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ONLY] <br />Received By: __ __ I <br />Zoning Validation: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 295 Church St, NE - Room 132 <br /> Salem, O~egon 97301 <br /> 8:00am - 4:30pm Phone 58g-5147 <br /> Code. A-Ph~ 588.7904 <br /> FAX 588-7~48 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br /> "07 oreck, us , ONLY <br /> <br />RESIDENTIAL COMMF~CIAL ( )New Use of Structure: <br />(~)agditio. ( )Rdo~tio. ( )agcUtion ( )Sign <br />( ) Alteration ( )Demolitim ( )Alteration ( )Demolition <br />( )Accessory ( )Other ( )Ch~ngeofOc~upancy ( )Other <br />D¢,~riv~o£Wo~:.C,~le ~.,+ t~*~ ................. <br /> <br /> Base-mere:1] M~dn Flcor: "1] Second Flcor:Il ~r: 114~i~hi: ' ........ <br /> i ----. <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br />if I hke subconu-aetor~, I Mil him only subcontraetoi~ reglstr, rcd with the Construction Cc~tractor$ Bmrd. ff I change my mind and do hire a general contractor, I will c~ntract <br />with a c.<mtractor who is registered withe Construction Ceotractofs Board, and wiilimmedhtoly notify Marion County of the name of the cmtracton <br /> <br />Contractor Business name & #: I Mailing Address: I Phone: <br /> ( ) I am a registered bu~Ider OR the authorized representative of a i~egistexed builder, <br /> <br />Architect name: I Mailing Add.ss: ] Phone; <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> <br /> square footage.) <br /> <br /> (1) Permit Fcc <br /> <br /> (2) 5% State Sumharge (.05 x Al) <br /> (3) Structural ?lan Review (.65% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (.40% x Al) <br /> (5) Yxlnislg St~mharge. if applicable (,05% x A 1) <br /> <br />Valuation: <br /> <br />B. Miscellaneous Fees <br /> (I) Dx/veway w/cud> @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17.00 <br /> <br /> O) Site Plan t~vlew (commemal only) @ $79.00 <br /> <br /> (4) Additional Plan Reviews otAddendums <br /> <br /> (5) Investigation Fee <br /> <br /> (6) Reinspectlon Fee @ $25,00 <br /> <br /> (7) Other hispeetions not l~st~d above <br /> <br />P.~CEIPT;. TOTAL <br /> <br />' .. septic, elc~fical, plumbing ~d metrical wo~ require serrate ~ts. Check wi~ Marion County B~lding 1,spe~ion ~fom ~ubmitt~g ~is a~hcafion. <br /> <br /> <br />