Laserfiche WebLink
FOR OFFICE USE ONLY] <br /> <br />Date: 17 ' /~''°-f~' } <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street <br /> <br /> 8;00am - 4:30pm Phone 585-fi147 Code-A-Phon~ 588-7904 , <br /> <br /> BUILDING PERMIT APPLiCATJDM-~v <br />CO~LE~ ~L S~CTIONS, 1 T~OUOH 4 ~0 0~t~.-~ ~,~¢gn~[9~ <br />1. Job Descripti~ <br /> <br />' FOR OFFICE USE ONLY <br /> City Setback Rextuiremcn~: <br /> <br />RESIDENTIAL COMMERCIAL ( i~/ew Use of Stmeturm <br /> <br /> ( ) A~di[io~ ( )R,loeafion ()Addition <br /> ( ) Alteration ( )Demolition ( )Alteration ( )Demolifon <br /> ,,.(~Aeeesmry ( )Other ( )ChaageofO¢¢ul~acy ( )Other <br /> <br />2, Location oflnstallation <br /> <br />Subdlvi*ion ~ Bilk <br />S~ %~sNp ~gc Z~c Map Wa~r Supply: <br /> ...... , ..... PfivateW¢][ ( )$pring ( ) <br /> <br />3. Contractor Information <br />rropet~yOw~ ~o.~4-b~ a,~ ~'~t-W>' IMaaias^d~ss 11373 <br /> <br /> ( ) ~ un~e~m~d ~at ~ must ~s~ as ~ e~st~e~ eon~ ~ ~c s~u~ ~ssold or offend ~ sale <br /> <br /> ( ) I wi~ ~ my o~ gme~l <br /> <br />If I him subcontractors, I will him oaly subc~ntractOr~ registered with the Construction Ccauactots Boa~. If i change my mind and do kite a general ¢otltraetor, I will contract <br />with a contractor who ia registered withe Cone. motion Contractor's Board, and willimme;liattly t~otify Marion County of th~ name of the contractor. <br />ContracmrBusincs~name&# h f'J....,,~., fJJ...2~L IvlailingAddress ~ <br /> (~) I am a regis~red builder OR m, attthoriz~d repmse~lt~tlv¢ of a regiaemd builder, mlle,~ <br /> <br />4. Fee Schedule <br />A, VALUATION (Se~ "Valuation Schedule" B. lVliseellan¢o~s Fees ~ ~ '7°~- ....... <br /> <br />io det~mfine valuation bas¢d on ~ <br />squam f~mge,) Valuation; <br /> <br />(1) Pe~it F~ <br />(2) 5% State Sumhame 605 x A I) = <br />(3) Structural Plan Review (.~% x A I ) ~ <br />(4) Fire & ~fe Safety Plan Review (.~% x Al) = <br /> <br />(1) Driveway w/curb @ $7,50 <br /> <br />(2) Driveway w/o curb @ $17,00 <br /> <br />(3) Si~ Plan Review (commercial e~ly) @ $79,00 <br /> <br />(4) Additional Finn Reviews or Addendums <br /> <br />(5) Investigation Fee <br /> <br />(6) Relns~eetioo Fee @ $25.00 <br /> <br />C/) Other Insl]e~rions not listed above <br /> <br /> (5) Zoning Sumha~ge, if applicabl~ (.05% x A 1) = -- <br /> <br />hereby certify that the above ~nformafion is ~[ ~d ~a[ [ ~ve mad and undemmd ~e ~atim Notice to Pr~eny O~er~ abmt Construction Responsib~fies on ~e <br />reverse side of ~is fo~, <br /> <br />Rev. 11/91 <br /> <br /> <br />