Laserfiche WebLink
MARION COUNTY BUILDING iNSPECTION <br /> <br />FOR DFFICi~ USE OJqLY] <br />Receive~ by: ~'~ .~ ~ <br />'Zoning Valldatiom_~''r~°'- I <br />Date: //-~-~ ~ <br /> <br /> US~'ONLYI <br /> Salem, OR 97301 <br /> <br /> FAX 588-7948 <br />MANUFACTURED STRUCTURE PLACEM~ - <br /> PERMIT APPLICA~ON <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH <br />1. Job Description <br /> <br /> (,~) Attached <br />Commercial( ) New( ) Replaeemmt( ) ( ) Detached ] ~ ~ 3~ <br /> <br />2, Location of Installation <br /> a 0'g , <br /> <br /> Site No:, <br />Subdi~sion Lot 1 Bilk <br /> <br />Cross Street ~ ee,,f <br /> <br />I t pth g5 I <br /> <br />Lot Width ~ <br /> <br />Map ' <br /> <br />J Urban Growfl/Boundary? <br /> <br /> Water Supp[)". <br />I Private Well ( ) S?ng <br />{ Comroumt¥,,Well ( ) City <br /> <br /> Contractor Intbrmation <br /> <br />(~) I o~, reside ~, 0r w~ ~side ~ ~e ~m~eted s~u~. ) I undenmd ~at i must ~ter a~ a mnst~m ~t~e~ ff ~e s~ is sold or offe~ for ~a/¢ before <br /> <br /> ) I will ~ my own gmer~ contramog <br /> <br />If I him subcontractors, I will him only subconttactom registered with the Con gini c'rion Contractors Board, <br /> <br />If I change my mind and do hire a genera/contractor, I will contract with a contractor who is m~dstemd with the Construction ContractoFs Boa rd, and will <br />immediately notify Marion County of the naroe of the contractor. <br /> <br />( ) I ttm a registe~d builder R the authorized seatauve' of a registered' builder' <br />Auth°fiZed agea[ °r leaaee: i/~/~ ~ ~ [Mailing Address:, 1,73 j~, [{ Caeeg~ <br />4, F¢~ Schedule <br /> <br />A, (1) Manufactured Horoe <br />or Modular Unit PlaeemenffComleetion @ $182.00= <br /> (2) State Fee @ 20.00 =__ <br /> O) State Surcharge @ 9.10=., <br /> @ 15,oo = <br /> (4) ZOning Surcharge (15,00 if applicable) <br /> TOTAL: $..~ <br />B, (1) Mfg.'d Stroetu~ Storage Fee <br />(2) Mfg.'d Stroemfe Storage Renewal @ $ 23.00 =__ <br />O) Zoning Surcharge (15.00 if applicable) @ 15.00 =- <br /> <br />C, Additional lhsp~tion <br /> <br />D, Investigation Fee <br /> <br />E. Other inqmctlons not listed <br /> @ 40,00 per hour (2 hour roin/mum) <br /> <br />$60 00 :: __ <br /> <br /> @ Sd0 00 = <br /> <br /> TOTAL= <br /> <br />RECEIPT; <br /> <br /> <br />