HomeMy WebLinkAboutPermit Building 2010-08-30CITY OF SPRINGFIELD
TRANSACTION RECEIPT
81 1-SPR2010-00147
1262 35TH ST
225 Fifth sr
Springfield,OR 97477
541-726-37 53
www.ci. springfield. or.us permitcenter@ci. springf ield or. us
RECEIPT NO: 2010000177 RECORD NO: 8l l-SPR20l0-00147 DATE:08/30/2010
Structural Building Permit Fee 224-00000-425602 $s0.00
Permit Fee ustment - Structural
SDC: Reimbursement Cost - Local Wastewater
224-00000-425602
442-00000-448024
$8.00
$484.44
SDC:Cost - Local Wastewater
SDC: Total Sewer Administration Fee
443-00000-448025
71 9-00000-426604
$260.76
$37.26
Permit Fee Adjustment - Plumbing 224-00000-425603 $57 00
State of Oregon Surcharge ('l 2ok of applicable fees)821-00000-21 5004 $13 80
Technology fee (5% of permit total) 100-00000-425605 $5.75
TOTAL
Credit Card
02681 D
raquel Hecht $926.87
$926.87
ruffit
DESCRIPTION AMOUNT DUE
s917.01
PAYMENT TYPE PAYOR CASHIER:CCARPENTER COMMENTS AMOUNT PAID
RECONCrv op SpnTcFIELD
Strurtu ral Permit Application
.PA'IOFICL'
225 Fifth Street o Springfield,OR97477 .PH(541)726-3753 . FAx(541)726-3689
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
This project has final land-use approval
Signature:Date:
This project has DEQ approval.
Signature:Date:
Zoningapproval verified: I Yes E No
Property is within flood plain: f] Yes E Uo
CATEGORY OF CONSTRUCTION
n Residential ! Govemment fl Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: ,, 'Zo 2 ?ru
City:$ryf Fr-N State:Ql2-ZIP..
Subdivision:Lot no.:
Reference:Taxlot:
PROPERTY OWNER
Name
Address:Ua
Crty: SOffWaP State: CL ztY:Q4\H
Phone:3t\-q a-;,%Far
E-mail:
This installation is being made on or f,arm property owned by
me or a member of my immediate family, and is exempt from licensing
requirements oRS 701.010
Sign here:
CONTRACTOR INSTALLATION
Business name:L
Address:
City:State nP'.
Phone:Fax
E-mail
CCB license no.:
Print name:
Signature:
SU B-CONTRACTOR INFORMATION
Name CCB License Number Phone Number
Electrical (A4*+D2-
Plumbing 'lqol? r
Mechanical
q€tSt-lfu
-- OuJtrAOU- tO
or if work is
(u^r,-g Na^J Brtr1-;a? S...)
DEPARTMENT USE ONLY
Permitno.:$J 0- /rll
Da.n",{fj b l/0
FEE SCHEDULE
&ffit*-
(
l. Valuation information
(a) Job description:
Occupancy
Construction type:
Square feet:
Cost per square foot
Other information:
Type ofHeat:
Enerry Path:
! new ! alteration E addition
(b) Foundation-only permit? ! Yes E No
$%oTotal valuation:
2. Building fees
$.6t-(a) Permit fee (use valuation table):
$(b) Investigative fee (equal to [2a])
$
(c) Reinspection ($ per hour):
(number of hours x fee per hour)
$ a?9(d) Enter l2%o surcharge (.12 x[2a+2fi2c1):
s(e) Subtotal offees above (2a through 2d):
3. Plan review fees
$(a) Plan review (657o x permit fee [2a]):
$(b) Fire and life safety (40% x permit fee [2a])
$(c) Subtotal offees above (3a and 3b):
4. Miscellaneous fees sah@ 2D
$(a) Seismic fee, lo/o (.01 x permit fee [2a]):
sTOTAL fees and surcharges (2e+3c+4a):