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HomeMy WebLinkAboutPermit Building 1990-10-2 r,; ~ 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 0 z ;.- ~ 9.: :l: c: ~ w Ii 0. 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.. .... ......~....~ . .- "'-'~';'~.;\Z~-'l:? ...0<;"".- N~m~(~l~i~~ ~!~~~~ -- . ~r ~~~nature \.,\.). ,~ Oc..9,~,lqqO 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 $ . OTK:R: ~? .: AMOU~,~~) . \)0 t"o..1 \ c..i\ SlGREJ)T~ .__~J~ "