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FOR OFFICE USE ONLY <br />..,.:;: .... <br /> <br />MARION COUNTY BUILDING <br /> 220 High Street NE <br /> Salem. OR 97301 <br /> <br /> 8:00 a.m.-4:30 p,m, Phone 588-5147 <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPTIi <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. Job Description <br /> <br />LIESJDEN'ITAL <br /> New SI:D w/garage <br /> New SFD w/o garage <br /> Addiinm <br /> <br />[~Acce~ory <br /> Relocate <br /> Demo <br /> Other <br /> <br />FOR OFFICE USE ONLY <br /> <br />COMMERCIAL <br />[ I New [ ]Sign <br />[ I Addition [ ] Demo <br />I I Alteration [ ] Other <br />[ 1 Change~Occupancy <br /> <br /> Usc ~lf Building: <br /> <br />2. Location of Installation <br /> <br />Mobil' omc Park ....... Space <br /> <br />Sec,ion~, Township gZ Range ~ 7~ne ~M Map Wa;erSupply: <br /> ....... Private WeR [ <br />[~t Width b--51 <br /> <br />3. Contractor Information <br />Ptopcf~y Owner Addres~ & Phone No, <br /> <br /> Mailing Addrcg~ & Phone No. <br /> <br />4. Septic information (Check where applicable) <br /> <br />Proposed No. Bcdm,')ms; 'Existing No. Bedrooms: New InstaLlation [] <br /> <br />Test I Iolcs Ready [] Will Call When Test Holc~ Ready [] <br />Existing Site Evaluation [] ExJstlng Site Evaluation No.: <br /> <br /> agree to build according to the submitted plans and sp¢c[fica6ons. Lhe laws of <br /> thc state ol' Oregon and the ordinances o~a~rion Countyr! <br /> <br />Signam~ of Applicant ~ ~ ~ ~~ <br /> <br />5. Fee Schedules <br /> <br />A. New One-and-Two Family Dwelling Code Valuation: $ <br /> (includes El, Me. Pi) <br /> <br />(1) Sq, Fl. __ x .28 <br />(2) 5% State Surcharge (,05 x Al) <br />(3) Base Fcc for Plao Review <br />(4) Zoning Surcharge (If Applicable) <br /> <br />(1) Permit Fee <br /> <br /> 185.00 <br /> <br />Subtotah $ <br /> <br />Valuation: <br /> <br />(2) 5% $lale Surcharge (.05 x B 1) <br /> <br />(4) Plans Check (,(x5 x Bi) ~' <br /> <br />Septic Fees (~neludes DEQ Surcharge) <br />(1) Site Evaluation <br />@) New Septic Installation Permit <br />(3) Authorization Notice <br />(4) Existing System Report <br />(5) Major Repair <br /> Mincrt Rep~tir (tank oily) <br /> <br /> /,,~ <br /> <br />Subtotal: $ ~'~'- 3 <br /> <br />Miscellaneous Peca <br />(1) Driveway w/curb @ $7.50 <br />(2) Driveway w/o curb @ $17.00 <br />(3) Site Plan Review (commercial only] @ $79,00 <br />(4) Investigation Fee <br />(5) Reln~pecllon Fee @ $25.00 <br />(6) Other inspections not listed above <br /> <br /> x $40 = <br />Totah $-~ <br /> <br /> <br />