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Home My WebLink AboutPermit Mechanical 2005-3-9 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00270 ISSUED: 03/09/2005 APPLIED: 03/09/2005 EXPIRES: 09/09/2005 VALUE: i" 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1479 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703253311600 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install gas insert Owner: SHERYL CLEMENTS . Address: 1479 CENTENNIAL BLVD SPRINGFIELD OR 97477 Phone Number: 541-726-4230 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor License Expiration Date Phone EMERALD SWIMMING POOLS OF ORE INJ~O\1,\~. 10/2212005 541-688-1090 . ~....Jg'- . v~lll , I BUlLDIrgi~u' j e\\ottn- N,\ON. ~eO 0 t\l\eS IS ~2-()O'\- ,..1,e tJte8:~~s=1nOse ~ 0"'''' 9 ~eS '0'1 Lot Size: R-3 \O\\o~ ~;~~'a~~~g s 0\ \ne ~ot\e Sq Ft 1st Floor: ~o\W\Ca: l \\0t1l~\~t\ Co~\~ \ne \e\e~.\C'Qo'U.ot\ Sq Ft 2nd Floor: Vlhr \t\ O~'" \fWfafyp~:f ~O\e. 'X<<i ~O\\t Sq Ft Basement: 0090. 'a~e ~9~~;egot\ ~~,,~Z~). Sq Ft Garage/Carport ~\\\mli~ \l!ftli':" ~~~ Sq Ft Other: (\U~~_~~ing: .. n/a Occu~ant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMEN 1 ll~1<l)RMATION I REQUIRED PARKING Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: R\\ ~~.O,!t~~l,:r: fY~\ \ ~XP\~t \F ~~~\r~\n1 I PUBLIC IMPROVF~~1uNOtR \\1\~~~~tO FOR . MU' Ceo 00 1<:'- \B,c,lk T COMMtN \.. n 1SitI )'a ype: f4-N'< '\ BO O{\'< Pt~~w~spoutS/Drains: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 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 Paee 1 of 2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2005-00270 ISSUED: 03/09/2005 APPLIED: 03/09/2005 EXPIRES: 09/09/2005 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 + 7% State Surcharge Gas Fireplace Gas Outlets 1-4 Minimum/Adjustment Mechanical Amount Paid Date Paid Receipt Number: $10.00 .$4.50 . '$3.15 $15.00 . $4.00 $26.00 3/9/05 3/9/05 3/9/05 3/9/05 3/9/05 3/9/05 1200500000000000308 1200500000000000308 1200500000000000308 1200500000000000308 1200500000000000308 1200500000000000308 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. LReauired Insoections , Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. 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 cardis located at the front of the property, and the approved set of plans will remain on the site at all times during construction. ~~~o"QQ 'C~ Ow;;;;r Contn@ors Sig~ature ~6'1-0S- D~ .. / Pal!e 2 of 2 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 #: (OIM -z..av . .-0 () z;-Z 0 C&<A~V'-.,.A-l ,(Slv d Date: 3/ '7/6 r- / / 11.-{71 .~tS ;\ .- Address: Issued by: . 'Statem,ent: Information Notice to Property Owners About, Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constrUction permit applicantswhoare 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, electrical, mechanical and plumbing permits, Licensed architect and engineer applicants, exempt from licensing under ORS 701.01 0(7)! need not submit this statement, This statf!Jment will be filed with the permit, , Fill in the appropriate blanks and Initial boxes 1 and 2, and either box 3A or 3B: ca- 1" I own, reside in, or will reside in the completed structure. . ~ 2., I understand that I must 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 ,general contractor that all subcontractors who work on the structureJIlust be licensed with the Con'struction Contractors Board, OR _t2K 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 ofthe name of the 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 ofthis form. :~~()~Q (1- e.Q~~ ',-.' 3/o9/oC:: " (Sl~atUre of penn it applicant) ( I .(Date) (White copy to issuing agency permit file, pink copy to applicant.) ( Prol'erty _o~er.doc 06-0 1-04 , " '.J ' Acting as ){ oltr Own General Con'tractor? " .' INFQRMATlbN NOTICE TO PROPERTY OWN'ERS - ABOUT CONSTRUCTION: RESPONSIBiliTIES t.. ... ,~ ~,.. 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 strjlcture, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to bean "employer" and the contractors you pontrac. t with will be "employees" if , . you use contractors not licensed 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 don'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 unemployment 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 combined number for both Oregon W.ithholding and- Unemployment Insurance Tax. To file for a BIN, caB 503-945-8091 or www.dor.state.or.us/formsoav.html1 for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, "- and must obtain workers' compensation insur., ance for your employees. If you fail to obtain workers' compensation insurance, you touidbe subject to penalties and be liable for all claim costs if 6ne 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"fi'om employees' wage, You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site, at \V\vw.irs.!J.ov_ . , Other ResponsibUities and Areas of Concern.s'" Code require!!1ents . . ~ . As the permit holder for this project, you are responsible for resolving imy failure to meet code may be brought to your attention through inspections. Liability Damage Insurance: Contact. your insurance agent to see if you have adequ'ate insurance coverage for and omissions such as falling tools, paint over spray, water damage from pipe punctures, or work that must be redone. ~ -<. -:., , - ., , (- . .. - , - -, \ ;' J. 0: \, '('-;; /, - /" r ' "J . ' ,- ,l .' \ _~~. ...... f -;>- " sure you have sufficient time to supervise your employees. Make sure you have the skills to as your own general'contractor, to coordinate the work of rough-in and to notify building officials as times so they can perform required inspections. additional questions call the Construction 14140, OR 97309-5052. (503-378-4621) or write the agency at PO Property _ owner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone rity of Springfield Official Receipt ~velopment Services Department Public Works Department Job/Journal Number COM2005-00270 COM2005-00270 COM2005-00270 COM2005-00270 COM2005-00270 COM2005-00270 Payments: Type of Payment Check 3/9/2005 RECEIPT #: 1200500000000000308 Date: 03/09/2005 Description + 7% State Surcharge + 10% Administrative Fee Gas Outlets 1-4 Gas Fireplace -Mechanical Issuance Fee- Minimum! Adjustment Mechanical Paid By SHERYL CLEMENTS Item Total: Check Number Authorization Received By Batch Number Number How Received djb 5112 In Person Payment Total: Page 1 of 1 8:35:08AM Amount Due 3.15 450 4.00 15.00 10.00 26.00 $62.65 Amount Paid $62,65 $62.65