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~oWcr~ VSE ONry <br />Received By: Date; <br />Zoning By: ___City: <br />Receipl #: /unoum:$__ ' <br /> <br />1. ,JOB Dg$CR/PT/ON <br /> <br />RESIDENTIAL <br />( ) New () Accessory <br />( ) Alteral/on ( ) Relocation <br />(t,,'~Addi~on <br /> <br />Description of Work: ~.~.-e ~.~ ~ <br />~lUaX~ Footage: Basemenl:l~ 1st Floor: <br /> <br />MAR[ON COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Sfflera, Oragon 97305 <br /> 8:00 am ~ 4;30 pm <br /> 24 hr. I~spection Line 373-4427 <br /> FAX 588-7948 <br /> <br />BUILDING PERMIT APPLICATION <br /> <br />) Addendum <br />) Other <br /> <br />2nd Floor: <br /> <br /> Nomber of Emp!oyee~: ~ Seating Capacity: ~ <br />2. LocATIoN OF INSTpfl.I ¢&TIoN ' ': ' <br /> <br />COMMERCIAL <br />( )New ( ) Multi Family <br />( ) Alteration < ) Add~adum <br />( ) Addition ( ) Sign <br />( ) Oth~r <br /> <br />iFOR CITY USE ONLY <br />iCity Setbacks: <br />".Front: Rear: <br /> <br /> Special: <br /> <br />( ) Change of Oec~penoy or Use <br />( ) Manufactured Dw~/ing Park <br />( ) R~c~eati°nal Vehicle Park <br /> <br />Other: No. Stories: ~ Units: [ Height: <br /> <br />Number of Bedrooms: Existing: ~'~ Proposed: 0 <br /> <br />Mobile Home P~k ( ) Mobile Home Subdivision Sp~e ~: To~ ~ Spies: <br />M~: a a ~ne: ~ ~elS~e: () SF () AC UOB: ()y () N <br /> <br />  Wat~gnPply: ( ) ~va~Well ~Co~uni~Well ( ) <br /> <br />3. CONTR/ -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />~ I am the PROPERTY OWNER and OTM, r~slde in, or will reside in the Completed slmclure and will be my own general ¢onhnmtor. I understand that I must <br /> register as a ~Onstrucli0n contra~or if the strue~r~ is sold or offered for sale before or upon completion. Ill hire subcontractom, I will hire only subcontractora <br /> registered with the Construction Contractors Board. ff I change my mind and do hire a general contractor who is registered with the Construction Contractors <br /> Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />() I am lhe AUTHORIZED R~PRESENTATIVE of the property owner or the eontra~tor. <br /> Business Name (please print)_ <br /> <br />Mailing Address: <br /> Street City: Zip: Phone: <br /> <br />() <br /> <br />Business Name (please prim): <br /> <br />..Registration #: <br /> <br />Mailing <br />Address: <br /> <br />4. FEES <br /> <br />S'tr~et City_: Zip: Phone: Fax: <br /> <br />A. VALUATION(See Valuation Schedule to;deteiqnin~ t~e valuafip~I <br />based on square footage of thc project) $ ~_L~}~J ~ <br /> <br />( 1 ) Permit Fee <br />(2) State Surcharge (5% x Al) <br />(3) Structural Plan Review (65% x Al) <br />(4) Fire and Life Safety Plan Review (40% x Al) <br />(5) Zoning Surctmrge, it'applicable (6% x Al) <br /> <br />B. Miscellaneous Fees <br /> <br />(1) Addl Plan Review / Addendum @ $50/hr, <br /> Mhfimum one-half hour <br />(2) Rein~pection Fee @ $50/per inspection <br />(3) Investigation Fee <br />(4) Inspections outside normal business <br /> Hours @ $50/hr, minimum two hours <br />(5) Inspections for which no fee is specifically <br /> <br /> (6) Seismic Surcharge, if applicable ( 1% x Al) = Indicated @ $50/hr, minimum one hour <br /> (6) Additional Sets of Pl,ans @ $10 per set ~- <br /> <br />I hereby certify that the above i~formation is ¢on'~t. Permits are non-transferrable a~d exptre if work is not started within 1 g0 day ff~ ~e or ifwo <br />su~peadad for 180 days. ^. ,e~ \ <br />NameofApplicant[PleesePr/at~: ~.~V~ {.~¥x't'~..~(,~{,.~ t~ <br /> <br />SignatureofApplicant: [~.,~t /,~/~__,,,~-__.__ . Date: t~ I~-."~ ~ a ~.~'.~ <br /> <br /> <br />