Laserfiche WebLink
FOR OFFICE USE ONLY <br /> <br />MARION C~LINTY BUILDING INSPECTION <br /> <br /> 8:00 ~,-4:30 p.m. Phone 598-5147 <br /> ,~ ~ Co~-A-Phone ~8-7904 <br /> -- FAX 58~-7948 <br /> <br /> DWELLING/.q.T~UL~L AND/OR SEPTIC <br />COMPLETE ALL <br />1. Job Description <br /> <br /> FOR OFFICE USE ONLY <br />PERMIT APPLICATION <br /> <br />RESIDI~NTIAL COMMERCIAL <br />[ ] NewSFDw/garage [ ] Accessory [ ] New [ ] Sign <br />I } NewSFDw/vgaraga [ ] R~ocate [ i Addition [ ]Demo <br />] I Additkm [/~}~Demo [ ] Altctalion [ ] Other <br />I 1 Alteratkm [ ] Other [ ] (,~ange/Occupancy <br /> <br />Location of installation <br /> <br />l~l Width ~t De~th Acres I~eg' L°t '/0N ~°meea ~ O~ Commtmity Wet[ 'riw~te Well [J J] CitySprthg <br /> <br />3. Contractor Information <br /> <br />~-~ Mailing Ad~tess & Phone No ffq~]-'~ <br /> <br />Mailing Address & Phone No. -~ 7 ~ <br /> <br />Mailing Address & Phone No, <br /> <br />Mailing Address & Phone No, <br /> <br />4. Septic information (Check where applicable) <br /> <br /> Test I lole~ Ready ~ Will Call Whom 'l'e~t ~lole~ R~u~dy [] <br /> <br /> Date Tank Last Pumpcxl: <br /> Pumper Foerrl Ap. ached [] <br /> <br /> am pcrformlnt; work on a property I own ot o~cupy. <br /> <br /> builder. <br />'l~e ~'~>rk/g'ill be pe.~ formed by a l'egistcrcd huikl~r,.~ <br /> <br /> agree to huild ac~rding lo ~c su~nJlled plan~ arid ~pecification~e ~ws <br /> ~a ~tam of Oregon ami thc 9tdinance~ ofMar o C~9pt <br /> <br />5. Fee Schedules <br /> <br />(1) Sq. F[ .... x .28 <br />(2) 5% State Surcharge (,05 x At) = -- .... <br />(3) Base Fee for Plan Review 185.0~J <br />(4) Zoni~lg Surcharge 0f Applicable) <br /> <br />Subtotal; $ <br /> <br /> (1) Permit Fee <br /> (2) 5% State S0rchargc ~1~I~[) .~7- r'~ .a_,.~ <br /> <br /> (4) I lens Check (.65 x BI) ~ <br /> <br /> Septic Pees ~ncludes DEQ Surcharge) <br /> <br />(2) New Septic l~lsm~ation <br />O) Au~ofi~afi~ Nmine <br />¢) Extst~g Sy~mm Rep~ <br />(5) Major Repair <br /> Min~ Re.ir (Unk ~ly) <br /> <br /> (1) Driveway w/curb ~ $7.50 = ~ .... <br /> (2) Driveway w/o curb ~ $17,00 = <br /> (3) Site Plan Review (c~l~nemial only) (~ <br /> (4) Invcatigalion Fee <br /> <br />(5) Rcinspection I~ee (~ 525.00 <br />(6) Other inspections not listed above <br /> <br /> x $40-' <br />Total: <br /> <br /> <br />