HomeMy WebLinkAboutPermit Signage 2010-2-10
225 FIITH STREET . SPRlNGFIEID,OR97477 . PH:(54I)726-3753 . FAX: (541)726-3689
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02/04/10 THU 13:00 FAX 5417263689
141001
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CITY OF SPRINGFIELD
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$202.00 including $100.00 Deposit and applicable fees.
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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 describ~d display will be
removed within fourteen (14) days from the date listed as the date of installation above, If tllli display 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 once per;caIendaryear per development area I also agree to call/he inspection line at
726-3769 by the end of the 14th day to reqnest an inspection to verify the removal ofthe display. This inspection
will begin the process to return the $ I?O deposit if the display has been removed. :
Signature Ie T)ate 2..l) 411 ()-
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ShaiOO. Drive(T:)/Building FannslBlimp_ 'e:nnaDts_BallOODS 1...oS.doc
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CITY OF~rt(JNvf<JJ!.LD
Building/Combination Permit
PERMIT NO: COM2010-00181
ISSUED: 02/10/2010
APPLIED: 02/10/2010
EXPIRES: 02/10/2010
VALUE:
Status
Finaled
225 Fifth Slreet, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5790 MAIN ST
,ASSESSOR'S PARCEL NO,: 1702334JOJ900
Springtield TYPE OF WORK: Blimp, Portable Sign, Etc,
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: Balloon: ref':COD201O-00022
Owner: POLEN DEVELOPMENT LLC
Address: 21970LYMPfC
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
1._'-:'
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:
Heighl of Structure
Type of Heat:
Waler Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
nla
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Serbacks:
Overlay Dist:
# Streel Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compacr: .
I.PUBLICIMPROVEMENTS I
Streellmprovements:
Slorm Sewer Available:
Special Inslruction:
"..:
Sidewalk'Type:
DownspoutslDrains:
Noles:
I.Valuation DescriDtion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page I of2
Status
Finaled
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line.
\ '
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Total Value of Project
Fees, Paid'
Fee Description
***+ 100/0 Administrative Fee***
+ 5% Technulogy Fee
Blimp + Special Permit
Amount Paid
Date Paid
$8,00
$4,00
$80,00
2/JO/JO
2/10/10
2/10/JO
Total Amount Paid
$92,00
I Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00181
ISSUED: 02/10/2010
APPLIED: 02/10/2010
EXPIRES: 02/10/2010
VALUE: .,
Receipt Number
220JOOOOOOOOOOOOl33
2201000000000000133
2201000000000000133
To Request an inspection call the 24 hour re(:,ordingat 726-3769. All inspections requested before 7:00
w,.,.>I ,.r~ ~."
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
Re,,"i,~e~ Ins'1~~tions.1
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
informalion hereon is true and correct, and I further certify that any and all work performed shall be done in accordance wilh
rhe Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
thaI NO OCCUPANCY will be made of any slructure wilhout permission of lhe Community Services Division, Building Safety:
I further certify that only contraclors and employees who are in compliance with ORS 701.005 will be used on this project.
I furlher agree to ensure that all required inspections are requested at the proper time, that each address is readable from lhe ,
street, that the permit card is located al the front of lhe property, and lhe approved set of plans will remain on the sire alall
times:r:::Slr:::~A-~'e ~ llfl r'r"o
Owner or Contractors Signature I Date
Co d t! Co......" h~
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Pace 2 of2
225,Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM20 1 0-00 181
COM20 1 0-00 181
COM20 I 0-00 181
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
2201000000000000133
Date: 02/10/2010
2:46: 12PM'
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 7315 In Person
Payment Total:
Amount Due
80,00
4,00
8.00
$92.00
Description
Blimp + Special Pennil
+ 5% Technology Fec
***+ 10% Administrative Fee***
Paid By
POLEN DEVELOPMENT LLC
Amount Paid
$92,00
$92.00
Page 1 of I
2/10/2010