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FOR' OFFICE USE ONLY <br />Received By: <br /> <br /> MARION COUNTY BUILDING,INS~C,TJO~ <br /> 220 High StreetNEj~'~' -- ~-~ <br /> Salem, OR 97301 <br /> <br /> 8:00 a,m,-4;30 p,m, Phone 588-5147 <br /> Code-A.Phone 588-7904 <br /> FAX 588.7948 <br /> <br /> DWELLING/STRUCTURAL AND/OR <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. Job Description <br /> <br />FOR OFFICE USE ONLY <br /> <br />LiCATION <br /> <br />RESIDE-NTIAL <br /> New SFD w/garage <br /> New SFD w/o garage <br /> Addition <br /> Alterat~0n <br /> <br /> CDMMER~iAL <br />[ ] Accessory [ ] New [ ] Sign <br />[ ] Relocate [ ] Addition [ ] Demo <br />[ ] Demo [ ] Alteration [ ] Dther <br />D<] Other~.~,,<.~- ~z~, [ ] ~ange/Occupancy <br /> <br /> Use of Building; <br /> <br />2. Location of Installation <br /> <br /> Sob Ad s ~ ' ........... 'l'~x ct, N ~ Cro~'s Steer <br /> <br /> Sectim .............. Township ~ngc I <br /> Water Supply: <br /> I~tWi ~ t tD / Arms /./~ I~g,~t ,Comet <br />~ / ~ .... ~ <br /> <br />3. Contractor Information <br />Auth, Agent/L.e.~ see ~q <br /> <br />4. Septic Information (Check where appllcable) <br /> <br /> Pmpos~No. Bedr~m*: ~ ExbtbgNo,~cd~m*:~ Ncw~sm~atlon~ <br /> <br /> Test l-I~es Read7 ~ Will Call Wh~ Test I-Ioles Ready <br /> <br />I agree to build according to the submitted plans and specifications, the laws of <br /> the sram of Oregon an~lJgq~tinanc~ou C~unty. <br /> <br />15-75 Roy. 17.90 <br /> <br />5. Fee Schedules <br /> <br />A. New One-and-Two Family Dwelling Coda Valuation: <br /> (includes El. Me, P1) <br /> <br />(1) Sq. Ft. x .28 <br />(2) 5% State Surcharge 605 x Al) <br />(3) Base Fee for Plan Review <br />(4) 7~ning Surcharge 0f Applicable) <br /> <br />Structural Permit <br />(Permil fee determined by valuation. <br /> El, Me, PI are separate permits,) <br /> <br />(I) Permit Fee <br />(2) 5~ State Surcharge (.0~ x II I) <br />('3) Zoning Surcharge 605 x gl) <br />(4) Plans Cheek (.65 x BI) <br /> <br />Septic Fees (Includa~ DICQ $orcharge) <br />(1) Site EvaluaOon <br />(2) New Septic Installatico Perm[t <br />O) Authorizatico Notice <br />(4) .Existing System Repoa <br />(5) Major Repair <br /> Minor Repair (ta~k only) <br /> <br /> 185,00 <br /> <br />Subtotal: $ ....... <br /> <br />Valuation: $ ....... <br /> <br />Subtotah $ "~ <br /> <br />Subtotah $ ..... <br /> <br />(1) Driveway w/curb@ $7.5g <br />(2) Driveway w/o curb @ $17,00 <br />(3) SiIe Plan Review (commercial only) @ $79.00 <br />(4) Investigation Fee <br />(5) Reinspection Fee @ $25,00 <br />(6) Other inspact[ons not listed above ~., <br /> <br />Total: <br /> <br /> <br />