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.... '7 ............................... ] MARION COUNTY BUILDING INSPECTION <br />FOR CITY U$[i ONLY ,, · ,~ ~-- g COMMUNITY DEVELOPMENT CENTER FOR CITY USE ONLY <br /> Re~iv~dBy:,~7/,,~'~ Date:~, I 3150 Lancaster Dr. NE-Sui~C City Setbacks: <br /> Zouing ~: ~ City:_Rt~fi~6t-~.'[_~ Salem, Oregon 97305 ~,,~,. _~.,~ x Rear' <br /> <br />.................................... .i 24 hr. Inspection Line 3/~d~f'~'}~//~//Special:__ <br /> FAX 58a'79/gl ......................................................... <br /> <br /> Dwell ng abels must be obtained at Marion Coaat~ Bulldlag l~pection and mn~t be placed at the lo~qj~ior t~o? ~o~bthg, ,lee~al sad mech~nleal <br /> <br />1. JOB~SC~ION ~uttOlNo UOla~. 7/- 77~ <br />(/N~S~eF~ily~elting~ch~Gamge ( ) N~Dupl~th~a, <br />(~) N~ sm~e Fam~y ~ell~g wi~ ~ch~ Gauge . ( ) N~ Duplex ~ ~ ~ <br /> <br /> Num~ ~B~: ~ E~ng: ~: ~ellkg HeiSt: /~ '- ~ ~ Ha~t: ~ '- ~ ~ <br /> <br />LOCATION OF INSTALLATION <br /> <br />Site ,a3dr~: <br /> <br />Subdivision: <br /> <br />~operty Locator: <br /> <br />Parcel Size: 0/~ SF ( ) AC <br /> <br />UGh: ()Y () N Ci~S~ <br /> <br />Wa~Su~ly: ~ ~W,II ( ) C~iWW~I (~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> () I am the PROPERTY OWNER and own, reside in. or will reside m the comple~d stmnlure and will b~ my own ~1 ~r. I undetstaad that 1 must n~gister <br /> as a coustruction contractor if thc mci'are is sold ox offia~d for sale befo~ or upon ~ompletion. lfI hire subcon~actors, I will hire only subomtm~s rcgist~xl with <br /> the ConsUuchon Contractors Board. Ifl change my mind and do hire a general ~ who is regist~ed with the Cons~ction Contractors Board, I will <br /> inun~diat¢ly notify Marion County of thc name of tho contractor. <br /> <br /> ( ) I am the AUTHORIZED REPRESENTATIVE of the property owner or the eoaWactor. <br /> Business Name (please print) <br /> <br /> Mailing Address: <br /> City Zip Phone <br /> <br /> V~0 I am a CONTRACTOR registered ~vith the State oLOregon, t - <br /> BusinessNan~(pleaseprtht): ~tht.b ~ ~i~ow_tto"x-- ~f~ ~:It*~t.. Registration#: /~/'-~' <br /> <br /> Street City Zip Phone Fax <br /> <br />4. FEES <br /> <br />VALUATION (See Valuation Schedule to dete~aune the valuation based on square <br /> <br /> LivingAma SquamFee, ,~/~ x $6466 = $ f~s ~f'/~,~_~_ <br /> GaragaSquareFeet ~ x $16'.27 = $ ~f~ <br /> <br /> Gross~ua. Feet /Z~f x $0.4050 = $ ~,~ <br /> Buil~g ~ $0.185 ~ ~uare f~ <br /> EI~ ~ $0,090 ~ ~u~e ~t <br /> M~iml ~ ~.040~t <br /> ~u~g ~ $0,090 ~ ~ua~ ~t <br /> <br />2. Plan Review Fee <br /> Groas Square Feet 1~0'~ f x *0.120/sq. Ft=$ o(~/ <br /> <br />( 1 ) Ponnit Fee (A-I) _ <br />(2) State Surcharge (.05% x A-l) <br />(3) Plan Review Fee (A-2) $ .'~.nOg~. -~t~' <br />(4) ~dia~ ~ R~iew/~m ~ $50~, <br /> minimumo~f~. /~~ $ /~f~ <br />(4) 7~;.~ ~"~"~-,~ii~bi~ ($ ..... ~ $ <br /> <br />(5) Investigation Fcc ($.4050 per sq. fi.) <br />(6) Reimpechon Fee, $50.00 <br />(7) Inspectious made ou~sida of normal <br /> business hours, $50/hr, minimum tv~ hours <br />(8) lnspeaions for which no f~ is specifically <br /> indicated, $50.00far, sinmmm one hour <br />(10) Foundation Only Authorization, $25.00 <br />(11) Additional Sets of Plans $10.00 per set <br /> <br />1 hereby ~'tify that the above information is correct. Pennits~re no/n-trans fejrable)~nd ex~e if v.~k is not started within <br /> Name of Applicant ~!,ease Print]: ~f~/~ [7 (4m~ t' <br /> <br />Sigaatur~ of Applicant :t~.._.~-~~''~ ~ <br /> <br />TOTAL <br /> <br />$ <br />$ <br />$ <br /> <br />180 days of issuance ox ifwork is suspended for 180 days. <br /> <br /> <br />