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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, 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 />Front: i Rear: <br />Left: Right:. <br />Special: <br /> <br />1. JOB DESCRIPTION <br /> <br />MANUFACTURED DWELLING PERMIT APPLICATION <br /> *FLOOR PLAN REQUIRED* <br /> <br />RESIDENTIAL <br /> ( )New Placement (~"'~placernent <br /> <br />( ) Additional Unit Add-on <br /> <br />Yea~ 0f Manufacturer: <br /> <br />TypeofSiding: ( )Wood ( )Metal ( )Vinyl <br /> <br />Super Good Cents Home ( ) Yes ( ) No (Provide Documentation) Number of Bedrooms:.2._ Existing: ~ Pwpos~d: <br /> <br />Garage or Carport ~,e'~, ~. o <br />( ) Attached ( ) Detached Height: <br /> <br />No, O£ Sectians: Length: Width: Height: <br />TypeofRoofing: ( )Comp ( )Steel ( )Metal PitSct:( )Y ( )N <br /> <br />2. LOCATION OF INSTALLATION <br />()MobilcHomcP~, ()MobileHomcSubdivisio. f~;**~ /~rr {sp~,: Tot~,Spaccs:. <br />3. CO~OR I~R~TION --- PL~AS~ INDICATE WHO IS DOING TH~ WORK <br /> <br />(~" I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I mUSt <br /> register as a construction contractor if thc struetare 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. ffl change my mind and do hire a general contra~,r who is r¢gister*d with the Construction Contractors <br /> Board, I will 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 /> Mailing Address: <br /> St~et: City: Zip: Ph0~: <br /> <br /> I am a CONTRACTOR registered with the State of Oregon. <br /> Business Name (pleese print): <br /> <br /> Mailing Address: <br /> <br />() <br /> <br />.Registration #: <br /> <br />4. FEES <br /> <br />Street City: Zip: Phone: Fax: <br /> <br />A. (1) <br /> <br /> (3) <br /> (4) <br /> <br />Manufactured Placement / Connections <br /> (includes EL, PL, ME connections & 30 feet <br /> each of sewer and water lines): <br />State Surcharge <br /> <br />State Administrative Fee <br />Zoning Surcharge, if applicable <br /> <br />$ 305.00 <br /> 15.25 <br /> <br />30.00 <br />30.00 <br /> <br />C. Miscellaneous Fees <br /> (1) Additional Inspection or Reinspection <br /> ~ $60/per inspection $ <br /> [Assessed for inspections beyond the third <br /> Inspection] <br /> (2) Investigation Fee ~ $305.00 $ <br /> (4) Other Inspections ~ $50 per inspection $ <br /> <br /> B. (1) *Earthquake-Resistant Bracing System (ERB) $ 85.00 NOTICE tOTAL $ <br /> (2) State Surcharge 4.25 EFFECTIVE 7-1-99 <br /> (3) State Administrative Fee 30.00 STATE SURCHARGE CHANGE <br /> * This fee is only charged when the ERB system is not FROM $% TO 7% <br /> part of the original manufactured dwelling installation. <br />I hereby certify that the above information is correct. Permits are n~n-trans~Yna exp~ wares-nut ~tar~d 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 /> <br />Signature of Applicant: <br /> <br /> <br />