Laserfiche WebLink
FOR ~CITY VALIDATION I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNrrY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> <br /> BUILDING <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL <br />( ) Addition ( ) Relocation <br />( ) Alteration ( ) Other <br /> <br />COMMERCIAL <br /> ( ) Addition <br /> <br /> ( ) Alteration <br /> <br /> Accessory ( ) Change of Occupancy <br /> <br />IFOR CiTY USE ONLY <br /> <br />City Setback Requirements: <br /> <br /> MARION COUNTY <br />BUILDING iNSPECTION ~.~'-..~~ <br /> I Os~ of Structure: <br /> ( )New <br /> ( )Sign o2~',~ ~' <br /> ( ) Other <br /> I ls thls a historical building? Yes <br /> <br />New ~ ] No. B~lrooms: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision <br /> <br />Block <br /> <br />Walcr Supply: <br />Private WcH ( ) 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, t~ide in, o~ will reside in the completed structure nnd will be my own general conUacto~. I uademand ~hat I must r~gister as a cons~uction <br /> conUactor if the smactut~ is sold or offered for sale befo~ or upon completion. If I hire subconm~tors, I will hire only subcontractors reglst~ed with th~ Construction Conm~ctots Board. <br /> If I change my mind and do hire a general co~Uactor who is registered with the Construction Con,actors Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />('ff'~ I am n CONTRACTOR registe~d with the State of Oregon. <br />Business Nnme Registration No. <br />(,~[ I am an AUTHOIHZRD REPRESENTATIVE of the property owner or con.actor. <br /> <br />4. FEE SCHEDULE <br />A. VALUATION (See "V-~io~ Schedu~" m de~a~ne v~ion based B. <br /> <br />on square footage of project.) <br />( 1 ) Permit Fee <br />(2) 5~ State Surcharge (.05 x Al) = <br /> <br />(5) Zoning Surcharge, if applicable (.05% x Al) = <br />(6) Seismic Su.,charge = <br /> <br />~7.55 <br /> <br />Miscellaneous Fees <br /> (1) Additional Plaa Reviews or Addendums <br /> <br /> (2) Investigation Fee <br /> <br /> (3) Re'tnspection Fee @ $25.00 <br /> <br /> (4) Other Inspections not listed above <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-mmsferrable and expire if work is not sta~ed within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Print): ~'~ ~ 0 ~ ~' Phone: <br />Signature of Applican~~ ~ Date: <br /> <br />71'¢- 7 <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />