City of Oakridge DEPARTMENT USE ONLY

48318 East First Street Oakridge, OR 97463 Permit No:

Phone 541-782-2258 Fax 541-782-1081 Application Date:
Date Issued & Paid:

JOB ADDRESS:
Assessor's Map No.: Tax Lot(s):
Lot: Block: Subdivision:
Class of work: □ Residential □ Commercial
□ New Structure □ Addition □ Alteration □ Garage/Carport □ Accessory Bldg. □ Mfg.Home □ Other_____________

Property Owner (PRINT):

Phone: Alt Phone: Email address:
Mailing Address: City: State: Zip:
Contractor (PRINT): Phone:
Mailing Address: City: State: Zip:
Contractor Number (CCB): Email address:
Engineer, Architect or Designer (PRINT): Phone:
DESCRIPTION OF WORK:

ESTIMATED FINISHED VALUE: $

NOTICE
THIS PERMIT IS ISSUED UNDER OAR 918-460-0030, 918-440-0050, 918-780-0040/ 0065/ 0080. THIS PERMIT BECOMES NULL AND VOID ID WORK IS NOT COMMENCED
WITHIN 180 DAYS, OR IF THE CONSTRUCTION OR WORK IS SUSPENDED FOR A PERIOD OF 180 DAYS.
I hereby certify that I have read and examined this appplication and know the same to be true and correct. All provisions of law and codes governing this type of work will be complied with whether
specified or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state of local law regulating construction or the performance of
construction.
PROPERTY OWNER Signature: Date:
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 OAR 701.010.

CONTRACTOR Signature: Date:

FOR PLANNING DEPARTMENT USE

Zone: Plan Review No: Requires Yard Setbacks: Front: Side: Front/Side: Rear:
Flood Hazard: ______YES ________NO Flood Zone: Number of Off-Street Parking Spaces Required:

Special Conditions: Approved By: Date:

PUBLIC WORKS USE FIRE DEPARTMENT USE
Wtr Mtr: Size: Tap: B'Flow X-Conn: Access:
Sewer: Special Permit/Monitoring: Tap: Fire Protection Equip.:
Streets/Sidewalks/Curbs: Comments:
Storm Drainage:
Comments:
Plans Reviewed By: Date: Plans Approved By: Date:
BUILDING DEPARTMENT USE
Const. Type: Sq.Ft.: Occ Group: Max Occ. Load: # of Units: # of Stories: Height:
Other Information:
Plan Checked by: Date: Plans Approved By: Date:
BUILDING PLUMBING MECHANICAL TOTAL
FEES FEES FEES FEES
PLAN CK PLAN CK PLAN CK PLAN CK
SURCHARGE SURCHARGE SURCHARGE SURCHARGE
DEFER/PHASE DEFER/PHASE DEFER/PHASE DEFER/PHASE
BLDG PLBG MECH BLDG, PLBG,
TOTAL TOTAL TOTAL & MECH TOTAL
School CET
Inspection line: 800.358.8034 Schedule by 5pm for next inspection day
Site Plan Review
Inspection Days: M & Th rev 11/23
TOTAL