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FOFt OF~C~ USE ONLY MARION COUNTY BUILEI~ II~I~C~O~ ~ ~OFFICE USE ONLY <br />' __~~_~~ 220 High Stre~ ~ ~~ .......... <br /> <br /> Code-A-Phone 588-7904 - <br /> FAX 588~7948 <br /> DWELLiNG/STRUCTURAL AND/OR SEPT~WS~;~ <br /> COMPLETE ALL SECTIONS 1 THROUGH 4 <br /> 1. Job Descrlpflon <br /> <br />RESIDENTIAL <br />[ ] New SFD w7 garage I ,Accessory <br />[ ] New SH) ,.~l~ garage ] Relocate <br />I [ Add/hen ] Demo <br />I I Yhcranon ] ()thee <br /> <br />COO~MI~ ERCI ~,L <br />[ ~Ncw [ ] Sign <br />[ I Addition [ ] Demo <br />[ 1 Aheratxon [ ]()filer <br />[ ] Change/Occupm/cy <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br /> Property Owner ~.~ Ma~ling Add.ss & Phone No <br /> <br />Mailing Address & Phone No <br /> <br /> Name & Number Madras Address & Phone No <br /> <br />4. Septic Information (Check where applicable) <br /> <br /> l'est 1 loleg Ready ~ Will Call When '1 esl Ilolea Read~ ~ <br /> <br /> builder <br /> l~e ~ork wdl be performed by a registered builder <br /> O~bcr <br /> <br /> thc state el Omgor~a~tda~c~non County <br />Signamte<~f,&pplicant I.-t '~F ~~ <br /> <br />5. Fee Schedules <br /> <br />A New One-and-Two Famdy Dwelling Code Yaluation~ <br /> (includes E1 Mc PI) <br /> <br />C <br /> <br />(1)Sq Ft__x 28 <br />(2) 5% State Surcharge (05 x A 1) <br />(3) Base Fee for Plan Review <br />(4) Zoning Surcharge iff Applicable) <br /> <br />(]) Pemfil Fee <br /> <br />SubtotaEl -- <br /> <br />(2) 5% State Surcharge (05 x B 1 ) <br /> <br />(4) Plans Check ( 65 x B1 ) / <br /> <br />Subtotal:; <br /> <br />Septic Fee~ (Includes DEQ Surcharge) <br />(1) Site Evaluation <br />(2) New Septic fn~ta[lat~on Permit <br />(3) Aulhorization Notice <br />(4) 'Existing Ss~mm Repor~ <br />(5) Major Repair <br /> Minor Repai~ (rank ~nly) <br /> Subtotal:; <br /> <br />(1) Driveway w/curb@ $7 50 <br />(2) Drbeway '*/O curb @ $1700 <br />(3) Site Plan Re~te,~ (commercial ~lly) ~ $79 ~) <br />(4) ~es[igatim Fee <br />(5) Re~8p~tion Fee @ $2500 <br />(6) O~er ing~clions not Ii,md able x $40 <br /> Total:: <br /> <br /> <br />