HomeMy WebLinkAboutPermit Building 2012-06-28€v"Ll
Structural Permit A
225 Fifth Street I Springfield, OR 974?7 . Pl(541f2e3753 r FAX(541)26-3689
This permit is issueil under OAR 918-460-0030. Permits expire if work is not started within 180 days
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
1'his project has final land-use approval.
Signature: N/A f)ate:
This project has DEQ approval.
Signature: N/A Date:
Zoning approval verified: f] Yes E No
Properry is within llood plain: fl Ves E No
CATEGORY OF CONSTRUCTION
f] Residential I Government E Commercial
JOB SITE I!.IFORMATION AND LOCATION
Jobsiteaddress:593 35th Street
city:SPringf ield state: OR y1y197 47 B
Subdivision: }[/[Lotno.:19
Ite l'erence:L T&{lot 17023112 oreoo J
PROPERTY OWNER
Name:Terry L Stafek
466rc,'.3895 Commercial Street
crry: SPringf ield state:oR zw:97 47 8
phone:541 -747_ 2433 Fax: N/A-
tl-mail:N/A
'Ihis instnllation is being made on residential or farm property owned by
me or a mernber of my immediate family, and is excmpt frorn licensing
requirements under ORS 701.010.
sign here; N/A
CONTRACTOR INSTALLATION
Business name: Monti nlectric
Address: PO Box 2 2 0
Ciry:Troutdal-e Skte: OR 7p,97 060
Phone.s03 -49!- 4909 Fax:N/A -
ll-mail: N/A
CCB license rru., 13 5326
Print name:
Signature:
SUB.CONTRACTOR INFORMATION
N*me (,CB l,icense Number Phonc Number
Illcctrical N/A
Plumtring rrr/a
Mrchanical N/A
or if work is
DEPARTMENT USE ONLY
Permitna.fl> -il1f
oate: fi/Zt/t-
FEE SCHEDULE
l. Yaluation information
(a) Job description: Cll CO r€
Occupancy S - 2
Construction type: I IB
Squarc feet: 2400
Cost per square foot N/A
Other information;
Type of lleat: N/A
Energy Path: N/A
I new fil alteration f] addition
(b) Foundation-only permit? [ Yes El No
Total valuation:$rz, ooo . oo
2. Building fees
(a) Permit lee (use valuation table):$ tstz
(b) Investigative fee (equal to [2a]):$
(c) Reirspection ($ per hour):
(numberofhours x fee per hour)$
(d) Enter l27o surchargc {.12 x pa+2ll*}c)}:$ iEL
(c) Subtotal offecs above (2a through 2d):$
3. Plan revicw fees
(a) I'lan revierv (657o x pernrit fee [2al):ttdl y
(b) Irire and life safety (40% x pennit fee [2a]):$
(c) Subtotal of fecs above (3a and 3b):$
4. Misccllaneous fees -77
(a) Seismic fec, l% (.01 x pernrit lee [2a]):$
TO'I'AL fccs and surcharyes (2e+3ct-4a):$2)3'-
Crrv *F $PRINCFrtit.D, t)ttECoN
'l"i]."''