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MARION COUNTY BUILDIN~.INSPF_.cCTI.ON <br /> <br /> Salem OR973~¢ ~ .... ~- ~ ~ ~.~ "J <br /> <br /> Code-A-Phone 588-7904 ~ ~ ~, ~ <br /> FAX 5~-7948 <br /> <br />FOR OFFICE USE ONLY <br /> <br /> DWELLING/STRUCTURAL AND/OR SEP~i~'~E~'~/-~PLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br /> COMMERCIAL <br /> [ I New [ ] Sign <br />]NewSf'D'&!ogarage [ ]Relocate [ [Addition [ ]Demo <br />Addition [ ] Demo [ ] Alteration [ I Olher <br />Alteration [ ] Other [ ] Change/Occupancy <br /> <br /> No Stones I Ba*emcnt Y I ] N <br /> <br />2. Location of Installation <br /> <br />Job Address "~ ' ...... Tax Acer ' ..... Cms~ Street "~-./c, <br />Mobile II c Park ...... Spae~'~ ~ <br />Section ~-- 'l'ownsh,p ~X Range ,~ &) ~nc ~ Map WatcrSuppl~ <br /> ........... Pri~ateWcll [ J SpdrtL. [ ] <br /> <br />Contractor Information <br />Propen wrier Mailin, Address & Phone No <br /> <br />Anth Agcnl~a$c¢ Mating Add.ss & Ph~e No. <br /> &Numar Mailing <br /> Mailing &d ss & l nc <br /> <br />4. Septic Information (Check where applicable) <br /> <br /> Ih)t lIolcs Read> [] Will Call Whom Tc~t Ho[cs Ready [] <br /> <br />]iumI~iOnn Attached [] <br /> <br /> i~ tree and correct Io Ihe best of my knowledge <br />[ { ~ pcrinnninf; wi~tk on a propar~y [ own or occupy <br />[ t,,l'¢I am~. a rcgi~t [~r~xt builder OR [ I the authorized r¢'pr~sentative of a registered <br /> ut[der <br />I ~Uwork will be ped~ed b~ a registered builder <br /> <br />Fee Schedules <br /> <br />A New One-and-Two Family Dwelling Code Valuatlom $.__ <br /> (meludes El, Mc, PI) <br /> <br />D <br /> <br />(1) Sq Ft, ___ x 28 <br />(2) 5% State Surcharge (,05 x Al) <br />O) lqas¢ Fee for Plan Review <br />(4) Zoning Sumharg¢ (If Applicable) <br /> <br />(Permit fee dctemtmed b~ '~aluation <br />El. Me. PI arc ~eparale perm/ts ) <br /> <br />(1) Permit Fee <br /> <br /> 185.00 <br /> <br />Subtotak $_ <br /> <br />Valuation:: <br /> <br />(2) 5% State Surcharge ( 05 x B1) <br />(2) Zc=h'4-~m'el~,rg,. ( 05 ~ )~) ~ ~_ C~ <br />(4) Plans Cheek (65 x [11) ~ <br /> <br />Sc. pIic Fees (Includes DEQ Surcharge) <br />(1) She Evaluation <br />(2) New Sepuc Installation Pcmlit <br />(3) Authon,mtion Notice <br />(4) Existing System Report <br />(5) Major Repair <br /> Minor Repair (tank only) <br /> <br />(1) Ddvewa5, w/curb@ $750 <br />(2) Driveway w/o curb g_~ $17 O0 = _ <br />(3) Site Plan R.e.~icw (commercial only) ~,9 $79 00 = _ .... <br />(4) Invc~tigatmn Fcc <br />(5) Remspcction Fee (O $25 O0 <br />(6) Other in~pechons not li~ted abo',e . x $40 = <br /> <br /> <br />