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' ' MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:IXI am-4:30pm Phone 5884147 <br /> C-ode.A.Phone 588-7904 <br /> FAX 588-?948 <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICATION <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 <br /> <br />1. Job Description <br /> <br />FOR OFFICE USE,ONLYI <br />Receivdd b.y:~ <br />Zoning Valid~ion~ <br />Date: x¢/t <br /> <br /> FOR OFFICE USE ONLY <br /> Oty Setback Requirements: <br />p~t: ~.~ / ]R~.r; 1 ~ / " <br />]L*ZtSia~; ~-/ }mgbtSae, ~'-/ <br /> <br />2. Location oflnsmlhtion <br /> <br />Sealon ] Z~e t~. g. <br /> <br />'ibwnsMp l(..9 ~. Range <br /> <br />Site No, <br /> <br /> Map l'tiva[eWa~ ( ) Spring <br /> Comer C0mm}~ly WO { ) City <br /> <br />3, Contractor Information <br /> <br />Owner I Mailing Addmsl [Phone No. <br /> <br />( ) I o~, mslde in, or will reside in the completed stmctu{~. <br /> <br />( ) I will be my ow~ gcmeral contractor. <br /> <br />If I hire mbcontractors, l will hi~ only subcontractor~ mgistcxed with thc Construction Contractors B oa~'l, <br />If I change my mind and do hire a general contractor. I will contract with a contractor who is registered with the Construction Contractor's Board. and will <br />hmnedhtely notify Marion County of thc name of ~ho contractor. ~ 6[,.~ ,;~ <br /> <br />( ) I am a regi~erexl builder OR the authorized representative of a regismmd bu/lde, r. <br /> <br />Authoriz/~d agent or leasee: IMalllng Address: [ Phone; <br />4. Fee Schedule <br /> <br />A. (1) Manufactured Home <br /> <br /> or Modular Unit l'lacem~l/Conneetion <br /> <br /> (2) State Fee <br /> O) State Surcharge @ 9,10-- <br /> @ 4z~D0 -. __ <br /> <br /> TOTAL: <br /> <br />B. (1) Mfg.'d Structure Storage Fee <br /> @ $ 25.00 = <br />(2) Mfg,'d Smlcmm Storage Renewal @ 25,00 = <br />O) Zoning Surcharge (15,00 it= applicable) @ 15.00 = <br /> <br />@ $182.00= Hg~,OO <br />@ 20,00 = ~.~4D. <br /> <br />C, Additional Inspection (cO $60,00: <br /> or Rcthspectlon <br /> <br />D, Investigation Fcc <br /> <br />E. Other in specfion s not 3J sted <br /> @ 40,00 per hour (2 hour minimum) <br /> <br /> $40.00 <br /> <br />RECEII~I': <br /> <br />~ervi~e or plumbing w~tcr/mw~r llne~ are ~eparate teqnlr~d permits, <br /> MC. 15,64 R~v 11-91 <br /> <br /> <br />