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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> 1'18IZon Salem,OR 97305 <br /> County 503-588-5147 <br /> r- Permit NA FAX: 503-588-7948 <br /> ottE'G oN. <br /> 555-23-008189—PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Ole Bergman Excavating, Inc. <br /> 1901 S church St <br /> Dallas, OR 97338 �ft� �h,1V <br /> r.• ,�' �` �MlfRi.[R - �,,.ra'+sr>, cwmo " '�' <br /> .w .: <Y «' `1' a �' - a, a .. - < <br /> No Code Edition Specified <br /> • <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: NEW INSTALL: 4 BDRM SFD <br /> is 4 ditiS fr •ZI FORMATI a ', <br /> Property Address: Parcel: Owner: KARLEN,AARON I <br /> 15083 Huiras Ln Ne,Silverton,OR 97381 071W12 00700- Primary <br /> Address: 15083 HUIRAS LN NE <br /> SILVERTON OR 97381 <br /> ^g`.{+';�, r � r -'r s �� � ar r ha s •n; a r; s� a _f <br /> ROFESS ONA._.«, ° , <br /> Business Name License Address Phone <br /> OLE BERGMAN EXCAVATING,INC. Installer 38311 1901 S CHURCH ST DALLAS OR 97338 503-508-3414 <br /> License <br /> 1 _ ._ <aM. a# a r. Aw ,rM , +" sRM_ <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 1.00 GPD $1,050.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,150.00 <br /> Note:This may not Include all the fees required for this project. <br /> This application will expire if application acceptance cannot be achieved within 180 days. <br /> All provisions of laws and ordinances governing this type of work will be complied with <br /> whether specified herein or not. <br /> All persons or entities performing work under this application are required to be licensed <br /> unless exempted by ORS 701.010. <br /> Printed on:09/27/2023 1 std_BuildingApplication.r <br />