Laserfiche WebLink
Date: <br /> <br />MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER ~ ICity S~k Pa~qui~agats: <br /> 285 Chumh St. NE - Room 132 <br /> Salem Oregon 97301 <br /> 8: OOam.4:3ODfll lahore $88:~1~ <br /> 24 hr. tmon LI~e'~SrLg0~ <br /> <br /> BUILDING PE~ <br /> <br />~B DESCRIPTION <br /> <br />P~ES ID ENT1AL COMMERCIAL ~.DB'~ .... Use of Stmclur~: <br /> (~) Addition ( ) Rel~ation ( ) Addition ( ) New ~ O ~ <br /> ( )Alteration ( )O~er ( )Alteration ( )Si~ ' / ~t~/ <br /> ( ) Accesso~ ( ) Ch~ge of Occupancy ( ) O~er <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision ~j']~ f~___../~ ~--"~[~ L~ Block <br />Mobile Home Park .~ Sp~" <br /> <br />~tWidt }--~ I LotD~t ~1 lcr~ lag.~t Car {~ ~l~i~Wtl ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) l am the PROPERTY OWNER and own, reside in, or will reside in the complev3d structure and will be my own general contractor. I understand that 1 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 subeontractor~ registernd with the Constructloa Contractors Board. <br /> If I change my mind and do hh'e a general contractor who is registered with the Conslruction Cont~actors Board, 1 will immediately notify Marion County of the name of the contractor. <br /> ()'~ I am a CONTRACTOR registered with the State of O~egen. <br /> Business Nan~ · R~gistratlon No. <br /> <br /> (~5/'--/I am an AUTHORIZED REPRESENTATIVE of the ptogerty owner or conuactor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />VALUATION (See "Valuation Schedule" to d~etemlia~ valuation based <br /> <br />on square footage of project.) Valuation: $ ' ~2_~ <br />( I ) Pe~nlt Fee <br /> <br />(2) 5% Sta~ Surcharge (.05 x Al) <br /> <br />(3) Structural Plan Review (.65% x Al) <br /> . <br />(4) 7i .... h* ornery man ~eview ~ 40vo x ~ ~/-j'~- <br />(5) Zoning Surcharge, if applicable (.05% x Al) <br /> <br />(6) Seismic Surcharge <br /> <br />/. <br /> <br />B. Miscellaneous F~s (1) Additional plan R~vi~ws o~ Add,Adams <br /> <br /> (2) Investigati.n Fee <br /> <br /> (3) Reinspection Fe~ @ $25.00 <br /> <br /> '/17 <br /> <br />I hereby certify that the above inform~on is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />MC 15-73 Rev IP95 <br /> <br /> <br />