Laserfiche WebLink
FORCITY ,USE ONLY <br />P~geived By: __Date: __ <br />Zoning By: City:__ <br />Receipt #:. Amount:$ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />CO/vEMUNiTY DEVELOPMENT CENTEg <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br /> 8:00 am - 4:30 pm <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br />Front: Rear: <br /> <br />Special: <br /> <br />1. JOB DESCRII~ION <br /> <br />BUILDING PERMIT APPLICATION <br /> <br />RES ENTIAL <br />~l)N]ew ( AccessOry ( ) Addendum <br />( ) Alt~afion ( Relocation ( ) Other <br />( ) Addition <br /> <br />COMMERCIAL <br />( ) New ( ) Multi Family <br />( ) Altemhon ( ) Addendum <br />( ) Addition ( ) sign <br />( ) Other <br /> <br />( ) Change of O~culmncy or Use <br />( ) Manufactured Dwelling Pank <br />( ) Recrearional Vehicle Padc <br /> <br />Use of Structure: Occupancy: Enemy: <br /> <br />Square Footage: Basem~ntf 1st Floor: <br /> <br />Other: No. Stories: Units: Height: <br /> <br />Number of Bedrooms: Existing: ProPosed: <br /> <br />Subdiv~i~: ~ ~t: Bilk <br /> <br />~ ~: Pmcel ~: Wa~ Supply: ( ) ~va~ Well ( ) ~ Well ( ) <br /> Ciw <br /> <br />3. CONTRAC?OR INFORMATION --- PLEASE INDICATE WHO IS DOING TIlE WORK <br /> <br />() <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in the completed slructure and will be my own general contractor. I un~d that 1 must <br />register as a eonslruetinn contractor it'the structure i~ sold or offered for sale before or upon completion. [fi hire subcontractors; I will hire only subcontractors <br />regJs~red with the Cons~etion Conltactors Bo0xd. lf~ change my mind and do hire a general contractor who is registered with the Cons~etion Conlraetors <br />Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />() <br /> <br />I am the AUTHORIZED REPRE ~_~0NTATeI~gE of the p~ol~r~y ow n~:.o~ the contractor. <br /> <br /> Street Citity: <br /> <br />Zip: Phone: <br /> <br />() <br /> <br />I am a CONTRACTOR r~gister~d with the State of Oregon. <br />Busiuess Name (please prim): <br /> <br />Mailing <br />Address: <br /> <br />R~gistration #: <br /> <br /> Street City: Zip: Phone: Fax: <br /> <br />4. FEES <br /> <br />A. VALUATION (Sec Valuation Schedule to detem~ine the valuation <br />based on square footage of the project) $ <br /> <br />(1) Permit Fee <br />(2) State Surcharge (5% x Al) <br />(3) Smmtural Plan Review (65% x Al) <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 applicable (1% x Al) <br /> <br />Miscellaneous Fecs <br /> <br />(1) Addl Plan Review / Addendum @ $50/hr, <br />Minimum one-half hour $ <br />(2) Reluspection Fee @ $50/pcr inspection $ <br />(3) Investigation Fee $ <br /> <br />(4) Inspections outside normal business <br /> Hours @ $50/hr, minimum two hours <br />(5) Inspections for which no fec is specifically <br /> Indicated @ $50/hr, minimum one hour <br />(6) Additional Sets of Plans @ $10 per set <br /> TOTAL <br /> <br />I hereby certify that the above infommtion is correct. Permits are non-transferrable and expire if work is not started within 180 days of issannffe <br />suspended for 180 days. <br />Name of Applicant [Please Print]: <br /> Mailing Addre~ ~ .,, ~ ). <br /> <br />Signature of Applicant: ~_./, ~t-L~/ <~')/~,~ Date: ~ //dC, <br />MC 15-73 Rev 9t98 <br /> <br /> <br />