HomeMy WebLinkAboutPermit Signage 2009-1-8
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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Construction Contractors License #
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,Descriptio' /uti n /1 ir :J.~'),(),~
Date of Installation \ \ \ 0 \ OC) Date of Removal ~1-"/r,~.:~~r;S\
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Permit Fee: $225.00 including $100~(!i~\'A~~\;.~~es.
By Signa, ture, I sta,te and, agree that I have car, efully com'i1~:i'i-o~~~d lrereby ,crtify "'.
all information hert:in is true and correct. I further agree ~ ~ ~t the above described
banner(s) and/or portable sign(s) is not larger than 60 sq~ ~4'i& will be removed within 30 days
from the date listed above. If the banner(s) and/or portable ~ is not removed within the timeline
specified, I will forfeit the $100.00 deposit. I also understand that this special permit can be issued
only twice per calendar year per development area. I also agree to call the inspection line at 726-3769
by the end of the 30th day to request an inspection to verify the removal ofthebanner(s) and/or portable
sign(s). Tbis inspection will begin the process to return the $100.00 deposit if the banner(s) and/or
portable sign(s) haS been remove~ '
Signatur" J\ /U,01f/tL ( UI/i~SY- I ~!?,!oq
Date of Application
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Receipt # r
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Issued B ~r
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Amount Collected
Shared Drive (T:)lBuilding Forms/BannerYortable Sign Permit CSD7-08.doc
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-00026
ISSUED: 01/0812009
APPLIED: 01/0812009
EXPIRES: 02/0912009
VALUE:
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line ,:'
SITE ADDRESS: 1900 MARCO LA RD
ASSESSOR'S PARCEL NO,: 1703251300400
Springfield TYPE OF WORK: Banner
PROJECT DESCRIPTION: Banner - 011009 removal date 02Q909
TYPE OF USE: New
Commercial
Owner: TRI-W GROUP LTD PARTNERSHIP
Address: 100 SE CRYSTAL LAKE DR
CORVALLIS OR 97333
,
Contractor Type
Sign
I CONTRACTOR INFORM~ TION I
Qu\leS j ~0\i\i\'I
Contractor nOI\ \e.'# Ie OlegOI\ \ \~i'oense
~,. Ole,. """ \tle Ie se '\_
OWNER_"..,"{\O'''' 1_"leO"" _,,\\ese..,.,n"-?.-OO ,
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, ~iO" """ I ~ - \ AI! I "r'/i ';U'Y
",o\i\ICa: 9'52-00'\-~U ~~I\ CW~\tle \e e'~i~e.\iOI\
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(l090., \tle ce ~'15~_~)'
Ce.\\II\~1 \01 \tI':1;~\lIl'il~at:
(l0{{\'tl Cel\\e'Witter Type:
Range Type:
Energy Path:
,Sprinkled Building:
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
I DEVELOPMEN~ INFORMATION I
Expiration Date Phone
nla
Lot Size:
Sq Ft 1 st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq FIOther:
Occupant Load:
REQUIRED PARKING
Overlay Dist: Total:
# Street Trees Rqd: Handicapped:
Paved Drive Rqd: C~act:
% of Lot Coverag~: ,\\'C. ~~ ~\
dQ\?''C. ~~,,~\\ \S ~
I PUBLIC IM~W::~Nl"s:i\~:? \\\\~ ~Q~t.'il \-\JI.
, ,~ ' ,~~v" .?\I-~v
\\-\\'0 u()?\1.t.U ()? \'Siil\!lValk Type:
p...1J\ \' ~Ct.'0 ",("It;).
()\'lI\'lI't: ~ ?t.'m1lwnspoutslDrains:
C "'\~()t;)
\I-~'
Front yard Sethack:
Side 1 Setback: .
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation Descri9tion I
Description
Tvpeof Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Page 1 of2
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO:COM2009-00026
ISSUED: 01/0812009
APPLIED: 01/0812009
EXPIRES: 02/09/2009
V.ALUE:'
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Valne of Project
Fees Paid I
Fee Description
***+ 100/0 Administrative Fee***
+ 5% Technology,Fee .
Banner Special Permit
Deposit
Amonnt Paid
Date Paid
Receipt Nnmber
$20.00
$5.00
$100.00
$100.00
1/8/09
, 1/8/09
1/8/09
1/8/09
1200900000000000004
1200900000000000004
1200900000000000004
1200900000000000004
Total Amonnt Paid
$225,00
I Plan Reviews I
To Request an inspection 'call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I Reouired ~ nsp~~~.i~~,~ ,
Banner Removal: To be reqnested the day following the expiration of the permit. If inspection is not reqnested,
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 trne and correct, and 1 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 of 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 at the front of the property, and the approved set of plans will remain ou the site at all
time~s during .construction.
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Owner or Contractors Sig;lature
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Date
Page 2 of 2
225 Fifth Street
Spriqgfield, Oregon 97477
541-726-3759 Phone
,
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2009-00026
COM2009-00026
COM2009-00026
COM2009-00026
Payments:
Type of Payment
CreditCard
cReceint 1
RECEIPT #:
1200900000000000004
Date: 01/08/2009
Description
Banner Special Penn it
Deposit
+ 5% Technology Fee
***+ 10% Administrative Fee***
Paid By
JCK RESTAURANTS
Item Total:
t:heck Number Authorization
Received By Batch Number Number How Received
djb
008085 In Person
Payment Total:
Page 1 of 1
9:49:06AM
Amount Due
100.00
100.00
5.00
20,00
$225.00
Amount Paid
$225.00
$225.00
1/8/2009