br /> <br /> City <br /> <br />Zip Phone <br /> <br />Zip <br /> <br />4. FEES <br /> <br />VALUATION (See Valuation Schedule to determine the valuation based on ~uare <br />~oota~) <br /> <br /> Li~4ng Area Square Feet 2~ x $64.66= <br /> Garag~ Square Feet ~ x $16.27 <br /> <br />A. 1. Permit Fee: <br /> Gross Square Feet ~/J~:~ x $0.4050 = <br /> <br /> Building ~ $0.185 per square foot <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 R*vinw Fee <br /> Grc~SquarcFcct x $0.120/sq. Ft=$~'4. <br /> <br />B. Fee Summary <br /> (1) Permit Fee (A-I) <br /> (2) State Surcharge (.05% x A-1 ) <br /> (3) Plan Review F~e (A-2) <br /> (4) Additional Plan R~view/Addendum ~ $50/hr, <br /> minimum one-balf hour. <br /> (4) Zoning Surcharge, if applicabie ($30.00) <br /> (5) Investigation Fee ($.4050 per sq. IL) <br /> (6) ~on Fee, $50.00 <br /> (7) Inspections mado outside of normal <br /> business hours, $50/hr, miinmum two hours <br /> (8) lnsp~tions for which no f~ is specifically <br /> indicate, $50.00thr, minimum one hour <br /> (10) Foundation Only Authorization, $25.00 <br /> ( 11 ) ,~i;,,~: SJ,~ ~,f ."1o~ 70 i f~. f,G in,, ~t <br /> ~'~ r--e~4.,9% o6~--t-~-) <br /> TOTAL <br /> <br />I hereby certify that the above information is core,ct. Permits .~¢lao~- .tra0s~bletand expily if vn~'k i~ notJIar~ '~tbi? 180 de,.v~$ of is,m~ce or ifv~k ist~jsp~led fo~ 180 days. <br /> Nan~ofApplicant[PleasePrint]:_ /ff l '" V~.~ ~r' g.d-~. ( ~.J~ /I~IF'I I~. ///t~/"d~J g~lt~ // ? <br /> Mailing Address:. j~./r]. ~'~O~' .'~ 7 ~'~O/'V~ t~. ~7__::~-~' <br /> <br />SignamreofApp|icant: - ~ ~'0 //'~ Date: ~'~-~r7 MC15~OgF,~ <br /> <br /> <br />