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FOR CITY VALIDATION I MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> DEVELOPMENT CENTER <br /> I <br /> 285 Church St. NE - Room 132 <br />Received By: ~ t~ ~l,}~~ COMMUNITY [City SethackRequirements: <br />' ff ~ I Salem, Oregon 97301 <br />Zoning Validatio6: ~. <br /> Phone 588-5147 ]Front: <br /> 8:00am-4:30pm <br /> 1 <br />Date: ~,~-/o9. '~ 6, I 24hr. Inspection Line 588-7904FAX 588-7948 Ii~ftside: ~a~_, iUightSide:c~O' <br /> ONE & TWO FAMILY DWELLING PERMIT <br /> *Includes electrical, mechanical, plumbing fe~ · <br />COMPLETE ALL SECTIONS,, THROUGH 4 <br /> ~1~i~ __ <br /> <br /> New Single Family Dwelling With Attached Garage !~,q <br /> (~New Single Family Dwelling With Detached Garage <br /> ( ) New Duplex "~' <br /> <br />BnergyPam: / J $o. Sto~es / J Detached Garage Height: ~ No. Bedrooms: ._~ <br />Square Feet: Basement:: . J Main Floor: Y3Y~ Second Floor: ~ Garage: 5~'~ Other: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />IM~'ingAd-ass ~.~,~ r3/0/ ,.~gSm IPh°ue~°. ~4'f~' <br /> <br />TaxAcct. No. ~:~l~t~/,~ -- It~ ! <br /> <br />Lot ~- <br /> <br />Block <br /> <br />Water Supply: <br />Private Well ( ) Spring <br />Community Well ( ) City <br /> <br />Zone ~'~ IMap <br />Irreg. Lot Comer <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 Conslxuction 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 />Business Name / Registration No. <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 />AJ <br /> <br />VALUATION: <br /> GrossSqFt /gd./I cfl x 64.66 = <br /> <br />1. PERMIT FEE: <br /> Gross Sq Pt /~/'/q , .~ntb- <br /> x $.3q57sq ft <br /> <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 $.315 PER SQ Fl' <br /> <br />2. PLAN REVIEW FEE: <br /> Gross Sq Ft t/gqq x..~'g~ <br /> <br />$ _63_7 <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) <br />2. State Surcharge (5% of A-l) <br />3. Plan Review Fee (A-2) <br />4. -~ Zcn~ng S;:r~;l.~$~ <br />5. Investigation Fee ($.41 per sq ft) <br />6. Reinspection Fee $25.00 <br />7. Other inspection $40.00/per hr (1 hr min.) <br />8. Overtime inspections $40.00/per hr (2 hr min.) <br />9. Footing/Foundation Only $25.00 - County Use Only <br /> TOTAL <br /> <br />:$ 6, 3 7. 9i <br />:$ ~/.qO <br />:$ <br /> <br />=$ <br />=$ <br />=$ <br />=$ <br /> <br />=$ <br />~$ q~7.3~ <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): _t~_~:)~l ~ ~/.,~,)~'~.~'~.$ Phone: <br />Signature of Applicant: ~Y~x.-~--~~~, Date: <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />