HomeMy WebLinkAboutPermit Building 2010-5-25
Structural Permit Application
! PEPARTMENT USE ONLY,
SPRINO..la:LO
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- CITY OF SPRINGFIELD,'OREGON' - .
225 Fifth Stree' < Springfield, OR 97477 < PH(541)726-3753 < FAX(54 1)726-3689
Permit no.:OiO- tt'IJ3'
Date:
This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days of ssuan e or if work is
suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
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 fiood plain: 0 Yes 0 No
CATEgORY OF CONSTRUCTION
o Commercial
Subdivision:
Reference:
7
PROPERTY OWNER
Name:
Address:
-r
Sign here:
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
Print name:
Signature:
I -SUB-CONTRACTOR INFORMATION;" ,
Name CeB License Number Phone Number
Electrical )/,A
Plumbing IrA.
Mechanical . AlA
FEE SC8EDULE
1. Valuation information .
(a) Job dcscription: 1>QVi17'" ilfl1d f'/4I1ucrl:..
Occupancy lilt ~
Construction type: NA
Square feet: -
Cost per square foot: -
Othcr infonnalion: fh,leef ;ne-/vlt!J <"ik....",lc. o,,1v.
Type of Heat:
Energy Path:
o new 181 alteration o addition
(b) Foundation-only permit? o Yes t8I No
Total valuation: $/tQ. fX>O
2., Building fees p
, , .-
(a) Permit fee (use valuation table): $
(b) Investigative fee (equal to 12al): $
(c) Reinspeclion ($ per hour): $
(number of hours x fee per hour)
(d) Enter 12% surcharge (.12 x (2a+2b+2cl): $
(e) Subtotal of fees above (2a through 2d): $
'3. Plan review fees ' " , -
(a) Plan rcview (65% x penn it fee [2a]): $i )i" 'i2-
(b) Fire and life safcly (40% x pennit fee [2a]): $
(c) Suhtotal of fees ahove (3a and 3b): $
4. Miscellaneous fees " '. - "
(a) Seismic fec, 1% (.01 x permit fee [2aD: $
TOTAL fees and surcharges (2c+3c+4a): $
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