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..[FOR'OI~-FICE USE ONLY <br />]Receiv~ By: ~ - - <br />[Zoning Validation: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> g:OOam - 4;30pm Phone ,5,$8-5147 <br /> Code-A-Phoa* 588- 7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 T/[ROUGH 4 <br /> <br />1. Job Description <br /> <br />RJSSID~N'I1AL '" -'COMMERCIAL ( )New Useof,q~ac[[~¥"~l~ L~UUI~ i Y <br />()Addition( )~O*.,SO,~ ( )Aaai~io. ( )Sig. -BUILDING INSPECTION <br />( ) Almrafi~ ( )Demolifim ( )Mterafion ( )Demo~don <br />( ) Aece~o~ ~ O~er ( ) ~ange of Occupancy ( ) O~er <br /> <br />DesefipfimofWo~; ~EW ROOF 0H SE~I~G R00~ - SEE S~D~ FREILIHGER <br /> <br />Location of Installation <br /> <br />PropenyOwner VINCENT ROBERTS I. MaillngAddress 14081 CESSNA N.E. <br /> Phone No. <br /> 678-5288 <br />JobAddrcss 14081 CESSNA N.E. TaxAcct. No. 1-74920-130-~. Cross Street BOONES FERRY <br />AURORAt OR 97002 I SiteNo. <br />Subdivision [ Lot 13 Btcxzk <br />Mobile Home Park SUNSET MOBIL ESTATES 'Space# <br /> <br />Sect/oil Township Range Zone Map Water S0pply~ <br /> PrivamWell ( ) Spring ( ) <br />botWidth 70' LotDcptb 100' Acres Ifmg, Lot Comee Communit)'WellXX) City ( ) <br /> <br />3. Contractor Informatinn <br /> <br />PropenyOwncr VINCENT & CHARLENE ROBERTS IMaillngAddmss 14081 CESSNA N.E.AUROI~FhoncNo: 503-678-5288 <br /> <br />own, reside in, or will reside in thc completed structure. <br /> <br />understand that ][ must register as a construction contractor if cbc structure is sold or offered for amc before or ulmn ecnnplction, <br />w/I/be my own general contracton <br /> <br />Co rector Bua ~e~s ~a~ e & #: I Mailing Address: ] Phot~¢: <br /> ( ) I am a registered builder OR the authorized representative of a mgistereg builgen <br /> <br />Amhitcct name; I Mai/icg Address: I Phone: <br />4. Fee Schedule <br /> <br />A. VALUATION (See "vainatio~l Schedule" <br /> to determine valuation ba~cd em <br /> square f~x>tage.) <br /> (1) Pefmk F~ <br /> <br /> (2) 5% State Surcharge (.05 x Al) <br /> <br /> (3) Structural lqan Review (.65% x Al) <br /> <br /> (4) Fire & Life Safety l'lan Review (,40% x Al) <br /> (5) 7~ning Surcharge, if applicable (.05% x Al) <br /> <br />Valuer/or <br /> <br /> 0 <br /> <br />;0 <br /> <br />B, Miscellaneous Fees <br /> (1) Driveway w/curb @ ,$7.50 <br /> <br /> (2) Driveway w/o curb @ $17.(Xl <br /> <br /> (3) Site Plan Review (eomnlerebl only) <br /> <br /> (4) Additional Plan Reviews or Addendums <br /> <br /> (5) ~v¢stigafion <br /> <br /> (6) Reins~ctim Fee ~ $25.00 <br /> <br /> U) O~er ~s~cfions not l/smd above <br /> <br />TOI \1. $ <br /> <br />I bcrcby certify dtat the above information is correct and that [ have read a~ld lllld¢13t4~ld the hlfomlatiott Notice to Property Owners about Construction Responsibilities on lhe <br />reverse side,of thi,~ form. " <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />