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Home My WebLink AboutPermit Signage 2004-3-4 I 225 FIrJ'H STREET. SPRINGFIELD, OR 97477 . PH:(,,4 J)72G-37,,:~ . fAX: (54.i')72(;<~G8~' ~, OOSj [); Job Location 21 ~.I) SU' ~. Assessors Mar I 703 Z- -,2- ~, /-rAIlv, SPALi.Nt ~i~ SLJ.12, ...0: .: - . bOJ;.' Owner ~f Property Po ~ fl C\/ ~..VIL::-NT L L ~ .~. . J ..~: 'Address 2-l9":} Ol"'-?MPIC Sr. '0' ~ City <;;;'.{J t2.1 AllTFllo""'\A <i): Contractor/Installer C?h21 ---.::. ~j Address _. OJ City e>) ~. .: d! Description a:ol ---' Date of Installation (Z)j 8~ ~; .' Sj ~l. (1)' ~, ----' UJ; ~i 00) .,"~i 00, ,,/ - CI:); ~~ ....oJ .~~ ~ 0; ~ ----' ~1 H; ~{ ...J~~ ~1 ~l '( .. ", . . . . City Job Number LQvV\ 2OOL(- OOZ 4 S- tJl.-'YfvI. fr( SoT.' Tax Lot 3.3 f - '3 2$ I 0/ z..OC C:h. ~ I A-PcVL-{I.'f<;J (L Phone :t 1../(.0 - m q ta,S' Zip q~\...I':r=l /_/5.:J" State cJQ C)v ltlJOS - 6T. ~~ 6\YMPlC- cs... P{L./ .vo-t"'l~ Sou ~ T\:)uMr Phone 33..3- - '3 2...~ I &fL Zip q"::t I{ 1-1- Construction Contractors Registration # . I' I ~ ^ A L\..lX)1\1 030 yOY State IV lit 'O\:pires , S~ "+ SOGA cuP 03/9D L( JAJ Date of Removal <r'~ ... ~ Permit Fee $80.00 + Required Deposit $100.00 + 10% Administrative Fee By signature, I state and agree that I have carefully completed this application and hereby certify that all infonnation herein is true and correct. I further agree and understand that the above described display will be removed within fourteen (14) days from the date listed as the date of installation above. lIthe display is not removed within the timeline specified, I will forfeit the $100.00 deposit. I also understand that this special penn it can be issued only once per calendar year per development area. I also agree to call the inspection line at 726-3769 by the end of the 14th day to req~ an inspection to verify the removal of the display. TIlis inspection will begin the process to return the $100:0()AIeposit if the display has been removed. Signature ~(il/1!1~ m/I R)( Val"" \le\J..dil;\,\",,4l)ate~W.s::.J(\4 ~......, A~ ~--i' 5t'AL.."~, 'l)vJ.jr,/ b.n>(/A'h-<L.j~"~L~~-')-.5t.g I / . ~ For Office Use Date of Application 03 04 0 Y 1 b#{.OvY\ZOOY -OOZLfS-R ." au 'Z 72 o ecelpL ATTENTION:Oregon laW~l!:lresd'gu. ~u A'l1nunl !\"I)lleetell ~'" tl-f d)rj\(~)ii"t:lttllty JOlIUW, ;J'\__ '. . les are set lOft \lotification Center. Those rUh 0 Il..R 952-00 n OAR 952-001-0010 throug. I \ J090 You may obtain copies of the ru as . . center. (Note: the telephone calling the Utility Notification number for the Oregon r-_~,'M:~ 1_RN1-:'I:'I?-?::I44). Shared Drivr...iT:I/Building FomlslBlimp _ PonablcSil;;OS _llalloons 1-03.doc L~weaJ3' ~(S \'aU lIl1t: EXPIRE IF THE WORK ~~~~r~~ ~~~i~ lHIS PERMI1IS NOl COMMENCED OR IS ABANDONED fOR ANY 160 DAY PERIOD. . t.- O-u.!<.. WvA~ ~~ _~ ~ . ," ., \' .. - OM 4 C) )iriO'.'J 3HT ~ 3RjC;;{] JJAHa r;...1:.'J ~,.'iT T' , "11'''''13'' '),. - ...., . () .... 'UA V~l tI 'ut ., :"'1." n....,J~.J ..J~I"""'I' ,fWl Cl.:i'iIJi.."I1..A 2/ h) !./;j~'.,~;..'..LJ:J .Uljll1;;'1 YAJ U\i( YM .' . .' - '1 -', " ..- ......... . . CITY OF SPRINGFIELD Building:lCombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO: COM2004-00245 ISSUED: 03/04/2004 APPLIED: 03/04/2004 EXPIRES: 09/0412004' VALUE: SITE ADDRESS: 2155 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1703254201200 Springfield TYPE OF WORK: Blimp, Portable Sign, Etc. TYPE OF USE: PROJECT DESCRIPTION: Balloon - from 030504 remove on/or before 031904 Owner: POLEN DEVELOPMENT LLC Address: 2197 OLYMPIC SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION , Contractor Type Sign Contractor OWNER License BUILDING INFORMATION' # of Units: #of Stories: Primary Occupancy Group: Height of Structure Secondary Occupancy Group: Type of Heat: Primary Construction Type VN Water Type: Secondary Construction Type: Range Type: t E _dlr'>" 't'il!] 0 # of Bedrooms: ENTION:Oregon law I 'n~r6J"ra u'tTty ATT ted by the Oregon II r_II........ "IIIA~ adop . _ _....... coot fort >I;ti!ication cen.te~1i.DEY.Ei.OPM~:r-JNFeRMATlON I SETBACK~. OAR 952-001-0 in copies of tne rJ,l,,, , "090 You may obta ...._ ,^I-.,hone Frontyard Setback: u . h center (NoteOverlayD.'st: . II' g t e' "f'''a''QI'! Side 1 Setback: ca '" the Oregon U#.St)'e"e't~~e~s Rqll: Side 2 Setback: number;~~,,,r:,, 1_R('\('\.~:!'Jl"ell'D'rIve Rqd: Rearyard Setback: % of Lot Coverage: Solar Setbacks: Street Improvcments: Storm Sewer Available: Special Instruction: NOTICE: I PUBLIC IMPROVEMENTS' THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. New Commcrcial Expirarion Date Phone Lot Si2e: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING Total: Handicappcd: Compact: Sidewalk Type: DownspoutslDrains: Notes: I Valuation Descriotion I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Page 1 of2 Value Date Calculated . . CITY OF SPRINGFIJ<..LU Building/Combination Permit PERMIT NO: COM2004-00245 ISSUED: 03/04/2004 APPLIED: 03/04/2004 EXPIRES: 09/0412004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fee.. P,llid I Fee Description + 10% Administrative Fee Blimp + Special Permit Deposit Amount Paid Date Paid Receipt Number $18.00 $80.00 $100.00 3/4/04 3/4/04 3/4/04 1260400000000000272 1200400000000000272 1200400000000000272 Total Amount Paid $198.00 I PIau Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection 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 Insnliftions I 1 Sign Final: After all required inspections are conducted and approved and the sign Installation is completed. 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 of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made ofany structure without permission ofthe Community Services Uivision, 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 addre!:s 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 times during construction. Owner or Contractors Signature Date Page 2 of2 .' 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00245 COM2004-00245 COM2004-00245 Payments: Type of Payment CreditCard .'" -~"'~"""'.'... 1Ii!' ". "., ~ '-0- . ~ __ .. .J. . .,.",~.. , ""-0 -' . , f<' Receipt #: 1200400000000000272 Description Deposit Blimp + Special Permit + 10% Administrative Fee Paid By GARY SPALTER Received By djb Check Number Batch Number Authorization Number 000314 004631 City of Springfielii' Official Receipt < Development Services Department Public Works Department - Date: 03/04/2004 9:35:18AM Amount Paid Item Total: 100.00 80.00 18.00 $198.00 How Received Amount Paid $198.00 $198.00 In Person Payment Total: . .