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o~Y VALIDATION <br /> tion: ~ <br /> IDate: ~ <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 /> 24 hr. Inspection Line 3734427 <br /> FAX 588-7948 <br /> <br />FOuR CITY USE ONLY <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 q~ 5t~ <br /> <br />New Single Family Dwelling With Attached Garage <br /> <br />New Single Family Dwelling With Detached Garage <br /> <br />New Duplex <br /> <br /> LocATioN OF INSTALLATION <br /> , <br />PropertyOw~r ~ ~ ~ M~lingAddresso~,~f~:~4~ V~ ._~75~2-~ <br /> <br />3. coNTRAcToR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />MARION COUNT~ <br /> <br />Oth~E <br /> <br />Block 7 <br /> <br />Water Supply: <br />Private Well ( ) Spring <br />CommunityWell ( ) City <br /> <br />..... : . q73o.z- F~o., /<5-03- 3b~q <br /> <br />() <br /> <br />I am an AUTHORIZED REPRESEI~YATIVE of the properW owner or contractor. <br /> <br />4. FEE SCltEDULE <br /> <br />B, PERMIT FEES <br /> <br /> S~ate Su~harge (5% of A-l) = $ ~ <br /> <br />Investigagon Fee ($.345 per sq fl) = $ <br />Reinspeelion Fee $25.00 = $ <br />Other inspection $40.00/per hr ( 1 hr min.) = $ <br />Overtime inspections $40.00/per hr (2 hr min.) ~ $ <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 ceffify that the above information is correct. Permits are non-~nsferrab!9 and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. <br />Name of Applicant (Please Print): ~ Phone: <br /> <br />MC 15-80 Rev 1/96 <br /> <br /> <br />