Laserfiche WebLink
FOR CITY VALIDATION <br />Re, ceived'By': ~//Tx~ ~ ~Z/.t.~ <br />Zoning Validation: ~fl · <br />Date: /~ -.2 7-9~' <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 /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESOlaTION <br /> ( ~ New Single Family ' ' <br /> ()NewSingleFamily~;~llllli~g;li~;et~t:thTd~;~e'g · g <br /> , w,upl x <br /> <br />IFOR CITY USE ONLY <br />City Setback Requirements: <br /> <br /> Front: ~ ,t Rear: ~-- I <br /> Left Side: ~-- / Right Side: ~ t <br /> <br />No. Bedrooms: <br /> <br />Other:~,. <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Subdivision <br /> S~fion ~ Township <br /> ~tWid~ ~, /~ ~tDep~ /i0{ Acres <br /> <br />Tax Acct. No. q ~O <br /> <br /> IMap <br /> <br /> Comer <br /> <br />Irreg. Lot ~O <br /> <br />Block / <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 CONTRACTOR with the State of <br />am <br />registered <br />a <br />Oregon. <br />Busings Name ,, <br />/%~)~ S~ ~t,f~ /~.~lease prlnt) Registration No. <br />I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br />Name <br />(please print) ~ ; _ <br /> .~ling Ad~es, Pbone !): t' t ~'(C.,J E ~ \VI <br /> <br />1[ <br /> <br />Ag <br /> <br />VALUATION: <br /> / <br /> Gross Sq Ft ! x 64.66 = <br /> <br />1. PERMIT FEE: <br /> GrossSqFt /Tq 7 x $.315/sqft $ <br /> * Building @ .1700 per sq ft <br /> Electrical @ .0600 per sq ft <br /> Mechanical @ .0200 per sq ft <br /> Plumbing @ .0650 per sq ft <br /> <br /> TOTAL $.315 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq Ft / 7q 7 ~ $.0950/sq fl $ <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) MARION COUN~ <br />2. State Surcharge (5% of A-l) BUILDING INSPECTION <br />3. Plan Review Fee (A-2) = $ <br /> <br />5, Investigation Fee ($.41 p~r sq ft) = $ <br />6. Reinspection Fee $25.00 = $ <br />7. Other inspection $40.O0/per hr (I hr min.) = $ <br />8. Overtime inspections $40.O0/per hi' (2 hr min.) = $ <br />9. Footing/Foundation Only $25.00 - County Use Only = <br /> TOTAL ~ t4 q t~ q ~.. =$ <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 /> <br />Name of Applicant (Please Print): <br /> <br />Signature of Applicant: <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />