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Received By:; <br />Date:: <br /> <br />MARION COUNTY4~UILDING INSPECTION <br />SenatOr BId~O. 225 <br />220 High Street NE <br /> Salem~ Oregon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:30 P.M. - 8::e0 A.M. <br /> <br />O w n ~e~,,~ Phone Mailing Address <br /> <br /> ~ / ~¢te ~o :: Cross St~et:: <br /> <br /> Phone:; ~dd~ss:: <br />Home Butlder~ R~istration NO <br /> <br />Residemial:: ~ New:: ~ Additi~h:: ~ Occupancy Use of Building:: <br /> <br /> NO FEE AMOUNT <br />Sase Price $2000 <br />Residential <br />New construction (;&eh fixture) $ 9,00 <br />Alterations (each fixture) ....... __ 900 .......... <br />_,.R,~,~located Residence (ea~,,fixture) 4,50 <br />Commereial <br />New Coq~tructi~"n i~ach fixture ....... (;;;/ ~,,,00 <br />Alterations (each fixture) 900 <br />Water Lines <br />For the first 100 feet ';~- fraction thereof ..... 20,00 ........... <br />For additional 100 feet 1500 <br />Sewer Service Lines <br />First 100 feet or fraction thereof "40,00 <br />Additional 100 feet 15 00 <br />Mobile Home sewer/wafer connection <br />......... (maximum 5 feet length 25 00 <br />Other (as par OSPSC an~i,,BuildJng Official <br /> On-Site Technical Review (apply at Marion Count~ only,,,,,,,,, ~ ...... __ ......... <br /> Re -In epa cti,o.n.,,Fee ................. 2500 <br /> FEE $ lO/ ~)"~) <br />STATE SURCHARGE ?'~)~ .......... <br />PLAN REVIEW FEE $ <br />INVESTIGATION FEE <br />Please return COMPLETE APPLICATION FLEET SURCHARGE $ <br />with the indicated fee. CITY FEE $ <br /> <br />[ am performing work on a property I own or occupy <br />I am a registered builder OR ( ) the euthori[ed representative of SIGNATUR,5 OF APPLICANT <br />a registered builde~ <br />The work will be performed b~ ~ registered builder <br />Other. <br />~ agree t~ i ns~a~ acc~ding t~ the submifted p~ns ~nd sp0ci f~cati~ns~ t~e ]aws ~f t~e ~tate ~f ' <br /> <br />MC 15-45 <br />Rev 12/87 <br /> <br /> <br />