Laserfiche WebLink
:[ WR CITY VALIDATION <br />IR~eived By: __ <br /> <br />IZol~l*g Validation: <br />IDate: <br /> <br />MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER <br /> I <br /> 285 Church St. NE - Room 132 City Setback Requirements: <br /> Salem, Oregon 97301 Left Side: Right Side: <br /> 8:00am-4:30pm Phone 588-5147 Front: Rear: <br /> <br /> 24 HR Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br /> MANUFACTURED DWELLING <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PERMIT APPLICATION <br /> 1. JOB DESCRIPTION *Floor Plan Required* <br /> <br />~ New Placement Garage or Carport <br />( ) Replacement C~ Attached <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers Year of Nd. of ,,~ Len~<~ t (_~tl Width~(~x <br />Name: Manufacturer Sections <br /> <br />Type of Siding: "~pe of Roofing: Square Footage: I ~ (.0~'~ No. of Bedrooms: <br />C2<~Wood <br />) Metal ( ) Steel Pit Set: Super Good Cents (~ Yes ( ) No <br />) Vinyl ( ) Metal *Include Documentation <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />City: ~.~ ~x~.~_ ~ - <br /> <br />Occupant: <br /> <br />Urban Growth Boundary? ( ) Yes ~No I Water Supply: ( ) Private Well {~) Community Well ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> I am the PROPI~RTY OWNER and own, ~side in, or will reside in the completed struclure and will be my own genera] contractor. I understand that I <br /> must mglster as a constmetlon contractor if the structure is sold or offered for sale before or upon completion. If l hire subcontractors, I will hire only <br /> subcontractors registered with the Construction Contractors Board. If 1 change my mind and do hire a general contractor who is registered with the <br /> Construction Conl~actors Board, I will immediately notify Marion County of the name of the contractor. <br /> <br /> I am a CONTRACTOR r~gist~md with thc State of Oregon. <br /> Bushness Name: Registration No.: <br /> <br /> Mailing Ad6ms$: Phone: <br /> <br /> I am an AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br /> <br />Name: <br />~g Add.ss: Phone: <br />4. FEE SCHEDULE <br /> <br /> A. ManufaOured Placement/Conm~ctions $245.00 = B. Additional Inspection/ <br /> (includes EL, PL, ME connections) (beyond third inspection) <br /> S~ateSurcbarge $12.25 = ReinspectionFee $60.00 ~ <br /> Stale Fee $20.00 = <br /> Zoning Sercharg~ (if applicable) $20.{10 = <br /> <br />TOTAL <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 <br />or if work is suspended for 180 days. <br /> <br />MC 154~4 Rev 8/96 <br /> <br /> <br />