Laserfiche WebLink
IFOR CITY VALIDATION <br />Receive~l By: C~/5~ <br />Zoning Validation: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br />IFOuR CIT~Y USE ONLY <br />City Setback Requirements: <br /> <br />Front:~,~ t Rear: ,,a~'-/ <br />Left Side: 5' IRight Side: ~ / <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbin~ fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 t ~t, ~ (1 [ <br />1. JOB DESCRIPTION ~ ~d,/. / > ,,,~'{' ~' <br /> (~New Single Family Dwelling With Attached Garage t <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br /> ( ) New Duplex <br />Energy Path: J ] No. Stories // ] Det~bed Gauge.eight: <br />Square Feet: Basement:: I Main Floor: jOa~F ~ Second Floor: Garage: ya~2~ ~ <br /> <br />No, Bedrooms: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />JobAddress ~' 20 /~ ~//~t'/.~ <br /> <br />Su~ivision ~$aal~ ~o~ <br />S~fion ~y'' Township ~ <br /> I <br />~tWid~ y~,~ ~tDep~ ~//, ~ [ <br /> <br />Range <br /> <br />Acres <br /> <br />Mailing Address ~p/a~,/~ ti ?/~/ <br /> <br /> Tax Acct. No. ~/,,,~ <br /> <br /> I~eg. Lot ~0 ] Comer <br /> <br />Block / <br /> <br />Water Supply: <br />Private Well ( ) Spring <br />Community Well ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I must register as a construction <br />contractor if the structure is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. <br />If I change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately notify Marion County of the name of the contractor. <br />I am a CONTRACTOR registered with the State of Oregon. <br />Busines~me / Registration No. <br />Mailing Addre~ ar ~ /.~//~9/ S~3; ~,/ ~/' ~3L9 ~hone ~g 5"~ ~vOa~2fS <br />I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />(please print) <br />Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> GrossSqFt / 7o29 <br /> <br /> 1. PERMIT FEE: <br /> <br /> Gross Sq Ft <br /> <br /> * Building @ <br /> Electrical @ <br /> Mechanical <br /> Plumbing <br /> TOTAL <br /> <br /> 2. PLAN REVIEW FEE: <br /> <br /> Gross Sq Ft <br /> <br />x 64.66 = <br /> <br />x $.315/sq ft <br />.1700 per sq ft <br />.0600 per sq ft <br />@ .0200 per sq ft <br />@ .0650 per sq ft <br />$.315 PER SQ FT <br /> <br />$ <br /> <br />17''~cl x $.0950/sq ft $ /tq-a~6 <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) =$ <br /> <br />2. State Surcharge (5% of A- 1) =$ <br />3. PI~ Review F= (A-2) ~ = $ / 6 q. ~ <br />4. "~ningsurcn~ge~zU.~i/ap~!:~ (~ ~ =$ ~ ~' <br /> 7~ <br />5. Investigation Fe~ ($.41 ~r sq ft) = $ <br />6. Reins~tion Fee $25.~ = $ <br />7. O~er ins~cfion $40.~/~r ~ (1 hr ~n.) = $ <br />8. Ore,me inspections $40.~/~r ~ (2 ~ ~n.) = $ <br />9. Footin~oundation Only $25.00 - County Use OMy = $ . <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. <br />Name of Applicant (Please Print): ~9/~ ~43 g~ Phone: :e~,~-- ~'~dcOa:2_~ <br />Signature of Applicant: /~../~"--_~~~.~ Date: /~/~ ~"/,~ .~ <br />MC 15-80 Rev 1/95 <br /> <br /> <br />