Laserfiche WebLink
],~FO~CITYUS~ONLY. t/) . ..~ .o~z I COMMUN1TY DEVELOPMENT CENTER <br />I R~eivedBy: s'~t//~nvw.~.'~ Dat~:~ ] 3150 Lancaster Dr. NE-SuiteC <br />I Zoning By: ~ City:~, I Salem Oreonn97305 <br /> <br />L ....... ~"./'J--d2'--~- ............... _--_~_J 24 hr Inspection Line <br /> <br /> ONI?'-AND TWO FAMILY DWELLING PERMIT <br /> lncludes elecetcal, mechanical, plumb~f~ees <br />D~ifing labels must be obtained at MariOl~ Couaty ~uiifiing l~spectio~ ~nd mast be placed <br />work. Con.ct Marion CounB; for instru¢fioms. <br />1. JOB DESCRIPTION l~][~fl/~?.Ul~l <br /> <br />~ New Single Family Dwelling ~,~ith A~acbed Garage <br />( ) New single Family Dwelling with Detached Garage <br /> <br />OescriptioaofWork: ~,~ //~, ~ <br />Square Footaga: Bas~n~: O <br /> <br />Number of Bedrooms: ~ Existing: Proposed: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />FOR CITY USE ONLY <br />City Setbacks: / <br />Front: ~g~ / Rear:. <br />LeR: 'g-" / Right: <br />~eeial: <br /> <br /> bJng, electrical and mechanical <br /> <br /> New Duplex wia( [~.~ ~C4frage <br />()() NewDuplexwidiD~0~atge <br /> <br />Other: Om'~ge: J/~f/~7 # Stories: <br /> <br />Drilling Height: Garage Height: <br /> <br />2. LOCATION OF INSTALLATION <br />Sit~ Address: Zip: Cross Strut: <br />Parco1 Owner: Maflin~ Address: City: <br />Subdivision: Bl~k: <br /> <br /> Map: Zone: Pam~lSize: ~SF () AC UGB: ()Y () N CitySewer <br /> s~i, System __ <br /> <br /> ~Localrn': Pamel#: Wa~rSupply: ( ) Priva~Welf ( ) ConmmailyWdl <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING Tlt~ WORK <br /> <br /> () I am the PROPERTY OWNER and eyre, reside in, or will reside th the contpleted structure abd will be my ~ ~ ~. I undemtand that I must register <br /> · s a construction contractor if the structure is sold or offered f~r sale before or upon completion. IfI hire subeon~ctovs, 1 ~ hi~ o~ly subex~ra~o~ rcgist~l~d with <br /> the Construction Contractors Bo~rd. IfI change my mind and do hire a g~neral contractor who is registered with tbe Constr~tion Contractors Bo~rd, I will <br /> immediately notify Marion Coun~ of the name of the contractor. <br /> <br /> ( ) I am the AUTHORIZED REPRESENTATPgE of the property owner or the contr~c~r. <br /> Business Name (please print) ~_! ~)t'l t~ ~fflJ <br /> <br />Marling Address: <br /> <br />Stxeet City <br /> <br /> (~'~ I am a CONTRACTOR register[ w~,'di die Sta~e of Oreg~a. <br /> Business Name (plezse print): ~._'~ <br /> Mailing Address: 0.,,9. ~o~t ~-qt __~_,'/) <br /> · Street City <br />4. FEES <br /> <br /> VALUATION (See Valuation Schedule to determine the valuali~ ~sed on square <br /> footaga) <br /> / x $ .66 <br /> <br /> Gross Square Feet ~ x $0.4050 <br /> ' <br /> Building ~ $0.185 per square foot <br /> Electrical ~ $0.090 per square foot <br /> Mechanical (~ $0.040 per square f~ot <br /> Plumbing ~ $0.090 i~r square foot <br /> <br /> Zip Phone <br /> Registration #: /~ ~ 77._T <br /> <br />Zip ~ F~ <br /> <br />B. Fee Summary <br /> (1) Permit F~e (A-l) <br /> (2) Stal~ Sumtmrge (.05% x Ail ) <br /> (3) Plan Review F~ (A-2) <br /> (4) Additional Plan R~iew/Ad~adom @ $50/hr, <br /> minimum one-troll ho~r. <br /> (4) 7.r~ ~i~ g~,G~q~; ff~pptical~l~ -( S30.00) <br /> (5) Investigation Fcc($.4050 per sq. fl.) <br /> (6) Reinsi~-tion Fcc, $50.00 <br /> (7) Inspections made outside of flormal <br /> business hours, $50/hr, minimum mo hey, rs <br /> (8) Insp~ions for which no f~ is specifically <br /> indicated, $50.00/hr, minimum one hour <br /> (10) Foundation Only Anthodzatio~, $25.00 <br /> (11 ) Additional Sets of Plans $10.00 per set <br /> <br />TOTAL <br /> <br />$ <br /> <br />I hereby certify that the above information is eorrccL Permits are non-tmnsfenable and expire if work is not started within 180 days of issuance or if work is suspend~ for t80 days. <br /> NameofApplicant[PleasePrint]: 7~,' ,f)offO <br /> MailingAddress: ~0, ~oat ~h/ St%'0 0/~.~'~0 <br /> <br /> <br />