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FOR OF~CE USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, OR 97301 <br /> <br />s;00 e,m.-4:30 p.m. Phone 588-S147 <br />Code. A.Phone 588-7904 <br /> FAX 588.7~48 <br /> <br />FOR OFFICE USE ON~ <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 ~ ~" <br />1. Job DeScription ~ ~ <br /> <br />RESIDENTIAL / COMMERCIAL <br />] New SFD w/garage [Ol/Ace~oq, [ ) New <br />] New iFD w/o garage [ ] Relocate [ ] Addition <br />] Addition [ ] Demo [ ] Alteration <br />] Alteration [ ] Other [ ] Ciaange/O¢cupancy <br /> <br />i I ~mou <br />[ i MARION COUNT¥ <br /> BUILDIN~ INRP~0T!( <br /> <br /> / IB..em=,, <br />2. Location of Installation <br /> <br />'J~h A(klress J~2 "T' ~C-(~'[5AZ~¢.~,, ~-M' '~ / ..... Tax Acct. ~o. <br />Subdivi~io, ' bt Block <br /> <br /> ¢ " I~.Lot C~ " Private Well [ ] Spring [ ] <br /> <br />I. Contractor Information Fee ~cffedules <br /> <br />Mailing Address & Phone No. <br /> <br />Contractor llusioc~ Name & Number Mldlmg Address & Phone No. <br /> <br /> ~e'hiw,;!.,, Mailing Address & Phone No. <br /> <br />4. Septic Information (Check where applicable) <br /> <br />Proposed No. Bedrooms; Eot {gtlng No. Bedrooms: New Iilstallation [] <br />Preposed Site Evaluation [] <br /> <br />]~xistiog Site Evaluation [] Existing Si[e Evaluat[on No.; <br />Proposed Iflstallation Per, it [] <br />-Existing ~¢ptie System [] <br />i'Xbting Dtairffield t.ength: Tank Size: <br />Da*e Tank Last Pomped: <br /> <br />[~ am performing work on a property I own or occupy. <br /> ] Other <br /> <br />agree to boild according to tho sulmlit~.d plans and SpeciBcatiotls, the law~ of <br /> <br />New One-and-Two Family Dwelling Code <br />(inalude~ P.1, Me, Pi) <br /> <br /> (1) Sq. Pt, ____ x .28 <br /> (2) 5% State Sumharge 605 x Al) <br /> O) Base Fee for Plan Review <br /> (4) Zoning Surclmrfic t~.~licable) <br /> <br />Structural Permit <br />(Permit fcc determined by valuation. <br /> El, Me, PI are separate permits.) <br /> <br />(1) Permit Fe~ <br />(2) 5% State Surcharge 605 x B 1) <br />O) Zoning Surcharge 603 x Bi) <br />(4) Plans Cheek 665 x BI) <br /> <br />C. Septic Fee~ (Includes DEQ Surcharge) (1) Site Evaluation <br /> (2) New aerie InstaEation P~rmlt <br /> O) Aulhccimfion Notice <br /> (4) Existing Sysmm Report <br /> (5) Major Repair <br /> Minor Repair (tank rely) <br /> <br />(1) Driveway w/curb@ $7.50 <br />(2) Driveway w/o curb @ 817,00 <br />('3) Site Plan Review (cOmmercial only) @ $79.00 <br />(4) l,~'vestigatlon Fee <br />(5) Reinepectic&n Fee @ $25.00 <br />(6) Other in~pections not listed above <br /> <br />185,00 <br /> <br />Subtotah $., <br /> <br />Valuation: <br /> <br />Subtotal: <br /> <br />Subtotal: $__.___ <br /> <br />Total: <br /> <br /> <br />