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MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, OR 97301 <br /> g;00;un-4:30pm Phone 588-5147 <br /> Code- A-Pho~I* 588-7904 <br /> FAX 588-794g <br /> <br />FOR OF¥ICE USE ONLY <br /> <br />COMPI,ETE ALL SEC 1 IONS, 1 THROUGH 4 <br />I. Job Description ~v fl "7 ~1~ <br /> <br />(~) New Single Family Dwelling w/garage <br />( ) New Single Family Dwelling w/o garage <br /> <br />Garage, attached <br />Garage, detached <br /> <br />Tress ( ) or Raaer (~ i t No, Stories ~ l Detached Gitrage llelght: / NO, Bed¢oo,m; ~. <br /> <br />2. Location of Installation <br /> <br />Contractor Information I <br /> <br />Water Supply; <br />Private Well ( ) Spring ( ) <br />CommunityW¢ll ( ) CRy ~ .... <br /> <br />( ) [ will be my own genera] ¢outra~or. <br /> <br />If I hire nub¢ont~aotora, I will hif~ only subcontractors registered with the Coas~Jon Con,actors B~d. If I change Iny mind agd do Mfe a g~al contra~ <br />who.is rog,s{erc~ wifl~ th~ Con~tmcll~a Con,actor's B ~ard, I w. ill~ofify .M~ioa Co~aty of the name ~ ~6 ~OllRaco5: <br /> (~ I an, a registered builder OR ~ ~thori~d r~eae~f a regis~r~ b~lder. ~P/e/ <br /> <br />4. ! ee Schedule <br /> <br />A. New ()ac-and-Two Family Dwelling <br /> (Jnk0des El, Me, <br /> <br /> {1) <br /> <br /> (2) 5% State Surcharge (.05 x Al) <br /> <br />(3) plan Review i I ~'~ $1_85.00_ , <br /> <br />(I) Driveway w/curb 6~ $7,50 = <br />(2) Driveway w/o curb q0 $1 ZOO = __ ..... <br />(3) Addifonal Plan R~views or Addendums = __ <br />(4) Investigation Fee = __ <br />(5) Reiaspection Fee @ $25.00 = __ <br />(6) Other Insp~e6.gJ~s not listed al~ve = <br /> <br /> · O AL $ <br /> <br />MC 15-80 Rev, 1~2 <br /> <br /> <br />