Laserfiche WebLink
i~ecei~ed By: Date:__ <br />Zoning By: City: <br />Receipt #: Amount:$ <br /> <br />1. JOB DESCRI~FION <br /> <br />,MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregan 97305 <br /> 8:00 am - 4:30 pm <br /> 24 hr, Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />BUILDING PERMIT APPLICATION <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br /> <br /> Left: Right: <br /> <br />RESIDENTIAL <br />(~ New ( ) Accessory ( ) Addendum <br />( ) Alteration ( )Relocation ( ) Other <br />( ) Addition <br /> <br />Description of Work: <br /> <br />install free standing sign <br /> <br />Square Footage: Basement: 1st Floor: 2nd Floor: <br /> <br />Number of Employees: <br /> <br />Seating Capacity: <br /> <br />COMMERCIAL <br />( )New ( ) Multi Family <br />( ) Alteration ( ) Addendum <br />I <br /> ) Addition (X) sign <br /> <br />( ) Other <br /> <br />( ) Change of Occupancy or Use <br />( ) Manufactured Dwelling Park <br />( ) Recreational Vehicle pank <br /> <br />Use of Structure: Occupancy: Energy: <br /> <br />Other: No. Stories: Ulna: Height: <br /> <br />Number of Bedrooms: Existing: Proposed: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Sit~Addr~s: 2160 Delores Way C~y: Aurora Zip: 97002 ] <br /> Cross Street: <br /> Phone: <br /> <br /> I Lot: Block <br />Subdivision: <br />( ) Mobile Home park ( ) Mobile Home Subdivision Space #: Total # Spaces: <br />Map: Zone: parcelSize: () SF () AC UGB: ()Y () N <br /> <br />Prope~y Locater: Parcel #: [ Water Supply~ ( ) Private Well ( ) Community Well ( ) <br /> City <br /> <br />CONTRAC~rOR INFORMATION --- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> I am [he PROPERTY OWNER and owm reside in, or will reside in the completed stracmre and will be my own general contractor. I underatand that I must <br /> regis~r as a construction contractor if the stmctare is sold or offered for sale before or upon completion. If I hire subcontractors, 1 will hire only subcontractors <br /> registered with the Construction Contra~-tors Board. if I change my mind and do hire a general contractor who is registered with the Construction Contragtors <br /> Board, I will immediately notify. Marion 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) F_uel__"N" Mart Pep Sto~____(Jarl Arntson) <br /> <br />Mailing'Address: 3246 NE Broadway Portland OR 97232 281-1161 <br /> Street City: Zip: Phone: <br /> <br />() <br /> <br />I am a C~)NTRACTOR registered with the State of Oregon. <br />Business Name (please print): i, iult~_-J.~b~ Broadway Sign Co <br /> <br />Mailhng 3255 NE Braodway Portland <br />Address: .... <br /> Streel ....... City: -- <br /> <br /> Registration #: 64107 <br /> <br />OR 97232 281-'3083 <br /> <br />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) Permit Fee <br />12 ) State Surcharge (~,~ A 1 ) <br />(3) Structural Plan Regiew (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) Seisnfic Surcharge, if applicable 11% xA1) <br /> <br />Miscellaneous Fees <br /> <br />(1) Addl Plan Review / Addendum @ $50/hr, <br /> Minimum one-half hour $ <br />(2) Reinspection Fee ~ $50/per inspection $ <br />(3) Investigation Fee $ <br />(4) thM)ections outside normal business <br /> Hmtrs @ $50/hr, miniman~ two hours $ <br />(5) Inspections for which no fee is specifically <br /> Indicated ~ $50/hr, mi~timum one hour <br />(6) Additional Sets of Plans ~ $10 per set $ <br /> TOTAL $ <br /> <br />hereby certify that thc above information is correct. Permits are non-transferrable mad expire if work is not started within 180 days of issuance or if work <br /> <br />suspended for 180 days. <br />NameofApplicant [Please Print]: Robert Gruber <br /> Malling)atdtT~ 3Z55~NE Broa~.way, Pori:iar. d,OR <br /> <br />Siguature of Applica:tt: <br />MC 15-73 Rev 9/98 <br /> <br />97232 <br /> <br />Date: J, ll~.~ll~- 5: i qOq <br /> <br /> <br />