HomeMy WebLinkAboutPermit Signage 2010-10-25
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~ ;~5 FIFTH STREET. SPRINGFIELD, OR 97477 . PH(;;i~;;~37St~<FAX: (541)726.3689'
o City Job Number $ f>/L ZJ:>/O -0 6 7 Z L(
, al~ Site Address: 511L1 ~ \.Sh-t.d-, S~fUld' . OK
~ Assessors Map_I 7 () 2. :3 '3 Lf L( Tax Lot: . 0 C) g-C (j
~ Owner 1Y\C)(.QNlZ1R Cle~i'NJ U-d p~ Phone:AI~ ~je.S
f1l.'" 54/-5) 3-- 'tfo~fj
~ Address ( . dL
~ City -::>~~ State Zip
:~ ~ Business Name, F:m" etc....l:Uls..hrl . - ~ pti.h-J A-tj VAe '0
~. _.'. De;/on of Proposed Sign(s): (please check and complete all approPri~t: information)
Q~ Wall' Freestanding Projecting Roof
:,.. ..JL"'Single Face Double Face Billboard Other
~ /",/
~.. Square Footage:? I Total Height above Grade: . ~
..' Vertical Dimension of Sign or Enclosure: 2. Lf I' Horizontal Width of Sign or Enclosure: q I lJJ II
10' . /
Dimension from Grade to Bottom of Sign Enclosure _ _ Electrical Installation:~Yes _No
(Tfyes additional electrical permit required)
. ~
~) Material Sign is Constructed of: A lu-~, pJ.t~'eJ.M 'vJ! ~) Value of Sign: 2.. (1)0
r II I jt~.;;r-..
ao~
E :::::
~~
@) ContractorlInstaller:
~
o
Marquee
List ALL existing signage and attach a photograph of each sign:
~
Sq. Fig.
(b) Type.
Sq. Fig.
Sq. Fig.
Sq. Ftg.
(d) Type
Ci:l<;'C'Q&..e, Si~ a-N~
Address: Po &x 721" 'it
City ~~I otZ. cr13 D 3
Construction Contractors Registration Number: ~(p
PhoneSD3. 31 ~ -0012..
.\.,
State:
at-
Zip: q13D J
Expires: D 3/1 J
OFFICE USE
~ Sign District: c'L Zoning C C.
~ By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information herein 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 Stale of Oregon pertaining to the work described herein. I
ao~ further certify that only contractors and employees who are in comp~ce with ORS 701.055 will be used on this project
00 I further agree to ensure that all required mspections are requested at the proper llIne, that project 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
times during the mstaIlationofthe slgn(s).
Signature~ 111 ;~ Date I'D/ 2'5/, D
Shared Drive(T:).IBui1ding Fonns/Sign Permit Applicationl-02.doc
Electrical Permit A
.
225 Fifth Street+Springfield. OR 97477+PH(S41)726-37S3+FAX(S41)726-3689
~
, DEPARTMENT USEONL Y
Pennitno.: $(0 .00 ?"2t{
Date:
This permit is issued under OAR 918-309..0000. Permits are nontransferable. Permits expire if work is Dot started within 180
days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
, CATEGORY OF CONSTRUCTION
o Residential 0 Government
JOB SITE INFORMATION AND LOCATION'
City:
Reference:
City:
Phon:
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intendad for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
City:
Phone:
E-mail:
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
~ I\~\? ~
t~w:-
iJ\y:-
440-2584-J (9/08lCOM)
FEE SCHEDULE'
Number of inspections per item 0 QIy. Cost Total
eo. cost
Residential, per uni~ service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 26.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Semces or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 96.00 $
401 to 600 amps (2) $168.00 $
601 to 1,000 amps (2) $206.00 $
Over 1.000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps orless (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feedern. section above
Branch circuits: new, alteration, extension per ptmel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 8.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) I $ 63.00 ~ -
Signal circuit or a limited.energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $68.00 $
,".' " APPLICANT USE .
(A) Enter subtotal of above fees $it, 7> ~ -
(Minimum Permit Fee $58.00)
(B) Enter 12% sorcharge (.12 x [AD $ 7::'-
(e) Technology Fee (6% of[Al) $~/~
TOTAL fees and surcharges (A through C): $ 7~ 71
S~RIN. G...fIE.~.D.."
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^. .. OREGON
.
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00724
5707 MAIN ST
CITY OF SPRINGFIELD
225 Fifth $t
Springfield,OR 97477
541-726-3753
permitcenter@ci,springfield,or.us
RECEIPT NO: 2010000870
RECORD NO: 811-SPR2010-00724 DATE: 11/18/2010
:Jf"~;';;:-:~ ~;f;Jt~-1;t;,,;~:;':'!,,';;1;'%"'~Qc:6,l.JNjlC:QpE'_1~~ -,';".' :AMOUNT Dl!!: .- - .;1
224-00000-425602 $80.00
224-00000-426102 $63.00
100-00000-425605 $7.15
.~..".~-~.,~...__._.---
224-00000-426605 $8.00
\821-00000-215004 $7.56
,.---
224-00000-425602 $42.00
TOTAL DUE: $207.71
,1',}'r,Z'; ~AMOONT PAID;~{,~.~-', .1J
rDESCRipTION.'-~""_",C1_.-
Signs: 0 - 35 Square Feet
Sign or outline Ii~htin~.
Technology fee (5% of permit total)
Admin fee (10% of applicable fees)
State of Oregon Surcharge (12% of applicable fees)
Sign Plan Review
11:!PAYMENT:TYPE"~:-'- :P~:WB_1 )5CASH'ER ~H08Pk'!:"___ ;f\C.9.MM~iiT:S~:':,'
Check
30555
KINNEE SIGNS INC
$207.71
$207.71