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FOR' OI~FICE/;~.4SE 9jN,LY MARION COUNTY BUILDING iNSPECTION I FOR OFFICE USE ONLY <br />[Zoi~ngValidation: .o? ,~ Salem, OR9730[~ i~ q~ [1~ /J ~/ ~t.l ii,.~,~.` "ll~ear; ~; <br /> 8:~ - 4:3 ~e 5~7 '~e~'" '" ~ Ri tSide <br /> <br /> BUmD G PERM APPLIC TJ $ <br /> CO~LE~ ~C SECTIONS, 1 T~OUGH 4 BUILDING INSPECTION <br /> 1. Job Description <br /> <br />RESIDENTIAL COMMERCIAL ( ) New , <br /> Use of Structure: <br />( ) Acces~o~ ( )Other ( )ChangeofO¢cupancy ( )Other <br /> <br />Tms~( ) orRaffer( ) & {~o, Szfies / ~....lOc[upant~dorNumberofEmployee$ ~ No, Bedrooms: ~ ....... <br />Square F~t: ...... B'a'~ment: .......... M~ Flmr': ~ , ........ Se'- ~ ~d Flmr: ~her: ................. , ...... Height; ..... <br /> <br />2. Location of Installation <br /> <br />Subaivision Z~C OS ~ ~ L~ ..... ~ "~l~k ,~ ~ <br />Mob~e Home Park S~ce ~ <br />I ..... Comer "~O PrivaLe Well < )Spriag < ) <br /> <br /> ................. Commu~iLy Well ( ) CiIy ( L~- <br /> <br />3. Contractor Information <br /> <br /> (~ I own. reside m. or wffi reside in the complel~d ~tm~u~, / <br /> ( ) ~unde~amt~a~mu~tmgisterasae~nsmm~n~m~t~rif~estm~um~ss~M~r~emdf~rsa~ebe~e~r~cmp~e~m. <br /> (~ I will be my o~ g~eral contra~or. <br /> <br />if I him subcontractors, ! will hire only subcontractors regist~ed with the Constmetlon Contraeton~ Board. If ! change my mind and dr) tfirc a general contractor, I wilt contra¢l <br />with a contractor who {s reglstered withe Construction Comractor% Board, and will immediately notify Mar{on Counw of the name of the ¢otg racier, <br /> <br />Contractor Business name & #: ] Mailing Address: ] Phone: <br /> <br />( ) I am a registered builder OR the authorized representative of a registered bellder, <br /> <br /> 4. Fee Schedule <br />! A. VALUATION (See "Valuation Schedule" <br /> <br />(I) Permit Fee <br /> <br />(2) 5% State Surcharge (,05 x Al) <br /> <br />(3) Smlclund Plan Review (,65% x A 1) <br /> <br />(4) Fire & Life Safer7 Plan Review (.40% x Al) <br /> <br />(5) ' ' ~ . appicable(05%xAl) <br /> <br />(I) Driveway w/curb @ $7.50 <br /> <br />(2) Driveway w/o euvb (-o~ $17 00 <br /> <br />(3) S~tc Plan Review (commerc~el only)@ $79~00 <br /> <br />(4) Add~tlonel Plan Reviews or Addendums <br /> <br />(5) Investigation Fcc <br /> <br />(6) Reinspectinn Fee @ 525,00 <br /> <br />(7) Other Iqspeclions not listed above <br /> <br />Name of AppliCa*t (Please l>fin~: <br /> <br />MC 15-73 Rev. II/9I <br /> <br /> <br />