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FOR CITY VALIDATION MARION COUNTY BUILDING INSPECTION <br /> I ~ ~' -~- ~: I . ~ COMMUNITY DEVELOPMENT CENTER <br />/Received By: ~ .e~ ~ 285 Church St. NE-Room132 <br />1Zomn Valldatt .._/~C ' r7/J /~ Salem Oregon 97301 <br />[ ' g ' 'on; /~.. ~ I .~.~(~ 8:00am-4:3Opm Phone 588-5147 <br />~Date' ? - ! ~ --~ "~ ' I 24 hr. Inspection Line 3'/3-4427 <br /> <br /> ONE & TWO FAMILY DWELLING PERIVIlT APPLICATION <br /> *Includes electrica~ mechanical, t~lumbln~g fEe*' <br /> <br /> (~NewSingleFamilyDwellingWithAtthchedGarage ~ AUG 1997 <br /> <br /> { )N,wm.lcx MARION COUNTY <br /> B'JiLDiNG iNSPECTioN <br /> <br /> FOR CITY USE ONLY <br /> <br />ICity S~back Requirements: <br />IFmnt: ~O ~ Rear: 5~ ~ <br />I 5' RightSidg: ~' ' <br /> <br />2. LOCATION OF INSTALLATION aatng q?og l. g"t, Phone No <br /> <br />3. CONT~CTOR INFO~A~ON ~ PLEASE INDICATE WHO IS DO~G T~ WO~ <br /> <br /> ~i~ess N~e ~ I ' ~ ~ ~ ~ Regis~fi~ NO. <br /> <br />Mailing Addr~s <br /> <br />print) <br /> <br />Phone <br /> <br />4. FEE SCHEDULE <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-l) =$ S0~' ~ <br />7.. State Surclxarg¢ ($oA of ^. 1 ) =$. ~0 ~ <br />3. Plan Revi~ F~ (A-2) = $ ~ [ O ~ <br /> <br />5. Investigation F*~ ($3451m sq t~) - $ <br />6. Reinspe~tion F~ $25.00 = $ <br />7, Other inspection $40.00/per hr ( 1 hr min.) = $ <br />8. Overtlm~ inspections $40.00/pcr hr (2 hr min.) = $ <br /> TOTAL =$ 737.17 <br /> <br />Dwelling labels must be obtained at Marion County ltaildiog Inspection and must be placed at the jobsite prior to inspection for pinmbin~, electrical and <br />mechanical work. Contact Marion Connty for instructions. <br /> <br />I hereby certify 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 />NameofApplicant (Please Print): J~/OhO ~41)~..~hrL~[.~Jf~m f.~)F?, .,;~ ) Phone: /StD)gI,,O-/dlqZl <br /> <br /> <br />