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Home My WebLink AboutPermit Mechanical 2007-10-25 ~, o~ · ....-4 ~.,' ~. u · ,...iI j ~ , I" ~ nl ~' ~.' o . ~' ~j U CL) n..1 r:./!) J ~' t "+ ~ $-to C), 00. ~. 1 1: , CU > o +-J. r/J ~ U~ o 0, ~. " \, So ~.s E::~[:: '= ~.\L G r;- [ 225 FIITH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753 · FAX: (541)726-3689 CityJobNumber CO~ ZOOt- OIS' ) -------......... \ \ (~ Job Location: '\ 0 a ~ \..--> \ ~ \ ~ uR 1 801(") ~L-l( s~~ \ C)~ C\,\I.V',,<(l-, 0/:S 0 c:::":J Tax Lot: Assessor's Map: o~er: ~~Ov~ ~ ",{\\Q.~\c~Y'\~ ~~''''..., ''',' Address: \ () oll:Q ~'ll\:::.i~b ~~ \) Phone:S-.\.\ \~ :::':"\SoO City: S~O~<0l~ State: a\<. Zip: C\,~\~ Preliminary Inspection for wood burning inserts is $61.50 (prior to insert). Wood Stove/Pellet/Insert Permit isJ.Zl-:-50 (includes applicable fees and surcharges). 'lJ/~ Contractor Information Contractor: C~ '8-\~1\) ~ ~c->l ~~ ~~ Address: . S2>d>~ '--{~", ~ ~~ City: ~y~,,,~%-- ~ ~ State: 6 ~ Construction Contractor's RegIstration #: -z6 7l(T Phone: S'"\-\ Zip: Expires: "\ 4\0 ~ ~ -;:);~\ ~\I.\'\. CO . B/26/0? , I By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I state that all information on this apPlication/pe.rmit is corre.ct an~ l~. ~ i.trr-- ," r~~n~i' . a:s: - ,IOn. '~ndM'eB as ~j' :~cll~wmI'mfrri~nla.lQU'a1i+y-or t e defaT '~ir~!y~ l2~ctioo ~ncy-Al'~L~ l6i)J. (j'/-;ac thn~pro\litl-t:u1mbeE-to the .~~~f..iftspe~I also understand that if I am requesting a preliminary inspection, the wall covering may be required to be removed. Signature: ~a..:,'-l.!l. ~.--'l.. ~ '>-'-:~h 0."\_' "'- , (j V Date: CJ~ a.A CclCC:i'\ FOR OmCE USE Date of Application: /ohS~"7 / t ATTENTION: Oregon faw requires you to follow rules adopted by the Oregon Utility t'ntifioatioA Center. Those rules a.rB set forth In OAR 952-o01..Q010 thrOUg~-OO1. Checked ~t~~btAln mpie as by calling the center. (Note: the telephone number for the Oregon Utility Notification Center Is 1-800-332-2344). Checked for Delinquencies: --- NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Shared Drive(T:)/Building FonnslWood Stove Pennit 7-07,doc CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01595 ISSUED: 10/25/2007 APPLIED: 10/25/2007 EXPIRES: 04/25/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1008 DIXIE DR ASSESSOR'S PARCEL NO.: 1802052407300 Springfield TYPE OF WORK: Wood Stove PROJECT DESCRIPTION: Woodstove insert TYPE OF USE: New Residential Owner: FRANK WILLIAMS Address: 1008 DIXIE DR SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION' Contractor Type Mechanical Contractor GOOD DEAL METAL PRODUCTS INC License 26743 BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure: Secondary Occupancy Group: Type of Heat: Primary Construction Type VB ~lJl~i~: Secondary Construction Type: On \a'14 tequltl~~ # of Bedrooms: :fn:.~.nO~: Ofe~ d '0'/ \ne Ofi~~~~ ~ N'J tU\eS adOP e "{nOse tu\e~~1iiding: n/a in\\? ~~.vfl ~r:ln\er. lU \t:""I.n~ " ,~A!H ~:~~R 952~~~-~~\a\d :T!~::i~FORMA TlON I 0090. .'(O~ne centet. ~on Ut\\\\'/ NO Frontyard Setback: ca\\lngr 10r \ne orelo0-33~)Y Dist: Side 1 Setback: nutn'o8 center \8 '\ # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Rearyard Setback: % of Lot Coverage: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Phone Number: 541-726-7500 Expiration Date 08/2612008 Phone 541-736-9876 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: _&'Ol\~Downspouts/Drains: E \~1\'\t ~ ~ ~O"t\ct.. S~fl.\.\. ~\\\ t.\\lJ\\\ \S ~O ~\\\S J;~t~ U~t>t.~ ~~~~~Ot\t\) fOR .,\)1. ~n\ . ~~~~ ~WYlescri~tion I $ Per .Sq ,Ft Square Footage or multiplier or Bid Amount Notes: Description Type of Construction Pa2e 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01595 ISSUED: 10/25/2007 APPLIED: 10/25/2007 EXPIRES: 04/25/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Minimum/Adjustment Mechanical Wood Stove/Insert Amount Paid Date Paid $20.00 $5.00 $2.50 $4.00 $17.00 $33.00 10/25/07 10/25/07 10/25/07 10/25/07 10/25/07 10/25/07 Receipt Number 2200700000000001630 2200700000000001630 2200700000000001630 2200700000000001630 2200700000000001630 2200700000000001630 Total Amount Paid $81.50 I Plan Reviews I 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'. I Reouired Insoections I Wood Burning 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. ~~~~~~ Owner or Contractors Signature ~ ds~~~a\ Date Pa2e 2 of2 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#: C-0l111\Z-007- 0/ S:-7j- Address: /() 0 E' ':n I Y/~:- ~L I (f /ZO~7 I I Issued by: , .~ Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction 'Contractors Board to :sign the following statement before a building permit can be issued. This statement is required for residential building, e{ectrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ' ORS 701.010(7), need not submit this statement. TIz.is statement will befiled with the permit. Fill ill the appropriate blanks and initial boxes 1 and 2,and either box 3A or 3B: ~L ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor ifthe'structure is sold or . offered for sale before or on completion. , ~3A. MygeneralcontractOris~,-,,;;,l b.:./' ( M&~ ( ,.,. , (Name) ,?-67 f/3 (CCB #) . I will instruct my general contractor that all subc()ntractors who work on the structur~ must be licensed with theConstrudiop. Contractors Board. OR o 3B. . I will be my own general contractor. If I hire subcontractors, 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 above information 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. ''-''~Q...~~~\~~~a~ ~~ ~S~d-00\ '(Si61at~ of permit applicant) (Date) (White copy to issuing agency permitfile, pink copy to applicant.) PropertLowner.doc 06-01-04 Acting as Y()ur eneral Contractor? INFORMATioN NOTICE TO PROPERTY OWNERS ASQ-UT 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 apd concerns. Employer Responsibilities , - You will, in most instances, be 'x:.u1ed to be an "employer" and the contractors you contract with wjll be "employees" if you use contractors not lict:;nsed with the Construction Contractors Board to do labor in constructing or to assist in the 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 d~n't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503~378-4988. Unemployment Insurance Tax: As an employer, you are required,to pay a tax for Un__mployment insurance purposes' on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. "~ The Oregon Business Identification Number (BIN) is a combin~d number for . ,both Oregon Wi~hholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.html1 for the appropriate fonns.' . ...., Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for y~ur 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 Division at the Department of Consumer and Business Services at 503-947-7815. u.s. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the lRS at 1-800-829-4933 or visittheir web site at www.irs.l!ov. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirem,?nts that may be brought to your attention through inspectiqns. 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. ' Time: Make sure you have sufficient time to superVise your employees. Expertise: Make sure you have "the skins to act as your o\\~ general contractor; to coordinate the work ofrough-iri 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 06-01-04 225 Fifth-Street Splingfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01595 COM2007-0 1595 COM2007-01595 COM2007-01595 COM2007-01595 COM2007-01595 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000001630 Date: 10/25/2007 Description Wood Stove/Insert Minimum/Adjustment Mechanical ~Mechanical Issuance Fee- + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By FRANK WILLIAMS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 6441 In Person Payment Total: Page 1 of 1 10:05:48AM Amount Due 33.00 17.00 20.00 2.50 4.00 5.00 $81.50 Amount Paid $81.50 $81.50 10/25/2007