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[FOR OFFIC~ uSE ONLYI. <br />Received By:' ~.t~'.~ 4 .~.Yk~ <br /> <br /> Date: ~ - d Z '~ --,,,~ <br /> <br />MARION COUNTY BUILDING iNSPECTiON <br />220 High Street NE <br /> Salem, OR 97301 <br /> $:00arn.4:30pm phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br />:OFFICE USE ONLY <br /> <br />COMPLETE, ALL SECTIONS, 1 TIIROUGH 4 [~ <br />1. Job Descrlptlon ~ 1 O 1993 __ <br /> ( <New Single Family Dwelling w/gm'ag; ( l,(Garage, attached MARION C0~J~T¥ <br /> ( ) New Single Family Dwelling w/o garage ( ) Garage, detached BUILDING INSP[C¥10N <br /> <br />Truss ( VJ or R.q'ter ( ) [ No. Storle~ ! [ D~taehod Garage Height: [ No. B~droonm: ~ <br /> <br />2. Location of Installation <br /> <br />.... ,,,,, <br />Mobile I~o~ P~k S~ ~ <br />~'°n~ b ~_6' *owns~,,,,,~S Ran~" '~ ~no ~ .... Map Wat~Su~ly: <br />Lo~ Widff~ /~/ L~Do~h ........ //0 / Aer~q I~eg. ~t ~ C~er ~ Commumiy~vate Wellwell(()) Spring(city~(~ ) <br /> <br /> 3. Contractor Information <br /> <br />(~r";wn, re~ide in, ~ will ;eside in thc completed s~t~. <br /> <br />If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor <br /> <br /> ( ) I am a registered builder OR the authorized representative of a r~gistered builder. <br />Architect name; [ Mailing Address: <br /> <br />4, Fee Schedule <br /> <br />A, New One-and-Two Family Dwelling Code <br /> (inlcude, q El, Me, FI) <br /> <br />(2) 5% State Sureh~e 605 x Al) = ~¢, ~ <br />(3) Plan R~view = ,~185,~ <br /> <br />B, Miseellanec~l$ Fees <br /> <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17,00 <br /> <br /> (3) Additional Plan Redew~ or Addendums <br /> (4) Investigation Fee <br /> (5) Rein~!oeodon Fee ~ <br /> (6) Other lasl~ctions not listed abov~ <br />RECEIPT: ~ ~g/~ ...... <br /> <br /> I hereby certify th~.l tile above irrformation is col'r0e and d a I have read and under~tand the Info,marion Notdee to Property Owners abo~lt Construction Responsibilities oil tile <br /> reverze side of this form, <br /> <br /> Site evalua6ons, septic, elearical, phmlbJng and mechanical work reqtfire serrate ~mitq. Cbcek with M~ion County Bud ng ~c~ on kfom subm tng ~Js application. <br />MC I5-80 Rev, lg)2 <br /> <br /> <br />