HomeMy WebLinkAboutPermit Building 2010-6-30
'B''- t> E:- ~
Structural Permit Application ~
~~~
.
DEPARTMENT USE ONLY
Pennit no.: {y/ 0- S'&7
Date: fP/~O/ID
./ I
Tbis permit is issued under OAR 91l1-46G-0030. Permits upire if work is not started witbin 180 days of.ssuance or .fwork IS
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
This project has fmalland-use approval.
Signature: Date: .
This project has DEQ approval.
Signature: Date:
Zoning approval verified: 0 Yes 0 No
Property is within flood plain: Dyes 0 No
CATEGORY OF CONS~UCTION
o Residential D Government . b Commercial
JOB SITE INFORMATION ANDOCATION
S. '7 S;
6/-'
Sign bere:
Signature:
Name
Electrical
Plumbing
Mecbaak:a1
SUB.:cONTRA9TORINFORMA TION
ceo Lirense Number Pbone Number
{-
,.
FEE SCHEDULE
1. Val nation information
(a) Job description:
Occupancy
Construction type:
Square feet:
Cost per square foot: .
Other infonnation:
Type of Beat:
Energy Path:
o new o a1terntion D addition
(b) Foundation-only permit? DYes oNo
Total valuation: T$
. 2: Building fees ". . , ,
(a) Permit fee (use valuation table): $
(b) Investigative fee (equal to [2a]): $
(c) Reinspection ($ per bOt..): $
(number ofbnurs x fee per bour)
(d) Enter 12% surcharge (.12 x [2a+2bl-2c]): $
(e) Subtotal of fe.. above (2a tbrougb 2d): $'
3. Plan review. fees ,A~/
(a) Plan review (65% x permit fee [2a]): ~. jI'> $ '2 Q'f';;'
(b) Fire and life safety (40"10 x permit fee [2a]): $
(c) Subtotal of f... above (3a and 3b): $
4.,MiScellaneousJee.
(a) Seismic fee, 1%(.01 x permit fee [2aD: $
TOTAL f... and..urebarg.. (20+3c+4a): $
~
2~ willamalane
t~ Park and Recreation District
Job. No. t!i(J-- 0 (p ?
SYSTEM DEVELOPMENT CHARGE WORKSHEET
January 1-June 30, 2010
NAME: i?rrlD: vAt.l..tfY 4WLbElLS PHONE: SZ!/-3" 7-(611'
ADDRESS: Ct>, (b)( B'2 CITY.5w~"'Er '*~ STATE~ ZIP: 9734"6
LOCATION OF PROPOSED BUILDING SITE:
S. '-l2 IJC>
Tax Lot Number: m~rP~\Dt
Street Address: 'J / q /3 2. /
/
Plat Name:
1. DEVELOPMENT TYPE (Check appropriate dwelling{s). Dwelling type definitions are on the
back.)
A. Sinale-Family Detached
NO. OF UNITS X $2,858 per unit =
$
B. Sinale-Family Attached
NO. OF UNITS 2.... X $3,100 per unit=
$ &, 2.. {JO
C. Multi-Family Apartment
NO. OF UNITS
X $2,641 per unit =
$
D. Sinale Room Occupancy
NO. OF UNITS
X $1,321 per unit =
$
E. Accessory Dwellina Unit
NO. OF UNITS
X $1,550 per unit =
$
WILLAMALANE SDC
$
2. SDC CREDIT (If applicable) SDC payer must furnish proof of
Willamalane Credit approvaL)
$ .@
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
$ ~:2P:'
~
Development Services Department
City of Springfield
-c; I 30 I :J..iJ( 0
Dale \0 . V\ ''2.0\D j~0..l
W
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.,,,,:':.-
.. ~.:
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1201000000000000781
Date: 06/30/2010
2:54: II PM
Job/Journal Number
COM20 10-00867
Payments:
Type of Payment
Check
cReceinll
Description
Plan Review Same As
Paid By
RIVER V ALLEY BUILDERS
INC
Item Total:
Check Number Authorization
Received By Batch Number . Number How Received
djb , 14773 In Person
Amount Due
250.00
$250.00
Amount Paid
$250.00
Payment Total:
$250.00
~'~~~':'.~;
,..~; .
~i "l
-- .:l~ t',.\
j~ I:l'." '\ ,.
'" L.... ","
Page I of I
6/30/2010