HomeMy WebLinkAboutPermit Building 2010-9-9
Struftural Permit Application
D~PARTMENTUSE ONLY
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Pennit no.:
Date: c;- '/-/0
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
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225 Fifth Street. Sp,ingfield, OR 97477. PH(541)726-3753' FAX(541)726-3689
o Residential 0 Government Commercial
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Job site address: II ~
City.
City:
Phone:
E~majl:
This installation is being made on residential or farm property owned by
me or a member afmy immediate family, and is exempt from licensing
requirements under ORS 701.010.
Sign here:
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Business name:
Address:
City:
Pho
E-mail:
StateoJZ-
Fax:
Z
Print name:
Signature:
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Name
Electrical
Plumbing
Mechanical
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. eose Number Phone Number
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(a) Job description:
Occupancy
Construction type:
Square feet:
Cost per square foot:
Other infonnation:
Type of Heat:
Energy Path:
D new 0 alteration
(b) Foundation-only permit?
Total valuation:
o addition
DYes
ONo
(a) Permit fee (use valuation table):
(b) Investigative ree (equal to [2a]):
,(c) Reinspection ~_-Jle!"hour): ~D
(numbeftJours x fee per hour) I'
(d) Enter 12% surcharge (.12 x [2a+2b+2c]):
(eJ Subtotal offees above (2. through 2d):
$
$ S~
$ r...::.
(a) Seismic fee, 1% (.01 x permit fee [2aD: $
TOTAL fees and surcharges (2e+3c+4a): $
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Structural Permit Application
....DEPARTMENTUsEONLy
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SPIZ..Z6IC"OO Z{, I
Pennlt no.:
225 Fifth Street. Springfield, OR 97477. PH(54 1)726-3753 . FAX(54 1)726-3689
Date: - ., '/ 0
This permit is issued uuder 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
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D Residential 0 Government 0 Commercial
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Job site address:
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(a) Job description:
Occupancy
o l.{':;"Ol
Construction type:
Square feet:
Cost per square foot
Other information:
Type of Heat:
Energy Path:
o new 0 alteration
(b) Foundation-only permit?
Total valuation:
o addition
DYes
ONo
$ l.(~
$ /04"7
Sign here:
(a) Permit fee (use valuation table):
(b) Investigative fee (equal to [2a]):
(c) Reinspection ($ r): 5<.>;7'0
(number of x ee per hour) /C
(d) Enter 12% surcharge (.]2 x [2a+2b+2c]):
(e) Subtotal of fees above (2a through 2d):
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.
Business name:
Address:
City:
Ph
E-mail:
ZI
(a) Seismic fee. ]% (.01 x permit fee [2a]): $
TOTAL fees and sorcharges (2e+3c+4a): $ IO'Z 0
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Fax:
Signal
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Name CCB License Number Phone Number
Electrical
Plumbing
Mechanical
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Str,uctm"al Permit Application
DEPARTMENTUSE ONLY
Spt2:z-Oft) -00 2S"
Permit no.: .
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(54 1)726-3689
Date: ,- , -/ c.)
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.
. ~.~n~4Q,gA~',;'~'Q~ERN~M"~NI0~Y~eFi~GY~~j;*~1;i~~~~~tW,1
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: DYes D No
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D Residential D Government Commercial
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Job site address:Ce...... C2......IV PoL.
City: StateO/L. ZIP!:f1.yz
Reference: I 7Cl3 Z.S3l.( D 6 ZOO
Coo PROPERTY QWNER
Name' ""~ ~ c ....... ~",c:l
Address: 1'2..'"1 S- <;;;\ r-ee.J U
City: ~ Statec.:lR..
Phone: - '2...ll Q Fax:
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:
Business name:
~
City:
Phone'
E-mail:
CCB license no.:
Print name:
StatoR-
Fax:
fl-
Signature:
;:i~:i_ff:(~Yf:~;~},~~~ii.Sl!~-~~()Nj1:r~AGI .
Name CCB License Number
Electrical
Plumbing
Mechanical
Phone Number
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(a) Job description: $/ DIN
Occupancy
Construction type:
Square feet:
Cost per square foot:
Other information:
~c..(<- t2..cf?/l- (II...
Type of Heat:
Energy Path:
D new D alteration
(b) Foundation-only permit?
Total valuation:
D addition
o Yes 'lIP No
.
Al~
(a) Permit fee (use valuation table):
(b) Investigative fee (equal to [2a]):
(c) Reinspection ($ _'-1'eiliour):
(numb .t-0ftrours x fee per hour)
$
$ZZI.!?..
(d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ 53'9
(e) Subtotal of fees above (2_ tbrougb 2d): $
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(a) Plan review (65% x permit fee [2a]): $
(b) Fire and life safety (40% x permit fee [2a]): $
(c) Subtot_1 of fees above (3_ aod 3b):
(a) Seismic fee. 1 % (.01 x permit fee fZa)): $
TOTAL fees and surcharges (2e+3c+4a): $ Sf. e
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