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I FO~ OFFIC~F~ ~ O~NLY] <br />/ Received by: / ~' ~ / <br />·/Z~n~ng Valida.t, ion:,~ / <br />IDate: ~/ q//~'~ I <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> CO~LET~ ALL SEC~ONg. 1 THROUGH 4 PER~T APPLICATION <br /> 1. Job D~cri' ~aon <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Sueet NE I FOR OFFICE USE ONLY] <br />Salem, OR 97301 i C~ty Set.tek Reqinmmonts: I~ ~ -- <br /> 8:00 arn4:30pm Phone 588-5147 <br /> Code-A-Phon~ 588-7904FAX ~8a-7948 I Left Sid~ <br /> <br />2. Location of Installation <br /> <br />Mo~e lime Pa~ , S~ g Y(~( ) <br />Se~inn I To~s~p 106 Range ~ Z~ ~ <br /> ' Private <br />Lot Wid~ ~ q~. ~ L~ De~h ~ ~ Ae~S I.cg. ~t Comer ~ Co~ffity We~.((, ) Sprig ( ) <br /> ........... > ,¢i~y <br /> <br />3. Contractor Information <br />( ~fI own, m~ide in. or will maid¢ ~11 the completed stmetmm, ' / / <br />( ~I will be my own general co~ttactor. <br /> <br /> If i hire subc. ontractor~. I will him only sub¢omract or~ registered with the Construction Contractors Board. <br /> If I change my mind and do lille a general contractor, I will contract with a cemractor who is registered with the Constmc6on Con[ractois Board. and will <br /> immediately notify Mar~on County of the name of the contractor. <br /> <br /> ( ) I am a reglste~d builder OR the autho/dz~d r~lX~sentative of a mgjst~r¢d builder. <br />~J~l~ ~'~ai[~ir!le:g~ ~ ~' ;7 ' l/~-' Address: [ Phone: <br /> <br />4_ Fee Schedule <br /> <br />A. (1) Manufilaured IIome <br /> <br /> or Modular Unit Placement/Connection <br /> <br /> (2) State Fee <br /> <br /> (3) State Surcharge <br /> <br /> (4) <br /> <br />B, (1) Mfg,'d Structure Storage }lee <br /> (2) Mfg,'d Stmcmm Storage Renewal <br /> <br /> (~) 7tuning Sumharge (15,00 if applicable) <br /> <br />sxs2,o0= <br /> 20.0o <br /> 9. lO= <br /> 15.00 <br /> <br />C. Additionallnapectica~ @ $60.00=___ <br /> or Reinspectlon <br /> <br /> D. Investigation Fee <br /> TOTAL: $g2~2,~ E. Other inspections not ~sted <br /> @ 40.00 per hoar (2 hour minimum) <br />@ $25,00-- <br />@ 25,00 ~ __ <br />@ 15.00 =__ <br /> <br /> ~ $40.00 =___ <br /> <br />TOTAL= $.,~), ~ <br />RECEIlW: <br /> <br />MC 15-64 Rev <br /> <br /> <br />