The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 2004-6-17 ""'~ r j f~ CITY OF SPRINGFIELD' Status Issued Building/Combination Permit PERMIT NO: COM2004-00721 ISSUED: 06/17/2004 APPLIED: 06/17/2004 EXPIRES: 12/17/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 574 CA~ WAY Sprin.g!1~ctN0~lrE OF WORK: ASSESSOR'S PARCEL NO.: 1~4if~ww.~tt= "It! "CR ~,~~ ftUS PERM ER It\\S ,,(,,~'l ,~- 'WPE OF USE: PROJECT DESCRIPTION: I~\lm>>tlD \5 A8AtlDO~D ~" r.J)MMENCEO ~~Q\~ Owner: JOSEPH KOERNEjtt'l18Q 1.11\1' · Address: 574 CARDINAL WAY SPRINGFIELD OR 97477 Pellet Stove New Residential Phone Number: 541-744-2079 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor JAMES ALLEN MCGREW License 11143 Expiration Date 04/19/2006 Phone 541-942-2941 I BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy <<;;roup: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: Height of Structure_.~.....~ ~ Ft 1st Floor: . .Type ofH~at: .......ftt\,.",'f,ft. 7.:.dt~::;.<Q\\\q.'.! F.t t 2nd Floor: ~~tf\~et"'Odirl"-W'~'-~ Basement: "1R\ilt\~~:~ij,j. .O\). ~~. .~~.~_. ~'. tt Garage/Carport ~_ ~et.'~ ~"Other: ~O~ ~~_~ .-=..~ . '~~":~~upant Load: - ap, o.fi~ t.-.otft'G't'-........UI8Jr-,-._ _, )A: ...,' --p. ~_. ~!....~,,-J"- _ 'tifJt,.k"..... DEV .Ml0NT. ~. . ~ :~.1~ . # Street Trees Rqd: Paved Drive Rqd: f'I,_ % of LotCoverage:"" . REQUIRED PARKING R-3 VN Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS. , .. Sidewalk Type: Downspouts/Drains: Street Improvements: Storm Sewer Available: Special Instruction: ,.." Notes: . .;~~:~ I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page lof2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-00721 ISSUED: 06/17/2004 APPLIED: 06/17/2004 EXPIRES: 12/17/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid I Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Minimum/Adjustment Mechanical Pellet Stove/Insert Amount Paid Date Paid $10.00 $4.50 $3.15 $15.00 $30.00 6/17/04 6/17/04 6/17/04 6/17/04 6/17/04 Receipt Number 1200400000000000926 1200400000000000926 1200400000000000926 1200400000000000926 1200400000000000926 Total Amount Paid $62.65 I Plan 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. L Reauired Insoections . Pellet Insert: After installation 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 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 times during construction. &~OD~t!;: ---. c, /11161 , Date Page 2 of2 225 Fifth Street . Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-0072I COM2004-0072I COM2004-0072I COM2004-0072I COM2004-0072I Payments: Type of Payment Check 6/17/2004 RECEIPT #: r:ity of Springfield Official Receipt evelopment Services Department Public Works Department 1200400000000000926 1:15:05PM Description + 7% State Surcharge + 10% Administrative Fee Pellet Stove/lnsert Mipimum/ Adjustment Mechanical ~Mechanical Issuance Fee~ Paid By JOSEPH KOERNER Received By djb Page I of I Date: 06/17/2004 Item Total: Check Number Authorization Batch Number Number How Received Amount Due 3.15 4.50 30.00 15.00 10.00 $62.65 Amount Paid 2467 In Person Payment Total: $62.65 $62.65 . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: COtN1ZC _0 en z. \ Address: c;7C{ ~IIVAL (".J"~ Issued by: b ~ Date: b -/ 7 -0 LI 'Staternent:lnformation Notice to Property Owners About Construction Responsibilities Note: Orego~ Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can ~e issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. I Fill in the appropri~te blanks and initial boxes 1 and 2, and either box 3A or3B: ...: . ~ -<<1. ~'2. I own, re~ide in, or will reside in the completed structure. 1 understand that Imust become licensed as a construction contractor if the structure is sold or offered for sale before or on completion, D 3A.My general contractor is (Name) (CCB #) . ~ .... ", '.,. . ;. I will instruct my genera.! contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board.' " ':.;-. : ," .,~;: .~. . .;'~~.,'" ., ..1,' ,'.I:,:"'ORr . ."...",~ . 1'........<, . " ~. ~.... .: . "'O.':~:. . '."'."' " ":. :'. . 3B~ l\Vill,be myo"'?1 general, c(;>Iitractl?f: ...', .".. '. .' ~, & " . " .~ _; \ il I. . 1[, I hir~ subF~:uh:actots~ I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name ofthe contractor. I hereby certify that the abovein:Cormation is correct and that I .have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ' . ~4 r1~_ ... . 1o/'7{(')f '. - (Si~::~permit applicant) . '(Dite) O;(Whit~ copy to issuing agency permit file,. pink copy. to applicant.) . Property _ owner. doc 03/11/03 Acting as Your Own General Contractor? J '.' INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be ."employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in th~ construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer; you must withhold income taxes from employee wages at the. time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For a State Business ill number, call the Business Information Center at 503-986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees.' For more' information, call the Oregon Employment Department at 50g~947-1488. " Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation . insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Divi'sion at the Depaitment of Consumer and Business Services at 503-947-7815.. . "",.- . '. ....', '." ","~,. ,", . . ...~~.' ... t' I ~ !. . U.S. Internal Revenue Service: As an employer, you must withhold: federal ihd6n?-e talF fr~.~ ,empToie~s' wages...-; . .. You will be liable for the tax payment even if you didn't actually withhold the trbt:.ForaFeq~ia:tEiN'ii:Um?,ef,call the '.. " IRS at 866-816-2065 or fax them at 801-620-7115. ii"'"'' ..' ':';. . '. , '..: ".1' . . ....).;..:\;.. E'.... . . ,.,~ . . Other Responsibilities and .Areas of Conc~rns , . :. I .1;.1~ ,: . : "; ".- -f.' .:'; '::'" . .~: :. . . :.~.. . Code Compliimce: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. . . Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for acCidents.and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be.redone. . T. M k \ 'h \ flfi" . I lIne: a e sllT~ yOil' a\;~ '~u, Clent time to Supel!'lse yom emp oye~s. ":-';.,. " '. \. ..... \' ,,/ J \ I..' .,.'.. , .. ~i - - \ - '-~ . 1 - _. .... . \ Expertise: Make sur~ y<?u have the skills to act as your ow~ general contractor, to coordinate t!1e work of rough-in and finish trades; and to notifY'building officials as the appropriate times so they can' perform the required inspections.'. '. '; . !~. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. ' Property_owneLdoc 03/11/03 ~~, 0; .,,~::- ~.. cdf u~ o~ ~; .r'l' ~. << 0' 0.1 .~,); C)y (U) ~: 00\ ' ~J ~. ~: ~: ..~) ~; ~., -----. (jJ).. ~. Q) I ",f ~c f/)j ~.. 0: ~ S!F'iRlB!i'TIG!Fn~!L[)) 225 FHTH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 . FAX: (541)726-3689 City Job Number COilf/l Z-O OC( --00 72. I Job Location: 57 L{ c,A-fZ-~ I ;J ,A-L w' ft.'/" Assessor's Map: I 7 0 ~ 2- 2.1 L Tax Lot: OLliOO Owner: ~~en\ A. KoefZNl!~ SIt.{ ~"'cl\~\ ~'4 ~fWlV\lW't.k~ I State: OK.... Address: Phone: 7~~ - AlJl~ ( ~\"'''''c.. ') S2.0- qS~ I (cc 11)- Zip:~ City: Preliminary Inspection is $45.00 (prior to insert) Wood Stove/Pellet/Insert Permit is $62.65 (includes Permit, Issuance Fee, State Surcharge and Administrative Fee). - Contractor: Address: Phone: "5Lf{ - . 9'12 - Z '7 'II Zip: ~7L{ Zl( Expires: 4-, '7 -Ob nIL Signalu""'rt-.~. Dale of Application: Date: fa I rl 107 ~V\~ t - - -- ,~~ ~ t>.,Q\ FOR OrnCE USE ,~~" ~{\ ,\,' . -~\. 'i,"f..\l ~~ ~t.~ ~'\) 'i\}~ b - f 7 - () L( u\\"\\t,~~~~ ~~:'V'i:.~ ~~\\~\)\)~ ",\\\';) \ ~\\\tt.v S) \)\\ \~ 5:)\)' V ~~~~IV~cal Status: 'C()~ \ IQ~ 'V \\~"l (l 1::1' Checked for Delinquencies: ~ Shared Drive(T:)/Building Fonns/Wood Stove Penn;t 3-04-04.doc