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HomeMy WebLinkAboutPermit Building 2011-8-22 " J '. Structural Permit Application IIPRINQF\IlLD '^ "";",, -,' '."", :.' , '.~"," ~..' '.^',," "l>1, " ~ .-:r<<&l....' '" 225 Fifth Street. Springfield, OR 97477. PH(54 1)726-3753 . FAX(541)126-3689 ../:..; .... ~-' DEPARTMENT USE ONLY Permit no.: 511-/1?? I ( Date: This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 180 days 0 suspended for 180 days. LOCAL GOVERNMENT APPROVAL This project has llnalland-use approval. Signature: Date: This project has DEQ approval. Signature: Date: Zoning approval verified: 0 Yes 0 No within Oaod plain: 0 Yes 0 No . CATEGORY OF CONSTRUCTION o Government JOB SITE INFORMATION AND LOC Job si{e nddress: C City: Subdivision: Reference: ZIP: PROPERTY OWNER Name: ZI City. Phone' E-mail: This installation is being made on residential or Carm property owned by me or a member army immediate rami!)'. and is exempt from licensing require r 701.010. Address: City: Phone: E-mail: CCB license no.: Print name: State: Fax: ZIP: Signature: SUB-CONTRACTOR INFORMATION Nllme cell License Number Pholle Number Electrical Plumbing Mechanical FEE SCHEDULE 1. Valuation information <aJ Job description: tf!ETyn tV/1V7 t-J ~ i-f- Occupancy u.... Construction type: v1( Square feel: Cost per square foot: Other information: Type or Hcat: Energy f::ltb: C}rt'Cw o II Iteration o nddilion (b) Foundation-only permit? DYes DNa - TotDI,"'alllation: $/!;lJO 2. BulJding fees ., (a) Permit fee (use valuation table): $ c.li'_ (b) Investigative fee (equal to [21l)): $ (c) Reinspection ($ per hour): $ (number of hours x fee per hour) (d) Enter 12% surcharge (.12 x f2a+2b+2cl): $;';~ (I:) Subtotal offccs above (211lhrougb 2t.1): $ 3. Plan review fees (a) Plan review (65% x permit fee [201): $ (b) Fire and life safety (40% x permit fee [2a]): $ (e) Subtotal offees abo\'e (33 and 3b): $ 4. Mis('ellnueous fees 2~~ (a) Seismic fee, ]% (.01 x permit fee l2a]): $ TOTAL fees and surchllrges (2c+3c+43): $ (g,? ~c. .~ A(V n~\y\J ~\ ~U \)'\-J \ V'\ . ;~~wj0~4J . ~'Q~ ~ (\,1J'\\\ SP~~~._.~~~ .'(~ . '\ OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 www.cLspringfield.or.us 811-5PR2011-01977 241 5 C 5T pe nnitcenter@cLspringfield.or.us '. . ACCOUNLCOOE 821-00000-215004 224-00000-425602 100-00000-425605 TOTAL DUE: DATE: 08/22/2011 AMOUNT.D.UE 6.96 58.00 2.90 67.86 AMOUNT PAID 67.86 RECEIPT NO: 2011002287 lOE5.CRIP-TION State of Oregon Surcharge (12% of applicable fees) Structural BuildingJ>ermit Fe: __ Tech~l?gy fee. (5% of permit total) RECORD NO: 811-SPR2011-01977 LP.A'l'rvIENJ..clyei::-"---___e&OR CASHIER: CCARPENTER. Cash Byan Lauber _C.OMMENT.S I .---' TOTAL PAID: 67.86