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225 FIFTH STREET' SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
City Job Number
COIo'VlZ.o.o c; - 0 I b 7 Z
'3bC{O mAl/v 51
1702"3. 14 Z
Tax Lot
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Job Location
Assessors Map
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Owner of Property
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Contractnr
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Construction Contractors License #
Expirpo
, Descriptio-
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Date of Installatirm
Date ofRemov~1
Permit Fee: $225.00 including:$100.00 Deposit and applicable fees.
By signature, I state and agree that I have carefully completed this application and hereby certifY that
all information herein is true and correct. I further agree and understand that the above described
banner(s) and/or portable sign(s) is not larger than 60 square feet, and will be removed within 30 days
from the date listed above. If the banner(s) and/or portable sign 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 ofthe banner(s) and/or portable
sign(s)_ This inspe ion will begin the process to return the $100.00 deposit if the banner(s).and/or
portable sign(s) h been remov d.
Date of Applicati?n
Job 1#
Receipt #
Issued By
/IS -
Amount Collecterl
Shared Drive (T:)lBuilding Forms/Banner]~le Sign Peimi.t CSD 7.QS.doc
Status
finaled
CITY OF ~n<'ll~GFIELD '
Building/Combination Permit
PERMIT NO: COM2009-01672
ISSUED: 11/19/2009
APPLIED: 11/19/2009
EXPIRES: 05/19/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541'-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS:' 3640 MAIN ST
ASSESSOR'S PARCEL NO.: 1702314202501
Springfield TYPE OF WORK: Banner
TYPE OF USE: New
PROJECT DESCRIPTION: Banner-portable signs. REF:C0D2009-00753
Commercial
Owner, GREEAR JAMES D
Address: 35625 NE WASHOUGAL RIVER RD
WASHOUGAL WA 98671
, I CONTRACTOR INFORMATION.
Contractor Type
Sign
Contractor
OWNER
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:.
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprink,ed Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement'
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
,I PUBLIC IMPROVEMENTS I
Street Improvements:
Sto'rm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutsfDrains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of2
Status
Finaled
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fpps P,.id I
Fee Description
***+ J 00/0 Administrative Fee***
+ 5% Technology Fee
BallDer Special Permit
Amount Paid
$10.00
$5.00
$100.00
Total Amount Paid
$115.00
I Plan Reviews I
Date Paid
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01672
ISSUED: 11/19/2009
APPLIED: 1 i/19/2009
EXPIRES: 05/19/2010
VALUE:
11/19/09
11/19/09
11/19/09
Receipt Number.
2200900000000001312
2200900000000001312
2200900000000001312
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.
Rellllired l~ectio~I~1
By signature, I Slate 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 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 on the site at all
"'".:1l'~~:; Gd'iM ~ _
O\\'ner or Contractors Signature
Page 2 of2
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It.
225 }i'ifth Street
Springfield, Oregon 97477
541"726-3759 Phone
Job/Journal Number
COM2009-0 1 672
COM2009-0 1672
COM2009-0 1672
PaYl1)ents:
Type of Payment
Check
cRecein~l
City of Springfield Official Receipt
Development Services Department
Public Works Department
~
RECEIPT #:
Date: 11/19/2009
2200900000000001312
Ocscription
Banner Special Penni!
+ 5% Technology Fee
***+ 10% Administrative Fee"'''''''
Paid By
JAMES GREEAR
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 1191 In Person
Payment Total:
Page I of I
9:42:06AM
Amount Due
100.00
5.00
10.00
$115.00
Amount Paid
$115.00
$115.00
11/19/2009