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O,R CITY VALIDATION ] <br />.eivedBy: ,~~ I <br />[Zofiing Validation: ~ I <br />[Date: '~S-%~ ~-~ I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 9730! <br /> 8:00am-4:30pm Phone $88-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />FOR CITY USE ONLY <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br /> <br />1997 <br /> <br />MARION COUNTY <br /> <br />qq 45q <br /> <br />New Single Family Dwelling With AOached Garage <br />) New Single Family Dwelling With Detached Garage <br />New Duplex <br /> <br />LOCATION OF INSTALLATION <br /> <br />I o~ o~e.ei~)UlLOlNG INSPECTION <br /> <br />No. B~: <br />Otber: <br /> <br />Block <br /> <br /> Section ,Z5 Townslfip~'*W~,g6 Range~O~*t~l~ Zone ~.~ Mapg2~J ZS~.. <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Water Supply: <br />Private Well ( ) Spring <br />Community Well ( ) City <br /> <br />1 am the PROPERTY OWNER and own, p~side in, or will reside in the completed stricture and will be my own general contractor. I understand that 1 must register ~s a construction <br />contractor if the structare is sold or offered for sale b~fiare or upon completion, If I hire subcontractors, I will hire only subcontractors registered with the Constnmfion Contractors Board. <br />If I change my mind and do hire a general contractor who is registered with the Construction Contractors Boar~L I will imm~diat, ely ~ofify Marion County of the name of the contr~tor. <br /> <br />I am a CONTRACTOR mgisterod with the State of Oregon. <br /> <br />I am an AUTRORIZED REPRlgSENTATIVE o f the propony omaer or contractor. <br /> <br />Mailing Address <br /> <br />Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Ba~d on square footage: <br /> <br /> c,~sqrt q'~z~ × 10.27 $ ~ <br /> mTAUS: /~/ <br /> <br /> ~sgqFt )~/ x *.345/sqa * <br /> <br /> TOTAL $,345 PER SQ FT <br /> <br />B. PERMIT FEES <br /> <br />2. State Sureharg~ (5% of A-l) =$ <br />3. Plan R~vi~w Fee (A-2) <br /> <br />Investigation Fee ($345 p~r sq fi) <br /> <br />Reinspoction Fe~ 225.00 <br /> <br />Other inspection $40.00/per hr (l hr min.) <br /> <br />Overtime insp~tinns $40.00/per hr (2 hr min.) <br /> <br />TOTAL <br /> <br />=$ <br /> <br />=2 <br /> <br />=2 <br /> <br />=2 <br /> <br />=2 ov-f~. ?? <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 cer~fy 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 ofApplicant (Please Print):.~ ~"ff4e'f. ~,~4~,/~r')~/7' Phone: <br /> <br />Signature o f Applicant: ~_ ~ Date: <br />MC 15-80 Rev 1/96 ~ <br /> <br /> <br />