HomeMy WebLinkAboutPermit Building 2009-8-26
Structural Permit Application
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32'-12 /hK\
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Penmt no.:
225 Fifth Street + Springfield, OR 97477 + PH(541)726-3753 + FAX(541)726-3689
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I Date: g-~Z6 -0 ,
This permit is issued ,~nder OAR 918-460-0030. Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days.
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This projecthas finalland.'use approval. I
SIgnature \ f tS Date: 1~~~;;.~;??\:\~~1~l~-~;~J~~~r~J;~IF.'~~-'~'~:9W~I~?U~~ri~~~\~~f;:?t~~~:'1(f:?:~~~,:~;1~: :';~:"~ .
I This project has DEQ approval. { I 1:1r~l&~rij~IlQHf(J):i~r.j)i,:~Jlg'~'~f~!':~~\}~;~:~~~Str;*~~~~~4R{~;~-~fli;Mf.:~_;;~t~~~~;~i~
Signature Date:. I (a) Job description: S""'-4I", ~W\'W 2es(u~(e
I Zoning approval verified: ..-It1Yes 0 No .1 I Occuparcy ((5/ /,,<. r I
l;'r,~~~;~_~:,;~~~~,~00d,~I~~:"[::J,,:::,:~.o"'Iij"5t<_:T"""II Construction type: ' ,rJ..v) I
rb~j~~:ii{~4t;:A'LEg_QB:Y~QFc",CQNS};RI}t;:TIQN~~..l:c'!',;~~r~~/i;! I Square feet lor 0 L I
IlE"'Residential I'D Government I 0 Commercial I I
Cost per square foot:
1~~~:~:~j;::_t~f.4Q~1l~itr.~TNB9.ijMATI3i>ij}YA~'R~r~Q~'AtT9Ht~~\~-~;~~~ I Other information:
I Job site address: ,s.?03 lisle\' I II
I fL () ,,", 1 'v I ~ 1 Type of Heat: E({
City: 51M In'\TI~1V1 State: tJL ZIP: -/7'1' - - ~
. I Energy Palh: 2 If jt/;tS:>lfL /cJ<cJ tXJ 1v~1:: I
1 Subdivision: f'l<\KoK-I /",~fc( 1 Lot no.: r=
I Reference: . I Taxlot: I 1....c.J new 0 alteration D addition I
h\ 'c' :, P,ROFERTV)9wr,fEf("-", '.)"'.'. ., - I (b) Foundation-only permit? DYes,..B1'lo I
I Name 6fl;:-J:.,-r ev- ~ T ',,' 11,~~a~ ~alua,~io~~~, <"<<"\\!if' "-"".", -" '" '". L$?: L~~~
_ 2'-Bulldlng ees'''~ '~:rr-~,' ,~, ",t{>9-~~~ ~ ~>~r '" ,',. '~ ; .~1"""~. ',-,
I Address: 'J. 'l. St:-,. I Av (:EjA}.J;>N( -;eel ,;:. -- , ,j.',"_zs- """""r";"'"y",."I""",.?:",S'-,"',,U,,,;',;,
I City eLl. ~~ I St;te- OCL. I ZIP cr7 4Cl81 (aJ Permit fee (use valuation table) $
I Phone: FIDe _ I I (b) Investigative ree (equal to [2a]): $ I
. I I (c) Reinspection ($ per hour): I
I E-mail: (number of hours x fee per hour) $
This installation is being made on residential or farm property owned by I (d) Enter 12% surcharge (.12 x [2a+2b+2c]): I $ I
me or a member of my il11,mediate family, and is exempt from licensing
requirements under ORS 701.0 I O. I '3\~;P~~I-~,~;t'~';~'~;'~:'~~i::';~~;;:;::~~.;:;:~~'"''"I<~~;'~'*zs-~ .
Sign here: q_.i.,.~~xe~I~.w,....e..eg,;I'iiH;',','!i';;;.;Z<*;\:'Bl!,,;;;sr;i\'\;"'i%J~i)').j,,,,,,,-I)" ,.'!-
i :::::: ~o~r'j;':~;;;'~1"'>";''''''i i ::: ::~~~~;=~~:i: :;~;:~ P']) i : :
: ~~~~es:'~;~;is I ~:~~ ~ ~; 97'111: :~~~~~;~;~;~~ii;~i~i!!!~j~~:::~::!(~:;,t9jk)t~;,M;I~~,k1f;mlJg~,"H;~;;J
I E-mail: t: AL:.o'l'1 (d Il..I",il. (JI\JN') I I TOTAL fees and surcharges (2e+3c+4a): $
I CCB license no.: . iKL 7.3 c..r I
I Printname ~,~/ "6 'YQ/ccx.-r-.! I
I Signature --k{j/ IS {~r-- I
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I Name,.. I CCB License Number Phone Number I
I Etectrical f:v<f.{q.-j I
I ptnmbing ~'!'l I
I Mechanical-s;:,.>t-l-!I