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F~R CITY VALIDATION MARION COUNTY BUILDING INSPECTION <br /> ,~ ,~ / . mi COMMUNITY DEVELOPMENT CENTER <br /> Received By: ~ ,/2t~ 285 Church St. NE - Room 132 <br /> · &~ - ' /7 ._ I Salem, Oregon 97301 <br />IZomng Validation: ~ I 8:00am-4:30pm Phone 588-5147 <br />I~ +. ~'?_ Q_ t~¢7 ~ 24 hr. Inspection Line 373-4427 <br />~_. a~e. ~--~- 7 /0' ~ FAX 588-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />Front: ~O/ Ram: ~ / <br />Left Side: ~x-~,e' Right Side: .J"' */ <br /> <br />( )<1 New Single Family Dwelling With Attached Garage <br />( ) New Single Family Dwelling With Detached Garage <br />( ) New Duplex <br /> <br />MARION COUNTy <br />BUILDING iNSPEnT?t~ <br /> No. Bedrooms: - ' ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />,,x A~,. ~o. 000 <br />Lot <br /> <br /> Water Supply: <br /> <br />mock 7 <br /> <br />3. cONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am the PROPERTY OWNER and own, maide in, or will reside Jn thc completed st~e~ure and will be my own general contractor. I understand that I must register as a construct/on <br /> <br />Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on square footage: <br /> C~oss Sq Ft ~.~. x 64.66 <br /> <br />B. PERMIT FEES <br />1, Permit Fee (A-l) =$ ~ <br />2. State Surcharge (5% of A-I) = $ ~ <br />3. Plan Re~iew Fee (A-2) x -- -- <br /> <br />5. Inv~tigafion F~ ($.345 p~t ~q ~) = $ <br />6. Rainsp~cfion F~ $25.00 = $ <br />7. Other impection $40.00/per hr (1 hr min.) - $ <br />8. Overtime inspections $40.80/per hr (2 hr mir.) = $ <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 worl~ Contact Marion County for instructions. <br /> <br />I hereby certify that the above information is correct. Permits are non-h-ansferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. s <br />NameofApplicant(Plecs~Print): .~. ~ /~/~ //~¢~~¢~ Phone: <br />Signature o f Applicam: Q/_~/~¢' - ~/1 . tr' ,.---- _t~-~--.~'J~ J/ --~"? , Date: <br /> <br />MC 15-80 Rev 1396 (J <br /> <br /> <br />