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MARION COUNTY BUILDING INSPECTION <br /> mR CITY US~ ONL.Y~.~L / y~ ~ COMMUNITY DEVELOPMENT CENTER FOR CITY USE ONLY <br /> Re~ivedBy: /-~.~ Date:~/ 3150 Lancaster Dr NE-SuiteC <br /> · ci ' ' t. lty ~emacics: <br /> ~,,By. ~2- _ t~.~,, Salem, Oregon 97305 ~.-. ~ ~" .___ -9~ / <br /> <br />................................... 24 hr. inspection Lhl¢ Al~4t~,~ ~- , <.. n~lt Special: <br /> FAX 588-791t~J <br /> ........................................... <br /> labels <br /> must <br /> be <br />worl~ Contact Marion County for instructions. <br /> <br />1. JOB ~CR1P TION <br />](~New SMgle Family Dwelling with Atlached Garage <br />( ) NewsingleFamilyDwellingwithDcqachedGarage <br /> <br /> Square Forage: ~ lsI Floor: 7~ ~Z <br /> Number of Bcdrootm: .~ Existing: <br /> <br />2nd Floor: 6 Gq <br /> <br />Occupancy: Const. Type: En~gy: <br />oth~:23~ o~: $5'6 #sto~: ~. u~: ~-- <br />DwellmgHeight: ,~o~'- '-6" Oar~eHei~ht: ,~_~'- 3" <br /> <br />2. LOCATION OF INSTALLATION <br />Su~ivisinn: Ll~[~ O<~ Lin: /~ Bl~: <br /> <br />Water Supply: ( ) Private Well <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />City Sex~ -- <br />Septic System <br /> <br />( ) Community Well ~)nL~' <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in the completed situcture and will be my own geneial contractor. I undersland lint I must regist~ <br />as a construction contractor if the structure is sold or offered for sale befo~ or upon completion. Ill hit* subcont~Oors, I will hire only subconfoietors registered with <br />the Const~uctinn Cononctors Board. If I change my mind and do hire a general conm~ctor who is reg~e~d with the Construction Con~ Board, I will <br />immediately notify Marion County of the name of the contractor. <br /> <br />I am the AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br />Business Name (please print) <br /> <br />Sa-e~t City <br /> <br />Zip Phone <br />t~)~ Registratio~ g: <br />Z~ ~o~ <br /> <br />I am a CONTRACTOR regis~ered..,Fith ttF State of (~n~gon.,. . I - <br />Business Name (please Print): ("fie/.(.. ('7 <br /> <br /> Street City <br /> <br />4. FEES <br /> <br />VALUATION (See Valuation Schedule to de-----------------~min~ the valuation based on square <br />fom~) <br /> <br /> LivingAma SquareFeet ,J~,~ × $64.66 = $ <br /> OarageSquareFc~t ~ x $16.27 = $ <br />.......................................................d/.f/. <br />1. 1. P~rmit <br /> Gross Sqnare Feet /qo~'~ x $0.4050 = $ <br /> <br /> Building ~ $0,I 85 per square foot <br /> Elec~rical ~ $0.090 per square foot <br /> Mechanical @ $0.040persquarefoot <br /> Plumbing ~ $0,090 p~r square foot <br /> <br /> 2. Plan Review Fee <br /> Gro~SquareFeet ,~Pf~ x $0.120/sq. Ft=$ <br /> <br />B. Fee Summary (1) P~rnit F~ (A-I) <br /> (2) State Surcharge (.05% x A-I) <br /> (3) Plan R~i~ F~ (A-2) <br /> (4) ~fi~ P~n R~i~/~dum ~ $50~, <br /> <br /> ( ) ...... ~ ...... .~, ~-~- ..... , ...... <br /> (5) lnv~i~fim F~ ($.~50 ~ ~. ~.) <br /> (6) ~s~n F~, $50.~ <br /> (7) Imams ~de ou~i~ offal <br /> ~si~ h~rs, $50~, mnmm ~o hou~ <br /> (8) lns~ ~ ~i~ ~ ~ is ~ffi~lly <br /> ~imt~, $50.~, ~m ~ ~ <br /> (10) F~ti~ ~ly Au~6m, $25.00 <br /> (I 1) Addifi~[ S~ of Plato $10.00 ~ ~ <br /> <br />I ber~by c~ify that theodore i~ ~f~..tion is correct,.P _ennfls/~e non--hie and e~ ifw~ is not ~ ~M 180 ~y, ai~ ~ if~a is .s~ ~ 180 <br /> ~o Apptl~t~nt]: (~ <br /> <br /> <br />