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"· - '~ DEPT. OF BUlLiNG INSPE~ION
<br /> Senator Building ~225
<br />App). Recd.; 2~ High St,,. N.E_ 2nd Floor
<br /> Salem, Oregon 97301
<br />By: ~h~i ~ 588-5147 -- 5~51~
<br /> 5:~ P,M ........................ COOeR-Phone ................... ~:0~ A_M,
<br />o~l~: 5-~3-~ ........
<br />
<br /> elac. #295;
<br />By' P~ttg
<br />
<br />Type of Permit::____ ~.~iLbile Home placement - ~d~.~? ~ ~; e{'~ I...~[N~'~-;~' , ,
<br />
<br />Owner: Run Pearegn
<br />
<br />Phone:_ 678~5939 Address: 77&-73 F~y R~4. N.~,
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<br />Bldr,,& No,,;.... Bill Bt-~mb,~u~h~ iv?~ , Phone:,,,,,, ~63.fi~0~ Address: 11f)~ .~ ~,,,A~-~ Rd, , Q701'~
<br />
<br />Plans by: Phone: Address:
<br />Usa of 81dg ~f~ B~rms,~ ~/~Jfl FI~,, FrDII! Sial08 R~
<br />
<br /> Lot No:: , Blk, No,: Sub. dy,: ............ I otSize:__ A!~xll~orner? D.O
<br /> Ares of Bldg,, 2nd Base- TOtal
<br /> Main Fir; Fit,; ~erlt: . Area: ~ ValuafloI1; , ....
<br /> Bldg, Permit 50.00
<br />Roof Type: _ Truss/Stick: Height: Fee: (+ 5%) . ~ _ 5.0
<br />Heating Wood Water
<br />System: .... ~tove: ,9~Jpply: ',.,;*,,> 1 "l .
<br />Septic Tank New
<br />Si[e Eval.: .... instal.;
<br />Exist, No.
<br />System: ym ~ , ..... Gals,:
<br />
<br />VALIC~ATtONS;
<br />
<br />I a tee to buHd acco/die 0 th ~t'/~
<br /> g ' g I e subm' ted plan afl~ 8p~c~fi~atlons, the laws Of the
<br />3tats of Oregon a~ the O~dtna~c~ of MariOn County. PERMfT EXPIRES IF WORK
<br />NOT COMMENCED WITHIN 1SO DA YS. / further e~presSly warrant that I compJy W#~
<br />the provisions of OR~ 701.~5 to 701. 125
<br />
<br />I am performing work or; a property l OW~
<br />or occupy
<br />I am a registered builder OR ( ) the
<br />authorized ~epreaentaJiva of a
<br />registered builder
<br />
<br />( ) The work wi//be performed
<br /> by e regi8tered builder
<br />( ) Other (please specify)
<br />
<br />REMARKS!
<br />
<br />Dobi~:~ proper~F. , Rome b~ 3~00 ~
<br />
<br />Elect. Fee: . AD:r~ .....
<br />
<br />Mech, Fee;
<br />
<br />Plumb. Fee:
<br />State
<br />Burchame: (4%) 3.60
<br />
<br />Plan~ Chk, Fee:
<br />Septic Tank
<br />Permit Fee: 6-0, ,00
<br />
<br />OEQ Surcharge; __ 5_~3~
<br />
<br />TOTAL FEE:~I ~1 ~ ~
<br />BLDG.
<br />
<br />Review Fee: , , ~ V / ~(,.
<br />
<br />I have reed fh~ application ~~stated information is true and correct to the best of my knowledge.
<br />
<br />S~GNA'TURE OF APPLICANt'; ~ ~.~
<br /> P~EASE NOTE: Driveway and sidewalk ;nspectiOn a~e required by Public WOrks:
<br />
<br /> Other permits required by this dept; Plumbing D Ele~ricsl D Me~han;ca~
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