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Permit Signage 2013-5-22
.,,1, ,. .w > "sc t"�s:.-",�.Y? ia7csn� ms ' M l �e rL, (r : . 225 FIFTH STREET • SFRINGFIELD,OR 97477'• FH:(541)726-3753 • FAX: (541)726-3689 .___:.. City Job Number S/ 5 -a �(07( C /� ' 0 Job Location 5-73-1 It'ia.In LLSi- JprinGe \c\ o2 ct 47g Assessors Map 17 (2 2- - 33- ` H 0 (-111;0 ( Tax Lot 1 bu920 2D Business Name Cl) Business Contact Name c34 ry � Riau in 1 - Phone 59 I -3�Li-gin U YY it \'ylc / (LC__niaibir- . ...q Owner of Property �(-Gt���11// I Address 4 0S Yin 1n6K(( em UC7l Ph/5 5 Ct 1 -ag4 -59 n COO City csyNn ncf t-\d _ State OR, Zip 4.--)4 7g � �C /nt c----o" J I . G Th = Address 'H ( J Phone (j ) /'-( 3O& 4P eCity State n C Zip U b 2- OConstruction Contractors License# Expires 0 16. 12 Description L ' J eDate of Installation 07 75Y 3 Date of Removal 6 7 3 / D/3 Permit Fee: $225.00 including $100.00 Deposit and applicable fees. h-+-■1 By signature, I state and agree that 1 have carefully completed this application and hereby certify that all information herein is true and correct. I further agree and understand that individual banners and aportable signs subject to this permit may not be larger than 60 square feet. I also agree and understand r--I that temporary signs shall be removed within 30 days from the date listed above. If the temporary • sign(s) are not removed within the timeline specified, I will forfeit the $100.00 deposit. I also • understand that this special permit can only be issued four (4) times per calendar year per development area. I also agree to call the inspection line at (541)-726-3769 by the end of the 30th day to request an ct inspection to verify the removal of the temporary sign(s). This inspection will begin the process to return the $100.00 deposit if the temporary sign(s) have been removed. 0 Property Owner Signature L�-•/ `�elir - Date 5- 1-7--2 DS CLi E For Office Use Date of Application -z/3 Job# 5/3-o ( n-s ( Receipt# 3-/0/ c) Issued By Amount Collected Z zS...- Shared Drive(T:)Buildiug Formt?emporary Sign Permit CSD 3-12 doc . SPRINGFIELD 225 Fifth St ..... .a=icii _1. .. - CITY OF SPRINGFIELD Springfield,OR97477 � Phone: 541-726-3753 OREGON Building / Sign Permit Inspection Phone:541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01031 www.springfield-or.gov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 05/22/2013 EXPIRES: 06/23/2013 STATUS DATE: 05/22/2013 APPLIED: 05/22/2013 SITE ADDRESS: 5737 MAIN ST,Springfield,OR 97478 SCOPE: Banner,Portable Sign • ASSESOR'S PARCEL NO: 1702334103401 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Temporary sign install 052313 removal date 062313 . OWNER: PACWEST ENERGY LLC Phone Number: ' • ADDRESS: 3450 COMMERCIAL CRT MERIDIAN ID 83642 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Sign Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED 1 • Inspections 6972 Banner Removal Banner Removal: To be requested the day following the expiration of the permit. If inspection is not requested,the applicant may forfiet the deposit. By signature, I state and agree,that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein,and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further. certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time,that each address is readable from the street, that the permit card is located atthe front of the property,and the approved set of plans will remain on the site at all times during construction. L 7. Owner€Contr ctor Signature Da•- • Springfield Building Permit 5/22/2013 2:41:27PM Page 1 of 1 t t SPRINGFIELD CITY OF SPRINGFIELD INV- 225 Fifth St l - TRANSACTION RECEIPT Springfiel .OR97477 a. OREGON 541-726-3753 811-SPR2013-01031 w w.springfieldor.gov 5737 MAIN ST permitcenter@springfield-or.gov RECEIPT NO: 2013001019 RECORD NO:811-SPR2013-01031 DATE:05/22/2013 DESC'IPTION I,-Wfr4 w rZgk:Y zatii"ac itt nialACCOU TtCODE/TRANS` OD °`4 a L1.-.u'.::=AMOUNT,DUE"k+4 Admin fee(10%of applicable fees) 224-00000-426605 1098 20.00 Banner, Portable 224-00000-425602 . 1065 100.00 Banner, Portable Deposit 821-00000-215500 1049 100.00 Technology fee(5%of permit total) 100-00000-425605 2099 5.00 TOTAL DUE: 225.00 W AYMENTd1YP,E PAY,OR casHIER:-,oeowLSer ,COMMENTS _-AMOUNTRAID Check thabet management inc 225.00 12810 TOTAL PAID: 225.00 •