Laserfiche WebLink
r ................................... n. MARION COUNT~J~ING INSPECTION [ .......................................................... <br /> ~ ~. c~ ~_~v //~/~ I co~Y ~~T~s~ ~ FOR CITY USE ONLY <br />"l R~By:~Date ~ I 3150L~c~~/~g( : c~ R~th.oks. . <br /> <br />..................................... <br /> F 5 f~. ~/ : ......... ~ ............................................... <br /> <br /> O~l~ng la.is must ~ obtained at Marion Coun~ Building lns~cfion and must ~ ~aced at ~e job sing iu~e~n for ~um~nfo e~tflcd ~d mech~ie~ <br /> ~r~ Con.ct Marion Coun~ for instruefion~ ' '~ <br /> <br />1. JOB DESCRIPTION <br /> ~ New Single Family Drilling with At~achcd Garage <br /> ( ) New single Family Dwelling with De-tached Garage <br /> <br /> Square Foota,,: ~ascmeut: D 1st Floe,: ?~ <br /> Numl~ of Bedrooms: .~ Existing: <br /> <br />( ) New Duplex with Attached Garage <br />( ) New Duplex with D~taohed Garage <br /> <br />Garage:~ ~// g Stories: ~ Units: <br /> <br />Drilling Height: Garage Height: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Site Address: <br /> <br />Subdivision: <br /> <br />MaP: <br /> <br />I P~I S~: ~F () AC <br /> <br />City: ~/..~,~ Zip: q75~ I Pho.~:.~/'~,~Z~ <br /> <br /> UGB: ()Y (.)~q~ CiB~S~'~'~''~ <br /> Septi, $y~ <br /> <br /> Wat~rSupply: ( ) PrivateWdl ( ) conmmmtyWeil <br /> <br />$. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />() <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in aha completed structure and vA11 bc my own general oontravtor. I unde~stsnd that I must r~gistcr <br /> <br />Mailing Address: <br /> <br />Street Cily Zip Phone <br /> <br />I am a CONTRACTOR registered with the S~ate of Oregon.. <br />Business Name (pleaso Print): ~'~t~;~'~ <br /> <br />~5~/. 2 5'7 ~ <br /> <br />Street City Zip Phone Fax <br /> <br />4. FEES <br /> <br /> VALUATION (See Valuation Schedule to daffnmne the valuation based on square <br /> foo~¢) <br /> LivingArea SquarcF~et/q'x'%~x $64.66 = $ <br /> Oarage Square Feet /,4g'/' x $16.27 = $ <br /> <br /> ~ 1. Permit Fee: /~ $ <br /> Gross Square Feet ~ ~,..~ x $0.4050 = <br /> <br /> Building ~ $0.185 per square faot <br /> Electrical ~ $0.090 per squa~ fern <br /> Mechanical ~ $0.040 per square foot <br /> Plumbing (~ $0.090 per square foot <br /> <br />2. PinuReviewFeeGrossSq.aroFeet //~ x $0.120'sq. Ft=$~7-~' ~ <br /> <br />B. Fee Summary <br /> (1) Permit Fee (A-l) <br /> (2) State Surcharg~ (.05% x A-l) <br /> (3) Plan Review Fee (A-2) <br /> (4) Additional Plan Review/Addendum ~ $50/hr, <br /> minimum on.half hour. <br /> (4) Zoning Surcharge, if al~licable ($30.00) <br /> (5) Investigation Fcc ($.4050 per sq. R.) <br /> (6) Reinsp~tion Fee, $50.00 <br /> (7) [nspo~ons made outside of normal <br /> business hours, $50/hr, minimum two hours <br /> (8) Inspeetions for which no fee is specLfically <br /> indicated, $50.00/hr, mimmum one hour <br /> (10) Foundation Only AuthOrization, $25.00 <br /> ~t 1 I) Additional Sets of Plans $10.00 p~r set <br /> <br /> certify that the above information is con. ct. Permits are non-~ansferrable and expir~ i~ wo_rk is not stared wi.thin 180 days of issuance or if wod~ is suspended for 180 days. <br /> NamoofApplicant[Pleas~Print]: ~-~e~ ~4~5 ff~ ~.~O~sl lMf,~t L(~C~ . <br /> <br /> Phone: c:~, - ~"I-Z~ 7 7 <br />Si~lature of Applicant: ...-/~_ ~...~ - Date: ~. t./_ ~(~' MC 15~o ~ <br /> <br /> <br />