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FOR OFFICE USE ONI]Y <br />R,eceived By: __ ~ ~ ~tA'r~4'~ I <br />i Zotfing Validation: o ~ ,, <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br />COMPLETE ALL SECTIONS, 1 TF[ROUGH 4 <br /> <br />bFOg oFHCv. US ONLY <br /> <br />L Job Description <br /> <br />RESIDENTIAL .... COMMERCIAL tjU ! ,~' (l~),v U~e of Structure: <br /> <br /> ~)Access~ ( )~er ( )~geofO~o~cy '" <br /> <br />Tress( ) or Rafmr( ) [ No, SmSa IOccu~tLm~orNu~o[EmpB~.s .... No. gedmms: <br /> <br />Location of InstaIlatlon <br /> <br />Se~i~ To~p ~nge ~e Map Water Su~ty: <br /> PdvamWell ( )Spring <br />Lot Wld~ '"~ Lot Dep~ ~ ~q Aema I~eg. ~t Co.er Commum[y WeB ( ) Ciw <br /> <br />3. Contractor Information <br /> <br />~) I am a registered bailder OR ~e authorized repre[entative of a regisl~n~l builder. <br /> <br />Architect name: [~L/ <br /> <br />4. Fee Schedule <br /> <br />A. YALUATION($ee "Valuat/on Schedule' <br /> to determine valuation ba~ed m <br /> square <br /> <br /> (1) Pe~it F~ <br /> <br /> ¢) 5% S~te Sumha~e (.05 x Al) <br /> (3) Stmclural 1~ Review 6~% X <br /> (4) Fire & I2fe Saf~W Plan Review (,~% x Al) <br /> (5) 7~ning Surcha~e, if app~cable (.05% X Al) <br /> <br />Valuation: $~.~ ~ <br /> <br />(1) Driveway w/curb @ $7.50 = ,, ,, <br />(2) Driveway w/o ¢~tb @ $17.00 <br />(3) Site PLan Review (commercial 001y) @ $79.00 <br />(4) Additional Phn Rcv~ew,~ or Ad~endum~ <br />(5) Jnvesdgafion Fee <br />(6) Reimpec~iot~ Fee@ $2~.00 <br /> <br />I hereby ~¢rti fy.~. at the above information s correct and that [ have mad and undemand the Information Nor.ce to Ih'oper~y Ow~lers about ConsUl et on Responsibil tle~ on the <br /> <br /> Site evaluations, ~eptie, electrical, plumb~.~d mechanical work require separate permits, Check with Marion County Building Inzpection b~fore ~ubmitting this application, <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />