HomeMy WebLinkAboutPermit Building 1990-10-2
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225 FIFTH STREET
SPRINGFIELD, OR 97477
G'A'TE"WA Y
.
MAL L
TE NAN TIM PRO V.E MEN T SON L Y
.DEVELOP~EST SERVICES DE?ART~EN!
City Hall 8uildino
Owner:
General Growth of California
.~U!LD!SG SArETY D!V!S!Q~
(503) 726-3759
.Telephone: (818) 907-3400
Job Site: (503) 766-4707
fax: (818) 907-8841
5200.00
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Address:
15821 Ventura 81vd. Suite 525
Encino, California 91436
TENANT IMPROVEMENT
Value of " Work:
&ili QN(j
Application fee:
Nature of Work:
Name of Tenant Business:.
b~t''( ~~tJ) Q\9-r.iO
E;joSi~~m-&
Job Site Address:
Size of ienant :pace:
Rro~ g'
3000 GATEWAY STREET
SUITE:
~~paceNo,
DESIGN TEAM
(Name)
Oddress)
(Phone No.'
Primary:
Mech/Plumb:
Ell!'!~t.riC:81!
CONTRACTORS
(Name) (Address) (Lic;')
General: FL 8\\1U\0~ _ \~~~nlf\Glk)\\~(t
Electrical: ~ ~ Q l \.'f\f\I r11\
.SuDervisorls Sionat~\e
."lumbino: \\1"'0.\> 't\1..'lS'h 9\ 1Irl\'r\\~
Mechanical:. .
(Exoires) .(Phone No.) ,
lcA~q 41L2.JQ( f\"Q~~QZ.-
\n~<f:,3 \l\?llq I
3~?_, ~!.11$L'
AGENT
(CONTACT PERSON)
(Name)
(Address)
(Phone No.)
. ~\.)~,,~ \ '- \::>
\\)?~T
. WHERE STATE LAW REQUIRES that electrical work be done by a licensed electrician, an electrical permit shall
not be issued "ithout the name and signature of the Supervising Electrician and his/her valid license
information. rurthermore, once an electrical permit is issued, it snall not be valid until the 'electrical
label. ~f's...~~~p':.c:()mpl~~~:~)~d signed by the Supervising Electrician and posted on the switching equipment for
the tenBtlttsoacp.;..( (~~.~ \nQt,"'lIr:tion!'l- on reverse ~i,dp. (0'" f"urther infot'1flJ'l~ ion)
,_!~bAv...~a, _~_::) :r.;.;~;'~- ~hi;-~'';;'~~eted apPlica~i~n ~:r permit, and d:-~erebY certify that all information
hereon is true and corT~.t..-and.l\ further certify that. any and all work performed shall be done in accordance'
. ......}:'~th...t.:,... .:.........lltH1CeS ol th,~..City.: ~f: Springfield and the LaNs of the State of Oregon pertaining to the work.
described herein! 'ard_1nati~UPA. NCY Of THE PREMISES WILL NOT BY UNDERTAKEN without the permission of the
_.,~uildlmrS'ltr".y Ulvision. in the form. of a CERTIfiCATE Of OCCUPANCY..
.... ......~....~ . .-
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N~m~(~l~i~~ ~!~~~~ -- .
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~~~nature
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Date
INSTRUCTIONS .- "aU PO_it Aool1cat1on
The tenant Dr hi. duly authorized agent mu.t complete
all. required space. on this applicatin form.
Incomplete form. will bo held without further
processing until the required information is provided,
resulting in unnecessary delays in issuing the permit.
THE APPLICATION MUST BE ACCOMPANIED BY A $200.00
APPLICATION FEE WHICH. WILL 8E APPLIED TOWARO THE
PROJECT PLAN REVIEW FEES.
Note: PLANS & SPECIFICATIONS and other con.truction
document. .hould not be included with this application
(the con.truction- document.. should instead be
submitted to the mall owner for review and
acceptance). The. owner will forward the accepted
document. directly to the City for Plan Review and
Permit..
Thi. application will be matched with the appropriate.
plans when they are received from the owner. Plans
not having ev~dence of the owner1s acceptance will not
be accepted. for review by the City. Plan. which are
received before the permit application will be held by
the City until the applicationi. received, and they
will be reviewed for Code compliance in the order that
the Aoolications are received.
The following information will assist in filling out
the Application form:
PERMIT # - will be assigned by the City upon
acceptance of the application.
VALUE Of WORK - .hould include all cost. for material
& labor lincluding contractor'. OH & P) and the cost
of all additional in.tallation. by the landlord which
are being charged to the tenant.(eg. additional roof
curb., etc.).
NAKE Of TENANT BUSINESS - Include the name of the
business 89 it will appear on the storefront, and the
name of the company, individual, partnership, etc. I if
it 1s different from the business name being used.
SIZE Of TENANT SPACE - Indicate the total floor area
specified in the lease for your business space.
DESCRI8E BUSINESS - Indicate the type of merchandisa
and/or service to be provide~ to cUstomers/clients."
SUITE - this i. tha. tenant le..e .pacenumber.
DESIGN TEAM -. Include the requested information for
tna de.ign profe..ional. who prepared Dr participated
in the preparation of construction documents. If all
or any portion of the'project is being designed by the
contractor(s), please so state in the appropriate
spaces.
CONTRACTORS - Include the requested information for
the general contractor & subcontractors.
Note: The State of Oregon does'" require commercial
contractors to be licensed through the Builders Board.
However, Persons installing or modirying electrical or
plumbing work must hold 8 valid Journeyman's'! license
for .these trades from the State.
. AS Of JIJl. Y I, 1989,. Oregon Law require. that a
supervising' electrician 'shall sign the permit
application, or the electrical portion of this'
combina~ion building' permit will not be issued.
THE. ELECTRICAL PERMIT HAY BE OBTAINED SEPARATELY BY
. THE EtECTRICIAH.
~ - The ,applic8tio~ must be signed and dated by
the tenant or his/her duly authorized representative.
,
FO.OFFIC[ US[
AI'l'lI CA TlDl RECLIVED:
VALUE Of WORK: - - - - - - - - $
SYSTDI OCV. 0iARGE:
(1.5= of Value)
$
.
BUILD III: PERIlIT:
Surchcarge:
$
SUBTOTAL:
$
.
PI.AN REVIEW fEE:
Le.. Application:
$
(-)
200.00
SUBTOTAL:
$
.
PtlJ'BIII::
.~a~
$ 50.t:b
CJ ..er)
$~,.Q ..:().
f"ixtures:
Surcharge:
SUBTOTAl: .
mCTRICAL:
reeders: ~a____amps
_a_amp.
Wiring: 2. or more cir.
Surcharge: .
$
22.50
SUBTOTAl:
$
.
PEOiAHICAL :
.AlC unit. Dr heaters:
Le.. than 100 MB~as6.50 $
Vent fans (lductl_a 3.00
Other vent .y.t. Dr
exhaust hood _a 4.50
rue 1 ga. piping
Surcharge:
SUBTOTAL
$
.
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AMOU~,~~) . \)0 t"o..1 \ c..i\
SlGREJ)T~ .__~J~
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