HomeMy WebLinkAboutPermit Building 2009-7-7
Structural Permit Application I DEPAR'rMENT USE ONLY
'PA~:G=:::J COM Z.OO 1'-010 [J
l~ Penn it no,:
225 Fifth Street. Spnngfield, OR 97477. PH(541)726-3753. FAX(54J)726-3689 E...::::l.. ~
This permit is issued under OAR 918-460-0030, Permits expire if work is not started within 118~:t:~S Of~~:&o;ifwork is
suspended for 180 days.
CITY OF SPRINGFIELD, OREGON
LOCAL GOVERNMENT APPROVAL I
I This project has final land-use approval. I
Signature: Date:
I This project has DEQ approval. I
Signature: Date:
I Zoning approval verified: 0 Yes 0 No I
I Property is within flood plain: 0 Yes 0 No I I
I r CATEGORY OF CONSTRUCTION I I
Iii Residential I 0 Government I 0 Commercial I I
I JOB SITE INFORMATION AND LOCATION I I
Other information:
I lob site address: /t 0 ,,--,.,0. 4....r./I~W l')r I I
Type of Heat:
I City: S,u': v'\.r n..,,~ ,., 'I State: n..- I ZIP:017l.iry '11 I
I ' ) \ I I Energy Path: --
Subdivision: Lot no.: ~
?~ 'ill b I I 0 new "bIaheration
I Reference: 17D oJ i::.- I..> Taxlot: 0 ( ex) I
I I (b) Foundation-only permit?
PROPERTY OWNER
I r. - --- I I \ I I Total valuation:
Name: 1.-.1,. ^ $I '\ A.-\.-,'t' (l,,^.A-.~ ~,v 12 B 'Id' f
I -..-' .,...., ,- I' UI mg ees
Address: II c \ vJ. ,...-7(h TIII..( W ..-. "
I ' ~. 1\ \ I n I' Ct4 (a) Permit fee (use valuation table):
City: ^.rI^(,\~"I'/\ State: 'J,...,tr" ZIP: I "
I -, ('. (b) Investigative fee (equal to [2a]):
Phone:\ I-,I./-I",Cj () 1/'7 Fax: -.:\ A1""t ~ I"
- I (c) Remspecl10n ($ per hour):
I E-mail:<'i':\,^ , (l \",,",,-,J 1.,~(5'_~{Jra. {/''''^ (number of hours x fee per hour)
This instaliation is being made on residential or farm property owned by I (d) E t 12" h (12 [2 +2b+2 ]),
b f ' d' C 'I d ' C I" n er /0 sure arge. x a c.
me or a mern er 0 my lmme late laml y, an IS exempt ITom Icenslng
requirements under ORS 701.~IO, I (e) Subtotal ~~a~ove (2a through 2d):
"IS' h f\ ~ A ! . , I 3. Plan review fees
if.. Igo ere: lAl~
I / PONTRACTOR INSTALLATION I (a) Plan review (65% x permit fee [2a]):
I' 1I O' I.I~ I (b) Fire and life safety (40% x permit fee [2a]}:
Busmess name: [,....V rvL .. '-
I I (c) Subtotal of fees above (3a and 3b):
Address:
\ ' I I ZIP: I 4. Miscellaneous rees
City: State:
I I (a) Seismic fee, 1% (.01 x permit fee [2a]): I $
Phone: Fax:
I E-mail: I TOTAL rees and surcharges (2e+3c+4a): I S
I ees license no.:
I Print name:
I Signature:
Construction type:
Square feet:
Cost per square foot:
FEE SCHEDULE 1
"RA-'H^/c/DSt f- !
vrs. I
I
1. Valuation informatio,n I
(a) lob description: .IJ cld
Occupancy , -
o addition
DYes
ONo
1$ ~':J-
$
$
$
$
s
$
$
$
cerf
9(1) -Z07b
c.Jk::.
6f7-0<-((/
1
I Name
I Electrical
I Plumbing
I Mechanical
SUB-CONTRACTOR INFORMATION
-.....j
I
I
I
I
ceB License Number
Phone Number
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
~~
Ge=~01- 0101]
I Date:
~itfp~PARf,roil~1&~N.mI~
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Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire jfwork is not started within 180
days of issuance or if work is suspended for 180 days.
~:~n=::~~~~V:~~~EBNM~~liP.R'OY~~"~'
eSide~ti~I~IEG~R~~~~::~.TRlJr~O~o=~'
:Joa~SITE:JNF,,'MATIO"ANDlt:OCATlqN~~'~1 I ~,:c~O~:i:~::II~~O(:~ ft. or portion $134.00 $ -II
]obsiteaddress: 1/ '\" /;J, 1-~V"Jle.vJ ~r thereof $ 25,00 $
I City: "fr,^ ~.\( j I Sta."te:.r'J1 I ZIP: '1'7 '"",771 I Limited energy (2) $ 32.00 $ 1
1 Subdivision: 0 3 Z 7 5 (-. ' Lot no.: Of 60D I Each manufactured home or modular $ 63,00 $ I
O('SCRIPyT/ON" QF.:W RK... __..,___~ dwelling service or feeder (2)
? J..l 0 ~(J f"\ . . LJ I Services or feeders: installation. alteration, relocation I
I.. ~ "-'">;::,,, , c'b ^^ /d-el'0I I <r7 0 II) t 200 amps or less (2) $ 81,00 $ I
r:=~:-:~~~:Q~r::jf;~~;~~ ~~: :::~~:::~~~ ~1::::: ~ :
I dd ~ --- ,{) I 601 to 1,000 amps (2) $20500 $ I
A ress: I/O,," IrL r,'rv:<...w ,"" .
I r-. I () 1 f'. lOver 1,000 amps or volts (2) $469.00 $ I
City: <::... ....'1 ""l+=-.""'.1 ( State: V"' ZIP: '4 -) t,p"77
I Phone~\L"/f-]~ Ie; f) C{1 I Fax: - .\&.-- e;. I Reconnect only (2) I $ 63.00 1 $ I
I/."" I L" ( r Temporary services or feeders: installation, alteration, relocation I
E-mail: \J OVV'... r~A.N:;o\ -i!..rP>- .IN" rro, _. (VI
This installation is being made on residential or fann property I 200 amps or less (2) $ 63.00 $ I
owned by me or a member of my immediate family, This I 201 to 400 amps (2) $ 87.00 $ I
p.up,a; is not intended for sale, exchange, lease, or rent. OAR
y.r~.~A_1i\l!i [:'::'::7:::'"'.:'=:::::::::~:oo. i
Business name: I a. Fee for branch circuits with purchase of a service or feeder fee: I
I Address: I Each branch circuit I I $ 6.00 , $ I
I City: I State: I ZIP: IJ~ranchcircuitswithoutpurchaseofaserviceorfeederfee:
I Phone: I Fax: ,.....vr First brancil'-t:ircuit (2) / S 55,00 $ S;;
I E-mail: ( I I Each ~nal branch circuit 1 S 6.00 $ b I
CCB license no.: I BCD license no.: --rMlsCcllaneous fees: service or feeder not included I
Signing supervisor's license no.: I Each pump or irrigation circle (2) $ 63,00 S I
I Print name of signing supervisor: I Each sign or outline lighting (2) $ 63,00 $ I
I Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 63.00 $ I
alteration, or extension (2)
Eaeh additional ins eetion: (I)
;;1>0'"
'total~
'C(1~!~
~~
~~
.:&:,ppl!fcANr!Us' '
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (.12 x [A])
I (C) Technology Fee (5% of [A])
I TOTAL rees and surcharges (A through C):
bl
$712
$ 30>
$ 7/ :r.~
$
440-2584-1 (9/08/COM)