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[o]~OR C.ITY VALIDATION <br />&~i~e d By: <br />nlng Validation: <br />ate: <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 /> <br />FOR CITY USE ONLY <br /> <br />COIVlPLETEALLSECTIONS,: THROUGH41. JOB DESCRIPTION ~U~ 27 ~ 77 '~g(~6 <br /> <br /> P. rsm~rrIAL CO/v~V~ERCIAL MARION C0 UI~]~,~ us. of s~ct~r~: <br /> J~,d..Addillon ( )Rel~adon ( )Aaa~ILDING iNSPE~l~W o~r~ ~t~ <br /> ( ) Alteration ( ) Omer ( ) Ahemtion ( ) Sign ~ ~~ <br /> ( )Acces~ ( )Ch~geof~cupancy ( )O~er <br /> <br />~escfipfionofWork J ls~isahismfic~bui~7 Yes - ~ <br /> <br />2. LOCATION OF INSTALLATION <br />Property O~er ~),~'/' Z ~ ~ .~. Mailing A~ss <br /> <br />Water Supply: <br />Private Well ( ) Spring ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> I am the PROPERTY OWNER and own, ~eside in, or will reside in the completed structure and will be my own general contractor. I understand that I must repair as a con~tmcfion <br /> eonm~ctor if the ~uemre is sold or offered for sale before or upon completion. If I hire subcontractors, I will hi~e only subcontractors registered with the ~onstrucfion Comr0ctorz Board. <br /> If I change my mind and do hi~ a general contxactor who is registered with the Consnucfion Contxactors Board, I will immodiately notify Marion Coumy of the name of the eomra@or. <br /> <br /> ( ) I am a CONTRACTOR m~stered wlth the Sml~ of O~gon. <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />(1) Additional Plan Reviews or Addendums <br /> <br />(2) Investigation Fee <br /> <br />(3) Relnspoction Fee @ $25.00 <br /> <br />(4) Other Inspections not listed above <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not start~ within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Print): <br /> <br />__Date: <br /> <br /> <br />