Laserfiche WebLink
FOR CITY VALIDATION <br />Received By: __ <br /> <br />Zoning Validation: <br /> <br />Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. JOB DESCRIIrrION <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 /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br />City Setback Requirements: <br /> <br />FOR CITY USE ONLY <br /> <br />( ) New Placetuent Garage or Carport <br />(/t() Replacement ( ) Attached <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers Year of No. of Length Width <br />Name: Manufacturer Sections ~,~ b ~ <br />TypeofSidlng: T~eofRoofing: SquareFoolage: /~ No. of Bedrooms: .5 + <br />( ) Wood (~) Comp <br />) Metal ( ) Steel Pit Set; Energy: <br />)Vinyl ( )Metal ~."Z~7.. '~'~-~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Mobile Home Phtk Name: <br /> <br />ISpace #: <br /> <br /> . q?ow~ship: Range: Acres: <br /> <br />Urban Growth Boundary? ( ) Yes l~ No <br /> <br />( ) Community Well ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) I am a CONTRACTOR registered witb the State of Oregon. <br /> <br />Business Name: Registration No.: <br />Mailing Address: Phone: <br /> <br />( ) I am an AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured placement/Connections $245.00 <br />(ineludm EL, PL, ME connections) <br />State Surcharge $12.25 <br /> <br />TOTAL <br /> <br />B. Additiona~ lnspeOion/ <br /> (beyond third inspection) <br /> Reinspect ion Fee <br /> <br />$60.00 <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not starled within 180 days of issuance <br />or if work is suspended for 180 days. /~_ <br /> <br />MC 15-64 Rev3/95 <br /> <br /> <br />