HomeMy WebLinkAboutPermit Building 2010-10-14
. Structural Permit Application
.' DEPARTMENT USE CrilLY
225 Fifth Street. Springfield. OR 97477. PH(541)726-3753. FAX(541)726-3689
Permit no':9 0 - ) 07
Date: /0 I I D
This permit is issued under 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 project has final land-use approval.
Signature: Date:
This project has DEQ approval..
Signature: Date:
Zoning approval verified: 0 Yes 0 No
Property is within flood plain: 0 Yes 0 No
t1i-:i":i,',:",iw'~";CAJEG' OR~';OF;'CONS' J"R"'U"C" 'J"I"O':'N' '''.:,.i.:: ,..,.........,.,..,..,:.......',...,_'..,,'.....,.
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o Residential D Government 0 Commercial
"',jPI3SITE: :iN,FORMATI9'NANi)....1..(iCATI9N(.,..;,i/.....
2 'S 1+'\
State: tr.<--
. FEE . SCHEDULE
.i;ya)u~tii,~.inform~Mi-lH;"u;...
(a) Job description: 'RGl..o., e'/...'
Occupancy ~
Construction type:. 12aa-C
Square reet: It 0
Cost per square foot:
Other information:
City:
Phone, "1
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.
Type of Heat:
Energy Path:
o new alteration
(b) Foundation-only pennit?
Total valuation:
-:'Z.'BAjidiiigfe~sj'U.;;i;:'.;:ii;.;;::;:,. '. ....
(a) Pennit fee (use valuation table):
(b) Investigative ree (equal to [2a]):
(c) Reinspection ($ per hour):
(number of hours x fe~ per hour)
o addition
DYes
DNa
Subdivision:
Reference. \1
. ,
Name:
;"".,
;:.,-,,',.-.
$
CONTRACTOR. I!:iSTAlLATION.:., _
Business name: "'\CtlG1VZ~ :1:....'-.
Address: I 55" I 3#\ ';::1\
City: i+ ld State: 11411
Phone641 - -;;441
E-mail: fY\L~"OO.( eW-\-41.lM~,r'\.L+-
CCB license no.: [ct.o 3 ~O
Print name: e:
$
Sign here:
(a) Plan review (65% x permit ree [2a]):
(b) Fire and life safety (40% x pennit ree [2a]):
(c) Subtotal offees above (3a and 3b):
';4, Mi~~elIaite~.us i'e~(-ci;.:9,'t:..:.i
(a) Seismic fee, 1 % (.01 x permit fee [2a]):
TOTAL rees and surcharges (2e+3c+.4a):
Signature:
..e....;.: :.'F::'.i-S(J~,.(;ONJ:Mc:!ii()R.It<lFO:R.MAtjQi'!~\:;-ft~'.:":'i,\fi\'\;::
Name CCB License Number Phone Number
Electrical
Plumbing
Mecbanical
. ',~:_::-.)'" '
ATTENTION: Oregon law requjres.you~o
follow rules adopted by the Oregon Utili,ty
Notification Center, Those rules are set forth
in OAR 952-001-0010 through OAR 952-06i.
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
NOTICE:1F1HE WORK
THIS PERMIT SHALL ETXH~~~ERMIT IS NOT
AUTHORIZED UNDER OR
rOMMENCED OR IS ABANDONED F .
;~y 180 DAY PERIOD.
SP~~N~. FIE~
.t~
. '::"~"OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00507
1225 28TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
perm itcen1er@ci.springfield.or.us
RECEIPT NO: 2010000567 RECORD NO: 81 I-SPR2010-00507 DATE: 10/14/2010
fDESCRIPTIONfSC~-;~ . '0'''':" .:j<''.''-0:. ;':;'C~,-~:::,i~-_:::~:'0;:j't:"-.g(:;C_Q:UNf,,(:;QQI;"',"'';c_-;'AMOUlfTDUE.::' 0 _
Building Permit Fee 100-00000-425602 $116.50
Technology fee (5% of permit total) 100-00000-425605 $5.83
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $13.98
TOTAL DUE: $136.31
LM.,(MENT'f~eE: '-:.~PAYQB.fu~CASHIER1:cCA~~<ENTER:;:rQ:QMM~l'ttS~'i:'<-;::!$,-':'+-',...:. ::~ ':AM6~UNT PAID,' ,.'.,' _'
Credit Card
052366
MCKENZIE ROOFING INC
$136.31
$136.31
.' .