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FOR OFF~A~ Ot~Nb~Y~A ~ARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY <br />Receiv~l ,By: ~~. ~ 2~ High S~t ~ Ci~ S~ck <br />~mn~:~l ~, Sacra, OR 97301 <br /> <br /> B~G PERM~ APP~ON <br />CO~LE~LSECTIONS, IT~OUGH4 --0OO ZZ MAY 2 <br />1. Job D~ripfion ~ '0~ <br /> <br />RESIDEICllAL COMMERCIAL ~ I,n, t,ul, ~uUll I~e of Structure: <br /> <br /> ()Alteration ( ) Dcmolitica ( ) Almralion ()Demolition <br /> ( ) Acce~$sov~ ( )Other ( )Onan§eofOccupancy ( )Other <br /> <br />Tmss~)° or R~fter( ) I No. Stories f I Occupant Load or Numbar ot l~npinye~s NO. Bedrooms: <br />Square Feet: Bastamem: I Main Floor. 15 :~ ] Second Floor: ] Other: Height: <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br />Pro~r~ Ow~r I Mailiag Address ] Phone No: <br /> ( ) Iowo~r~sid~in, otwill~esid¢intlmcompletedstmctum. <br /> <br /> ( ) ~und~rstandthat~mustregisterasa¢~nstmc~onc~ntmctorifthestmctumiss~dor~eredf~rsa~¢bef~moru~p~e~. <br /> ( ) I will b~ my ow~ gememl c~mtractor. <br /> <br />If I hire subcontractors, I will hire only subccmtractors registered with the Construction Cc~tractors Board. If I change my mind and do hire a general contractor, I will contract <br />with a contractor who is registered withe Constmcti~a Cc~tracter's Board, and willimmediately notify Marion County of the name of the contractor. <br /> <br />Arehitect,~m= ~.~. ~_.~:~ IMaltagAdd~s:tOq6 /3~.~yE <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> to determine valuation based an <br /> sqmtm footage.) <br /> (1) Permit Fee <br /> <br /> (2) 5% State Surcharge ¢05 x Al ) <br /> <br /> (3) Structural Plan Review (.65% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (.40% x Al) <br /> <br />(1) Driveway w/curb @ $7.50 <br /> <br />(2) Driveway w/o curb @ $17.00 <br /> <br />(3) Site Plan Review (conmaercial only) @ $79.00 <br /> <br />(4) Additional Plan Reviews or Addendums <br /> <br />(5) Investigation Fee <br /> <br />(6) Reinspecfion Fee @ $25.00 <br /> <br />I hereby ~ ,e nifty ~at the above information is oon~ct and that I have read and understand ti3e Informatic~ Notice to Property Owners abo~t Construction ResponsibLhiies on the <br />reverse $10e oI Ibis form. , <br /> <br /> Site evaluations, septic, electrical, plumbing and mechanical work require seperate permits. Check with Marion County Building Inspection before submitting this application. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />