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FOR OFFICE USE ONL~ <br />Plan Approval: <br />Date ReCeived: ~ _ <br />Date Reviewed :,[~~L~ <br />Reviewed By: I1~' w w I~ u = ~ <br />Expiration Datep~l~ , <br /> <br />~,ddress; <br /> <br /> STATE OF oREG6N ~"~l~r-~ · . <br /> BUILDING CODES AG~ENCY ~' <br /> PREFABRICATED a~RUCTURE~ pROGRAM <br /> 1535 EDGEWATI=a NW~ SALEM~ OI~EGON 97310 <br /> TELEPHONE: (5{)3) ~373-1255 <br /> FAXi (593) 378-2322 <br />PREFABRICATED STRUCTURE= APPLICATION <br />_. FOR PLAN APP,ROVAL oR RENEWAL <br /> <br />Mfr's No, <br /> <br />Blazer Zndus~r±ea <br /> <br />~. o. ~?x 489, 945 elegy st. , <br /> ~ State: Zip C~de; <br />Aums~le.,, QR <br /> <br />Phone: <br /> <br />QUtLffi~ IN~ECTION <br /> <br />Numberof Modules: '~:: , <br /> <br />~U--C us~om Structures {one of a kind) <br /> <br />.~bmiffed with plans,) <br /> <br />C~ty; State: Zi? Code: I Phone: · <br /> <br /> DESIGN OPTION DESIGN PLANS ONLY) STRUCTURE DESIGN DATA <br /> ~ ~..~/ Occupancy Group ~ AS plasslfled in the <br /> Dragon ~ftuctural 8peolal~ Code. <br /> <br /> ;Ioof Load - live Ioa~ capabili~ in pounds per square foot, <br /> Roof Load - live Icad capabili~ in pounds per ~quare foot, <br /> Nind - Hodz0ntal wlna d~ign (MPH) Exposur~r C or D <br /> <br />PLAN REVIEW FEES Agency <br /> Adjustmen~ FEE CALCULATION iNStRUCTIONS <br /> Dateline Building Valuation from Building Valuation Oata Sheet, then dedu~ 11% for site <br />,~uildin~Valuation~ $ ~'~ Ci~(~ $ work. <br /> <br />St~u~uml: $ [~[ ~, , ~ $ Additional hourly Fee~ may be c~a~ed. <br />Mechanical: $ ~. ~: ~ $ <br />Fee; $ ~. ~ $ O~nent P~S & addition~, cha~ge~ or revislofls to p~ans, <br /> <br />Total <br /> Fee: <br /> $ <br /> $ <br /> <br /> and/orf~a~not~omplote~oins~,onswill~adeprlort~plan~l~ }~v~ ~ ~ Omgo~ 8uIIdi.g C~e$ A~n~y. N.~,E.A, = Notioe to ~oal ~forcome~ A~e~ <br /> ~UBMI~AL CHECKLIST ~~ .' Make Chec~ payable to: <br /> ~ies of Plans ~= } BUI~OING CODES AGENCY <br /> ~ ~ JFee Enclosed: $ .... <br /> <br />Coplos of Q.c. M~nual <br /> <br /> <br />