HomeMy WebLinkAboutPermit Building 2012-03-15, ral Permit ApplicatioP-
225 Fifth Street o Springfreld,ok97477 o PH(541)726-3753 r FAX(541)726-3689
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issuan
suspended for 180 days.
LOCAL
This project has final land-use approval
Signature:Date:
This project has DEQ approval..
Signature:Date:
Zoaingapproval verified: I Yes D No
Property is within flood plain: ! Yes D No
! Residential E Govemment
.S
State:- 1 IC ztP:17V77
Subdivision:Lot no
Ref'erence:Taxlot:
PROPERTY OWNER
Name: f4 (KeU b.nrrctm__7 v€s
aao'.rr' 7t I Caryrt** *C U,af sqs€ D)
City: E Ueail{State: Ol-Z\PJ TVL\ /
'10 7 Fax:
E-mail
This installation is being made on residential or farm property owned by
me or a member of my immediate family, and is exempt fiom licensing
requirements under ORS 701.010.
Sign here:
CONTRACTOR INSTALLATION
Businessname: ARO€LL bl/Si4rcflOd L,L.L
Address: 116O I f(aag71 e f
City: fP/,r,rYznep I State: fff .zrY? 7y7 7
Phone: 5f / -7tt 7- g7 3 V pax:{,1-V7 87gS
E-mail lle I /t h
CCB license no.: l77l3Z
Print name €ef rD Li
Signature:
Name CCB License Number Phone Number
Electrical -s,77
Plumbing
Mechanical
or if work is
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DEPARTMENT USE ONLY
Permit no.:f1 2 -rl6i7
Date: 7/tf/tZ
FEE SCHED.ULE
1. Vr
(a) Job description:
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Co nsrru cti o n ryp., "1]FB
Square feet:
Cost per square foot:
Other information:
Type of Heat:
Energy Path
E new Wakeration f] addition
(b) Foundation-only permit? fl Yes n No
Total valuation s'Dwn
(a) Permit fee (use valuation table):$ 2:37=
(b) Investigative fee (equal to [2a]):$
(c) Reinspection ($ per hour):
(number ofhours x fee per hour)$
(d) Enter l2% surcharge (.12 x [2a+2b+2c])s zza:
(e) Subtotal offees above (2a through 2d):$
:Il;--i::::i:--:-
:;;. I i.- ,,,. :
(a) Plan review (65% x permit fee [2a])$ rstu
(b) Fire and life safery (40% x permit fee [2a]):s ?3?
(c) Subtotal of fees above (3a and 3b):s
#,'{t&
(a) Seismic fee, lYo (.01 x permit fee [2a]):q
TOTAL fees and surcharges (2er3c+4a)SgTZ
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