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FOR CITY USE ONLY <br />R~eived B~__ Daxe: <br />Zoning By: _City: <br />Reeeipl m Amount:$ <br /> <br />1. JOB DES~ON <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem. Oregon 97305 <br /> g:00 am -4:30 pm <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />BUILDING PERMIT APPLICATION <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br />Front Rear: <br />Let~: Right: <br />Special: <br /> <br />RESIDENTIAL <br />( ) New () Accessory <br /> (') Alteration ~ Relocation <br /> ( ) Addition <br /> <br />Addendum <br />Other <br /> <br />COMMERCIAL <br />( } New ( . Multi Family <br />~ Akerauon ( ~ Addendum <br />~ ~ Addition t ) Sign <br /> <br />Change of Occupancy or Use <br />) Manuthotur~d Dwelling paflt <br />5 Recreational Vehicle Park <br /> <br />UseofStructure C~O~'~N Occupancy: A'3 Energy: <br /> <br />Other: No. Stories: I Uthls: Height: <br /> <br />Number of Bedrooms: Existing: Proposed: <br /> <br />Subdiv~ion: ~t: Block <br />( ) Mobile Home P~k ( ) Mobile H~e Subdivision Space g: Total ~ Spaces: <br />Map: ~ne: P~elS~e: () SF () AC UGB: ~Y () N <br /> <br />~ ~cator: P~cel ~: Wat~ ~pp~: ~ ~v~ Well ( ) Commm~ We~ ( ) <br /> Cay <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />I am the PROPERTY OWNER and own, 777!'~ ? :7, ~7-':" -::'--~ L~ the completed structure and will be my own general contractor. I understand that I mu~t <br />r~gister as a constnmtion conlmetor if the struclure is sold or offered for sale before or upon completion, If I hire subcontractors, 1 will hire only subcon~'aetors <br />registumd with the Conslmction Contractors Boa~d. If I change my mind and do hire a general contractor who is registered wffi~ the Construction Conlractom <br />Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />() I am t~e AUTHORIZED REPRESENTATIVE o f ~he property owner or the contractor. <br /> Business Name (please prim) <br /> <br /> Mailing Address: <br /> <br />() <br /> <br />I am a CONTRACTOR r~gistered with the Slate of Oregon. <br />Business Name (please print): <br /> <br />Registration #: <br /> <br />4. FEES <br /> <br />A. VALUATION (See Valuation Schedule m determine the valthation. ~ <br />based on squere footage o f the project) $ <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 Surcharge, if applicable (6% x Al) <br />(6) Seismic Surcharge, if al~plicable (1% x A 1) <br /> <br />B. Miscellaneous Fees <br /> <br />(1) Addl Plan Review / Addendum (~ $50/hr, <br /> Minimum one-half hour $ <br />(2) Rein~loection Fee ~ $50~er inspection $ <br />(3) Investigation Fee $ <br />(4) Inspections ontside normal business <br /> Iamttrs ~ $50/hr, arinimum two hours $ <br />(5) Inspections for which no fee is specifically <br /> Indicated @ $50/hr, minimum one hour <br />(6) Additional Sets of Plans ~ $10 per set $ <br /> TOTAL $ <br /> <br />I hereby certify that the above information is correct. Pemfits are non-transferrable and expire if work is not started within 180 days of issuance or if work <br />suspended for 180 days. <br />Nuate of Applicant [Please Print]: _ ' _ ' <br /> Mailing Address: - ~._ . <br /> ..~Phon ' <br />Signature of Applicant: <br />MC 15-73 Rev 9/98 <br /> <br /> <br />