HomeMy WebLinkAboutPermit Building 2011-08-12Structural Permit APPlication
225 Fifth Street o Springfi eld,OR97477 . PH(541)726-3753 a FAX(541)726-3689
SPFINGFIELD
h,
DEPARTMENT USE ONLY
permit no,, !l I - 17 g c2
Darc: fl1zl t r
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of issua nce or if work is
suspended for 180 days.
Crrv or S PRTNGFIELD" OREGON
Date:
This project has final land-use approval.
Signature:
Date:
This project has DEQ approval.
Signature:
Zoningapproval verified: ! Yes E No
Property is within flood plain: f] Yes D No
JOB SITE INFORMATION AND
CATEG ORY OF ONSTRU
! Residential fl Government
Job site address
State:€tzerfrLotSubdi{ision:/
TaxlotRef'erence:
RTY EP
Name
Address:
ZIP,State
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 from licensing
requirements under ORS 701.010.
Sign here:
CoNTRACTOB INSTALLflT|O.NL 4 ,
Business
/-
State11
Phone Fax
E-mail
CCB license no.
Yrintnameff$,, | |
SU
CCB License Number Phone NumberName
Electrical
Plumbing
Mechanical
.FEE SCH
1.V aluation
Occupancy
Construction fype:
Square feet:
Cost per square foot:
Other information:
Type of Heat:
Energy Path:
I new alteration n addition
(b) Foundation-only permit? ! yes E] No
Total valuation
2. Buildiug fees
(a) Permit fee (use valuation table)$70
(b) Investigative fee (equal to [2a]):$
(c) Reinspection ($ per hour):
(number of hours x fee per hour)$
(d) Enter 12% surcharge (.12x12a+2b+2c))l $ tt aL
(e) Subtotal of fees above (2a through 2d):$
(a) Plan review (55% x permit fee [2a]):Q
(b) Fire and life safety (40o/" x permit fee [2a]):$
(c) Subtotal offees above (3a and 3b)$
(a) Seismic fee, 1%o (.01 x permit fee [2a]):$
TOTAL fees and surcharges (2e+3c+4a)s lBfl
I
(a) Job descriptioil ey-n6d?
s/rfr,rlr.l
SPRIN6FIgLO
www.ci.springf ield.or. us
:;,TRANSACTION RECEIPT
811-SPR2011-01930
942 28TH ST
CI'IY OF SPRINGFIELD
225 Fifth st
Springfleld,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
o
RECE|PT NO: 2011002232 RECORD NO: 811-SPR201 1-01930 DATE: 0811212011
Building Permit Fee
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
224-00000-425602
821 -00000-21 5004
1 00-00000-425605
TOTAL DUE:
97.00
11.64
485
113.49
Check
8248
CROSSFIRE WORLD OUTREA 113.49
TOTAL PAID:I13.49
COMMENTS