HomeMy WebLinkAboutPermit Building 2011-07-01Structural Permit Application-ffi225 Fifth Street o Spring{ield, OR97477 . PH(541)726-3753 . FAX(541)726-3689
This permit is issued under OAR 9f 8-460-0030. Permits expire if work is not started within 180 days of
suspended for 180 days.
ce or if work is
DEPARTMENT USE ONLY
Permit *,
S /./ -/{ t )
Date
Date;
This project has final land-use approval.
Signature:
This project has DEQ approval.
Signature:Date:
Zoningapproval verified: E Yes E No
Property is within flood plain: E Yes n No
f] Residential !,Covemment ! Commercial
IN.AND L(
Job site address: CS't f24tn 3f
Stzte: OZ zrPt /2y?7
Lot noSubdivision
'axlot'. OReference
rName:
Address:
State: 6 E-ztP: l7l)?
Phone:Fax:
E-mail:
Sign here:
n mls installation is being made cn residential or farm properly owned by
me or a member of my immediate family, and is exanpt from licensing
requirements under ORS 7010I0.
RACTOR
Business name:
Address:r
State: )/-ZP://217f,
Phone:$Ql- 7Cq 24*9 Fax
CCB license no.:
E-mail
Print name:3ot - Dal['rra.,.-
Signature:
Name CCB License #Phone Number
Electrical
Plumbing
Mechanical
(a) Job description
Occupancy
Construction type:(
Square feet:
Cost per square foot:
Other information:
Type of Heat:
Energy Path
E ne*
(b) Foundation-oniy permit? n Yes n No
Total valuation:$/ /nf
(a) Permit fee (use valuation table)$ /{72:
(b) Investigative fee (equal to [2a]):$
(c) Reinspection ($ per hour):
(number of hours x fee per hour)$
(d) Enter 12% surcharge (.12x[2a+2b+2c]):aLal
(e) Subtotal offees aboye (2a through 2d):.
3. PIan review fees
$
(a) Plan review (65% x permit fee [2a]):$
(b) Fire and life safety (40% x permit fee [2a]):$
(c) Subtotal offees above (3a and 3b):
I
l$
,, 'l
(a) Seismic fee, 1o/o (.01 x permit fee [2a]):$
(b) Technology fee,5Yo (.05 x permit fee[2a])$ 47L
(c) Continuing Education Fee $2.50 $2.50
sDrrJTOTAL fees and surcharges (2e+3c+4a+4b+4c):
Building Owner or Owner's agent authorizing this application:
1.