HomeMy WebLinkAboutPermit Building 2010-06-30Structural Permit Application
225 Fifth Street o Springfield,OR97477 i PH(541)726-3753 r FAX(541)726-3689
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DEPARTMENT USE ONLY
CO'*t?9(O - (>O 76(
Permit no.
Date: f, -3O -/ O
This permit is issued under OAR 9f 8-460-0030. Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days.
LOCAL (
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 ptain: ! Yes E No
E<Residential ! Govemment E Commercial
Jobsiteaddress: E3f S 3r"to
City: Str{ r r.l4.Fre AD State: oi(Ztr: | )t1 -l l
Subdivision:Lot no.
Ref'erence:t3 Taxlot:8t
Name 6 o'J
^l
Address:33 5
City: SpRTNr-F,€LP State: ci{ZIP:
Phone:.${t- ?r3 - cfgqs Fax:
E-mail
This installation is being made on residential or farm properly owned by
me or a member of my immediate family, and is exempt from licensing
requirements under ORS 701 .010.
Sign here:
Business name: ToXV D€NAl <crNSt:
Address: )<C c^) €O<€a)c,o rb r5,<
City: 6cra-.atg State: <r /Q ZlPtc(?S<*
Phone:(4l-?S# 4al7 Fax: 57l-!k3- )5/4+
E-mail: "Tla,rJY ,l Deat*t D r.SN. c-cpt
CCB license no.: / f3 4+?
Printname: "TLuY D€Nd
Signature:
Name CCB License Number Phone Number
Electrical I .r\
Plumbing (-Fr\-
Mechanical
(a) Job description: ?E4otlr coklE L otr fru^rcbl,r
Occupancy A
Conrtr*tion typ., / VK,
Square feet:
Cost per square foot:
Other information:
Type ofHeat: Nl
Energy Path:
^
/+
fl new EFalteration n addition
o(b) Foundation-only permit? E Yes
Total valuation:$ 2taa99
$(a) Permit fee (use valuation table):
(b) Investigative fee (equal to [2a])$
(c) Reinspection ($ per hour):
(number ofhours x fee per hour)$
(d) Enter 1 27o surcharge (.12 x L2a+2b+2c)):$
(e) Subtotal offees above (2a throu
(a) Plan review (65% x permit fee [2a])
s2d):
$
(b) Fire and life safety (40o/o x permit fee [2a])q
(c) Subtotal offees above (3a and 3b):
(a) Seismic fee, 1%o (,01 x permit fee [2a])$
TOTAL fees and surcharges (2e+3c+4a):$
ANDSITE
PROPERTY OWNER
if5
FEE
1.
2. Building fees
Plan
$
4. Miscellaneous fees
225Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
I elopment Services Department
Public Works Department
RECEIPT #: 1201000000000000812 Date: 0711212010 e:28:46AM
Job/Journal Number
coM20l0-00861
coM20l0-00861
coM20l0-00861
coM2010-00861
Description
Plan Review Residential
Building Permit
+ 12o State Surcharge
+ 5%o Technology Fee
Amount Due
44.04
67.75
8.13
3.39
Item Total:$123.31
Payments:
Type ofPayment Paid By
Check Number
Received By Batch Number
Authorization
Number How Received Amount Paid
Check TONY DENN CONSTRUCTTON djb 1 350 In Person $123.31
Payment Total: --STII3T'
cReceintl Page I of I 7lt2l20t0
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