HomeMy WebLinkAboutPermit Building 2010-6-30
Structural Permit Application
DEPARTMENT USE ONLY
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Date:
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: DYes D No
Property is within flood plain: D Yes D No
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D Residential D Government ~ Commercial
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Job site address: 63?. hel ~;;T.
City: ~ yrh (i~'1 State: Or. ZIP: '77'-/77
Subdivision:
Reference: 1703 Z 7 ( 0
PRQPERTVOwNER
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Pro- f2..,J.
State: Or.
Fax:
225 Fifth Street. Springfield. OR 97477. PH(54 t)726-3753. FAX(541)726-3689
Phone:
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:
E-mail:
CCB license no.:
Print name:
Signature:
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Name CCB License Number Phone Number
Electrical - / 75 373 7'77 770/
-
Plumbing 8 rq"f If ql't - 6€ 0 I
Mechanical LI'-I€13 6\?~ - 500 L{
- -)
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(a) Job description: 1hf- eJr"'", Re ....."J. 4. I
Occupancy
Construction type: [)I",,,J Fra-W1.e..
Square feet: :<;(00 be ,~.... 0",,,,,,"-.1..,, Id
Cost per square foot:
Olher information:
Type of Heat:
Energy Path:
D new ~ration D addition
(b) Foundation-only permit'? D Yes .El1'l' 0
Total valuation: $ S-6
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Ca) Permit fee (use valuation table): $
(b) Investigative fee Cequal to [2a]): $
(c) Reinspection ($ per hour): $
(number of hours x fee per hour)
(d) Enter 12% surcharge (.1Z x [Za+Zb+Zc]): $
(e) Subtotal of fees above (2a through 2d): $
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(a) Plan review (65% x permit fee [Za]): $ ~OZ-"-
(b) Fire and life safely (40% x permit fee [Za]): $ I 8 bI!!-
(e) Subtotal of fees above (3a and 3b): $ l{ B8! L
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(aJ Seismic fee, 1% (.01 x permit fee [2a]): $
TOTAL fees and surcharges (2e+ 3e+4a): $
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TRANSACTION RECEIPT
COM2010-00862
632 SHELLEY ST
www.ci.springfie\d.or.us
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541.726-3753
permilcenter@ci.springfield.or.us
DATE: 08/26/2010
RECEIPT NO: 2010000146
RECORD NO: COM20 10-00862
IDE' SCRiPTION '",~ iH "Iii#Ii:1i1ii! 'Wiill'jkjHilii!j!;1iT1l'ITI"I""1>;j.".",,
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SDC Transportation Admin
SDC Transpo Reimbursement
Planning Final Occy Inspection
Mechanical Permit fee (based on value of work)
Building Permit Fee
Admin fee (10% of applicable fees)
Balance of Minimum Plumbing Permit Fees
Fire, Life, Safety Plan Review
Deferred Submittal
Fixture
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
SDC: Improvement - Transportation SDC
PAYMENT TYPElI::: ,PAYOR ":i'LC~SKIER:IDeOWLSB~i: I
Check
42242
tree products hardwoods inc
i''''T':;'AP:CQj!!Nrf!'~Q.DEij::rt~;Wl!j:]~;\;];;;t/+!:!l!;lIO~iM'OUNT;;DUE.ii;;i;'F:>;';;:
719-00000-426604 $2,129.42
446-00000-446026 $9,169.20
100-00000-425002 $261.00
224-00000-425604 $77.50
100-00000-425602 $465.25
224-00000-426605 $22.80
224-00000-425603 $1.00
100-00000-425602 $186.10
224-00000-425602 $228.00
224-00000-425603 $57.00
821-00000-215004 $72. 09
100-00000-425605 $41.44
447-00000-448027 $11,060.27
TOTAL DUE: $23,791.07
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Partial payment. SDC deferred
22358.90 per MS.
$23,791.07
$23,791.07