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MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Street N'~ -, q_~,,~ir~-4,FOR OFFICE USE ONLY] <br /> Salem, ~"4~g ~ X~'~/~ ~ ~ / ~ ~itY ~e'ba~'k Requlrements'' / <br /> <br />COMPLETEALLSF'CTIONS. I THROUGH 4 MABION COUNTY q~_ <br />I. <br /> <br /> ( ~5 Altached <br />Commercial( ) New( ) Repheement( ) ( ) ~etached <br /> <br />Manofacmrm'a Year of Color of Lengthl W}dth: <br /> <br />2. Location of Installation <br /> <br />Subdivision ~ [Bi~, Urban Gmwlh Bou~da~? <br /> <br />Seaim ffff Town~p ~$ Rsng,2~ Z~e ~ Map Wa~rSupply'. <br /> Pfivale Well ( ) Sp~g ( ) <br /> <br />3. Contractor Information <br />P~pex~y Owner [ Maili.g Address" [Phone No. <br /> <br />If I him subcontraetom, I wSll h~re only sub¢ontractor~ registered with the Con~lraction Conta'actor~ Board, <br />If I change my mind and do him a general contractor. I w/Il contract with a contractor who i~ m~stered with the Constru¢6on Contractor's Board, and wiII <br />mediately notify Marion County of tho name of the ¢ontracton <br /> <br />Contraotor Buslness Name & #' <br />(~) I am a registered builder OR the authorized representative of a t~gistemd builder. ' /,/ca~/ ' <br /> <br />4. Fee Schedule <br /> <br />A. (1) Manufactared Horn¢ <br /> or Modular Unit Placemem/Conncc~ion <br /> <br /> (2) S~ate Fe~ <br /> <br /> (3) State Surcharge <br /> <br /> (4) Zordng Surcharge (15.00 if applicable) <br /> <br />e ~ "/,,,*..a<'- <br />e <br /> <br />B, (1) Mfg.'d Stmemr~ Slorage Fee <br /> @ $ 25.00--__ <br /> (2) Mfg?d Stmemm Storage P~newal @ 25,00 ~_ , <br /> O) Zoning Surcharge (15.00 ff applicable) @ 15,00 = <br /> <br />C, Addillonal Inipe¢Oon Q3 $60.00 ':__ <br /> <br />D, Inve*~gafion Fee <br /> <br />E. Other ~nSl~c[ion~ not listed <br /> @ 40.130 ~r hour (2 hour minZmmm) <br /> <br /> <br />