Laserfiche WebLink
FOR Cl2'Y USF.~INLY <br />Received By: Date: <br />Zoning By: City:. <br />Receipt #: Amount: $ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancastcr 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: Rear: <br />LeR: Right: <br />Special: <br /> <br />1. JOB DESCRIPTION <br /> <br />MANUFACTURED DWELLING PERMIT APPLICATION <br /> *FLOOR PLAN REQUIRED* <br /> <br /> 9~,~Ncw Placement ( )Replacement ( ) Additional Unit Add-on <br /> <br />Type of Siding: ~Wood ( ) Metal ( ) Vinyl <br /> <br />Garage or Carport <br />( ) Attached ( ) Detached Height: <br />No. Of Sections: Z Length: 59_I '¢/idth:~ 'Height: <br />TypeofRoofing: ~)Comp ( )Steel ( )Metal PitSet:( )Y ~N <br /> <br /> Super Good Cents Home ( ) Yes ~No (Provide Documentation) <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> ( ) Mobile Home P~ ( ) Mobile Home Subdivision <br /> <br /> Map: Zone: P~ce[ Size: ( ) SF <br /> <br /> Pmpe~ ~cator: P~ce, ~:~5 ~R0 ~ <br /> <br />Number o f Bedrooms:...~ Existing: <br /> <br />Proposed: <br /> <br />3. CONTRACTOR INFORMATION --- PLEASE INDICATE WHO IS DOING THE WORK <br /> ~ I am the PROPERTY OWNER and reside in, will reside in the structure and will be 1 understand that I <br /> OWn, <br /> or <br /> completed <br /> my <br /> general <br /> contractor. <br /> must <br /> register as a construction ~ontractor if the structure is sold or offered for sale before or upon completion, Ill hir~ subcontractors, I will hire only subconh'actors <br /> registerod with the Constrqction Contractors Board. If I change my mind and do hire a general contractor who is registered with the Construction Contractors <br /> Board, I will immediately notify Marion Count~ of thc name of the contractor. <br /> <br /> ( ) I am the AUTHORIZED REPRESENTATIVE of the properq' owner or the contractor. <br /> Business Name (please print) <br /> <br /> Mailing Address: <br /> Street: City: Zip: Phone: <br /> <br /> ( ) I am a CONTRACTOR registered with the State of Oregon, <br /> Business Name (please print): <br /> <br />Registration #: <br /> <br /> Mailing Address: <br /> Street City: Zip: Phone: Fax: <br /> <br />4. FEES <br /> <br />A. (1) Manufactured Placement / Connections <br /> (includes EL, PL, ME connections & 30 feet <br /> each of sewer and water lines): <br /> (2) State Surcharge <br /> <br />$ 305.00 <br /> 15.25 <br /> <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 inspection <br /> [Assessed for inspections beyond the third <br /> Inspection] <br /> (2) Investigation Fee ~ $305.00 <br /> (4) Other Inspections ~ $50 per inspection <br /> <br />TOTAL <br /> <br />$ <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 />MC 15-64 Rev 9/98 / - - <br /> <br />DO, e: <br /> <br /> <br />