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FpR CITY VALmA. T ION <br />Reeeiyed By: ~~ <br />Zonin~'¥alidation: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Or~gon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 3734427 <br /> FAX 588-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />LeRSide: ~-'/ RightSide: ,~ f <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPL/~ATION <br /> *Includes electrica~ mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, I THROUGH 41. JO' DESCRIPTION <br /> (~ N,w Single Pamily Dwelfing With Attach~l C, amg, ~A~ <br /> <br />( ) New Single Family Dwelliug With De~ached Garage <br /> <br />( ) New Duplex <br /> <br />Square Fect:/yt~ Basement:: I Madt I?,ooE <br />2. LOCATION OF INSTALLATION <br /> <br />Lot Width Lot Depth Ac~s <br /> <br /> MARION COU <br />8UILDiNa <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I ~m thc PROPER~ OV~N~R znd own, r~$ide in, or will r~slde in the comp] ~l~ stractur~ a~d will be my own general contractor. 1 undea~and that 1 most register as a construction <br /> <br />Mail~ng Addr~s <br /> <br />(pl~ print) <br /> <br />Phone <br /> <br />4. FEE SCHEDULE <br /> <br />1 B, PERMIT FEES <br /> <br /> 2. Smt~ Sumharge (5% of A-l) <br /> 3. Plan Review Fee (A-2'~ ~, =$ <br /> <br /> 5. invesligatinn Fcc ($.345 per sq ft) = $ <br /> 6. RemSpection Fee $25.00 = $ <br /> 7. Other in spection $40.00/per hr (1 hr min.) - $ <br /> 8. Overtime inspections $40.O0/pcr hr (2 hr min.) = $ <br /> TOTAL <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 cefdfy that thc above infonn*tion is correct. Permits are no.n-tnalsferrablc and expire if work is not stared within 180 days of issuance or if work is suspcndod for <br />$ignatarc of Appiican~a~,~ -J~ ~" Z ~ ~ · Date: <br /> <br /> <br />