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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br />Re~cip~ g: Amount: $ <br /> <br />MARION COIIN~fY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salero, Oregon 97305 <br /> 8:00 am - 4:30 pm <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br /> <br />Lc~: Right: <br />Special: <br /> <br />1. JOB DESCRIPTION <br /> <br />MANUFACTURED DWELLING PERMIT APPLICATION <br /> *FLOOR PLAN REQUIRED* <br /> <br />RESIDENTIAL <br /> ( )New Plaogment ~Replacemcnt <br /> <br />Type of Siding: ~ Wood ( ) Metal <br /> <br /> ( ) Additional Unit Add-on <br />Year of Manufacturer: t~ <br /> <br />( ) Vinyl <br /> <br /> Super Good Cents Home ( ) Yes J~ No (Provide Documentation) <br /> <br />2. LOCATION OF INSTALLATION <br /> Sita Address: C!t~I ~[ [/~-I~]~t- zip: qZ~ <br /> <br />Garage or Cnrporl <br />( ) Attached ~ Detached <br />OfSee.ons: Len : 6¢' <br /> <br />TypeofRoofing: (~Comp ( )Steel ( }Metal <br />Number of Bedrooms: Existing: <br /> <br />Height: <br /> <br />Cross Street: <br /> <br />Width: ~."~ Height: <br /> Pit Set:l )Y I )N <br /> <br />Property Locator: <br /> <br />Proposed: <br /> <br />Zipq hone: <br /> <br />() Mobile Home Park ~,M, obile Home Subdivision [ Space i*: Total # Spaces: <br /> <br />Map: Zone: Parcel Size: ~ (~) SF ( I AC UGB: ()Y () N <br /> Par c~l #: <br /> <br />I WaterSapply: ( j Private Well .~CommunityWell ( )City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />() <br /> <br />I am ~he PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general eonUactor. I understand that I mast <br />register as a construction contractor if the structure is sold or offered for sale before or upon completion. Ill hire subcontractors, I will hire only subcontractors <br />registered with the Construction Contractors Board. ltl change my mind and do hire a general contractor who is registered with the Consh-uction Contractors <br />Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />1 am the AUTHORIZED REPRESENTATIVE of the properly owner or the contractor. <br />Business Name (please print)_ <br /> <br />Mailing Address: <br /> <br />() <br /> <br /> Street: <br /> <br />i am a CONTRACTOR registered with the State of Oregon. <br />Business Name (please print): <br /> <br />Mailing Address: <br /> <br />City: Zip: <br /> <br />Registration #: <br /> <br />4. FEES <br /> <br />City: <br /> <br />Zip: Phone: Fax: <br /> <br />(1) Manufactured Placement / Connections <br /> (includes EL, PL, ME connections & 30 feet <br /> each of sewer and water lines): $ 305.00 <br />(2) State Surcharge ~ <br />(3) State Administrative Fee 30.00 <br />(4) Zoning Surcharge, if applicable 30.00 <br /> <br />B. (1) *Earthquake-Resistant Bracing System (ERB) $ 85.00 <br />(2) State Sumharge 4.25 <br />(3) State Administrative Fee 30.00 <br /> * This fee is only charged when the ERB system is not <br /> part of the original manufactured dwelling installation. <br /> <br />C. Miscellaneous Fees <br /> (1) Additional Inspection or Reinspection <br /> ~ $60/per inspect'ton <br /> [Assessed for inspections beyond the third <br /> Inspection] <br /> (2) Investigation Fee ~ $305.00 <br /> (4) Other Inspections ~ $50 per inspection <br /> <br />TOTAL <br /> <br />$ <br /> <br />$ <br />$ <br /> <br /> $ <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 <br />issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant [Please Print]: <br /> Mailing Address: <br /> Phone: <br />Signa~ of Applic~t: ~~_ <br />MC 15-~ Rev 9~8 <br /> <br /> <br />