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FOR CITY USE.ONLY ¢ <br /> <br />E~ceived By! Date: <br />Zoning By: City:_ <br />Receip~ #: Amount:$ <br /> <br />MARION COUNTY BUILDING INSPECTION ............................................................ <br />COMMUNITY DEVELOPMENT CENTER FOR CITY USE ONLY <br />315o Lancaster Dr. ~E - Suit~ C City Setbacks: <br /> Salenl, Oregon 97305 : From: <br /> : 8:00 am- 4:30 pm L~fl: Riglat:. <br /> 24 hr. InspeCtion Line 3734427 Special: <br /> FAX 588-7948 <br /> <br />1. JOB DESCRIPTION <br /> <br />~ENTIAL <br />(). New ~.).Aoce~sosy ~g~ Addendum <br /> Alteration <br /> ~ Addition : (~ Relocation '( }' Other <br /> <br />BUILDING PERMIT APPLICATION <br /> <br /> COm~Ec~L <br /> ]( )New , ( )MulfiFami!y ()ChangeofO~cupancyorUs~ <br /> . I ( ) Alteralion ( ) Addendum ( ) Manufaetmed DWelling park <br /> I ( ) Addition ( ) Sign ( ) Recreational Vehicle lhu-k <br /> ,( )Other <br /> <br /> Use of Structure: Energy: <br /> Square Footage: I st Floor: Other: Units: ' Heighl: <br /> <br />Number of Employees: S~01ing Capacily: Proposed: <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision: : , [ Lot: Bl~ck ~ <br />( ) Mobile HOme pattc ( ) Mobile Home Subdivi*ion Space '#: Total # SPaces: <br /> <br />Map: Zone: parcelSize: () SF () AC [o ~'~tg~._~.. UOB: ()Y () N ? <br />Proper¢y Locator: parcel #: ICityWater Supply: ~ Private Well ( ) community Well ( ) <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am the PROPERTY OWNER and own, reside m, or will reside m the compl~t~l ~mctnre and will be my 0wg~ g~meml oon~actor. I Understand that I must <br />r~gi~ter a~ a eomtmetion contraotor if the s~ru~a~re i~ sold or offered fo~ safl~ b~fore or upon eompletioa; If I hire suboontractor~, I will hire only ~uboontraelors <br />registered with the construction Contraetors Board. If I ohange my mind and do hire a general contractor who is registered with tho Comtmelion Contractors <br />Board, I will immedia~ly notify Marion County of the name of the contractor. <br /> <br />() <br /> <br />I am the AUTHORIZED REPRESENTATIVE of the prol~erty owner or ~he c~r. <br />Business Name (please prim)__ <br /> <br /> Mailing Address: <br /> Street Cily: Zip: Phone: <br /> <br />( ) I am a CONTRACTOR regis~red with the State of Oregon. <br /> Business Name (please print): <br /> <br />Mailing <br /> <br />Rggistration #: <br /> <br /> Street City: Zip: Phone: Fax: <br /> <br />4. FEES <br /> <br />A. VALUATION (See Valuation Schedule to determine the valuation <br />based on square footage of the project) $ <br /> <br />(1) Pm'~nit Fee <br />(2) State Surcharge (5% x Al) <br />(3) Structural Plan Review (65% x A 1) <br />(4) Fire and Life Safety Plan Review (40% x Al) <br />(5) Zoning Surcharge} if applicable (6% x Al) <br />(6) Seismic Surcharge, if opplieable (1% x Al) <br /> <br />Miscellaneous Fees <br /> <br />(1) Addl Plan Review / Addendum @ $50/hr,, <br /> Minimum one-half hour <br />(2) Reinq>ection Fee ~ $50~er inspection <br />(3) Investigation Fee <br />(4) Inspections outside normal business <br /> Hours ~ $50/hr, minimum two hours <br />(5) Inspections for which no fee is specifically <br /> Indicated ~ $50Pur, minimum one hour <br />(6) Additional Sets of Plans ~ $10 per set <br /> TOTAL <br /> <br />I hereby certify that the above information is correct, Permits are non-transferrable and expire if work is not started within 180 days of issuance or if Work <br />~ded for 180 days. <br /> <br /> Mailing Address: <br /> <br />Signature of Applicant: <br />MC 15-73 gev 9/98 <br /> <br />/ <br /> <br /> <br />