HomeMy WebLinkAboutPermit Building 2011-2-1
Structural Permit Application
.PAINOP..l..O
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DEPARTMENT USE ONLY
Permit no:5 / f / & J
Date: 2- (
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.
LOCAL GOVERNMENT APPROVAL
This project has finalland-usc approval.
Signature: Date:
This project has DEQ approval.
Signature: Date:
Zoning approval verified: 0 Yes 0 No
Property is within nood plain: 0 Yes 0 No
CATEGORY OF CONSTRUCTION
o Government
Commercial
Job site address:
City:
Subdivision:
Reference: :3 -ooSO
PROPERTY OWNER
Name:? ~r /1.."-
Address: '2.t;o "P1lV"
City: ''be ZIP: 6'3"l01>
Phone:Z06-'3,r; -GoU>o
E-m,il: villa... ~1'lIJ. $I.\...l ",. c.M\
This installation is being made on residential or farm property o\\'Tlcd by
me or a member afmy immediate family, and is exempt from licensing
requirements under ORS 701.010.
Sign here:
CONTRACTOR INSTALLATION
.,
S
ZIP:17D35
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Ewtnnil:
CCB license no.:
Print name:
.
Signature:
SUB-CONTRACTOR INFORMATION
Name
Electrical
Plumhing
Mechanical
ceo License Number
Phone Number
FEE SCHEDULE
1. Valuation information
(a) Job description: lalanl- J:m1'l'W!W1c-.q..
Occupancy M/<:;-'2.
Construction type: m-P7 ~11M s
Square feet: t?1.'^,Oi ~.~ . I I
Cost per square foot:
Other information:
Type of Ueal:
Energy Path:
Dnew ~ alteration o addition
(b) Foundationwonly permit? DYes DNo
Total valuation: rJ:j~nr
2. Buildiug rees .
(a) Permit fee (use valuation table): $
(b) Investigative fee (equal to L2a]): $
(c) Reinspection ($ per hour): $
(number of hours x fee per hour)
(d) Enter 12% surehllIge (.12 x [20+21>+-2e]): $
(e) Subtotal offees abon (28 through 2d): $
3. Plan review fees
(n) Plan review (65% x pemlit fee [2a)): $ JeWit.
(b) Fire and life safety (40% x pennit fee 12a]): $
(c) Sublotal offees ahove (3a and 3b): S
4. Miscellaneous fees
(a) Seismic fee, 1% (.01 x pennit fee [2n]): $
TOTAL fees and surcharges (2e+Jc+4a): $
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