HomeMy WebLinkAboutPermit Building 2007-12-18
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO' COM2007-01870
ISSUED' 12/18/2007
APPLIED. 12/18/2007
EXPIRES' 06/18/2008
VALUE. c $ 50000
.
225 FIfth Street, SprIngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
SITE ADDRESS 443 5TH ST
ASSESSOR'S PARCEL NO 1703352409200
SprIngfield TYPE OF WORK Smgle Fam,ly ReSIdence
TYPE OF USE
AlteratIOn
ResldentlOl
PROJECT DESCRIPTION Pellet Stove (used)
Owner
Address
MCCAULEY BENJAMIN F & DEBRA L
443 N 5TH ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION I
Contractor Type
Mechamcal
Contractor
OWNER
Ltcense
ExpiratIOn Date Phone
BUILDING INFORMATION I
#ofUmts
PrImary Occupancy Group
Secondary Occupancy Group
PrImary ConstructIOn Type
Secondary ConstructIOn Type
# of Bedrooms
# of StorIes
Height of Structure
Type of Heat
Water Type
Range Type
Energy Path
Splmkled BUlldIDg
Lot SIze
Sq Ft 1st Floor
Sq Ft 2nd Flool
Sq Ft Basement
Sq Ft Garage/Carport
Sq Ft Other
Occupant Load
n/J
I DEVELOPMENT INFORMATION.
REQUIRED PARKING
Frontyard Setback
S,de I SetbJck
Side 2 Setback
Rearyard Setback
Solar Setbacks
Overlay Dlst
# Street Trees Rqd
Paved DrIve Rqd
% of Lot Coverage
TotJI
HandIcapped
Compact
I PUBLIC IMPROVEMENTS I
Street Improvements
S,dewalk Type
Storm Sewer AvaIlable
Speclallnstruchon
Downsl'outslDraIDs
ATTENTION Oregon law reqUires you to
follow rules adopted by the Oregon Utility
NOTICE: Noliflcallon Center Those rules are setforth
THI~ ewA1T SHAll EXPIRE IF THE WORK In OAR 952-001-0010 through OAR 952-001-
AUTHORIZED UNDER THIS Pqtl!l1:-: It. I'~'" ~ 1I6:il;ith'e'~~~~:"(~~fe:t:h~';;I~~~~~e':r
COMMENCED OR IS ABANDO~lIIlon DescnDtlon 1 number for the Oregon UlIllty Notlflcallon
ANY 180 DAY PERIOD. $ Pel Sq Ft Square Footage Center IB 1-800-332-2344).
DeSCrIptIOn Tvpe of ConstructIOn Value Date Calculated
or mulhpher or BId Amount
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Notes
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Page 1 of2
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Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2007-01870
ISSUED: 12/18/2007
APPLIED 12/18/2007
EXPIRES: 06/18/2008
VALUE: $ 500.00
225 Fifth Street, SprIngfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
TotJI Value of Project
Fees PaId I
Fee DeSCrIptIOn
-MechaDlcallssuance Fee-
+ 10% Admmlstl Jllve Fee
+ 5% Technology Fee
+ 8% State Surcharge
Mmlmum/Adjustment MechaDlcal
Pellet Stove/Insert
Amount PaId
Date PaId
Receipt Numbel
$20 00
$500
$250
$400
$1700
$33 00
12/18/07
12118/07
12/18/07
12/18/07
12118/07
12118107
1200700000000001506
1200700000000001506
1200700000000001506
1200700000000001506
1200700000000001506
1200700000000001506
TotJI Amount Paid
$8150
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 ReolJlred InsnectlOns I
Freestandmg Pellet Stove After IDstallatlOn
By sIgnature, I state and agree, that I hJve carefully eXJmIDed the completed applicatIOn and do hel eby certIfy that JII
mformatlOn hereon IS true and correct, and I further certify that any and JII work performed shall be done ID accordJnce wIth
the OrdIDances of the City of SprIngfield and the Laws of the StJte of Oregon pertaIDmg to the work deSCrIbed herem, Jnd
thJt NO OCCUPANCY Will be mJde of Jny structure wIthout permISSIOn of the CommuDlty Services DIVISIOn, BUlldIDg Safety
I further certIfy thJt only contractors and employees who are ID compliance WIth ORS 701005 Will be used 011 thIS IHOject
I further agree to ensure that all reqUired inspections are requested at the proper time, tholt edch address l!ol rCJdable fl om the
street, that the permIt card IS located at the front of the propert), and the approved set of plans Will remJID on the site at all
times dUfmg constructIOn
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Owner or Contractors SlgnJture
Date
Paee 2 of 2
225 FIfth Street
Sprmgfield, Oregon 97477
541-726-3759 Phone
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CIty of Sprmgficld Offictal ReceIpt
Development ServIces Department
PublIc Works Department
Job/Journ.,) Number
COM2007-01870
COM2007 -01870
COM2007-01870
COM2007 -01870
COM2007-0 1870
COM2007-0 1870
Payments
Type of P ,lyment
Check
cRecclOtl
RECEIPT #:
1200700000000001506
Date. 12/18/2007
DeSCriptIOn
~Mechamcallssuance Fee-
Pellet Stove/Insert
Minimum/AdJustment Mechanical
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
raid By
DA VID DRAKE
Item Total
Check Number AuthorizatIOn
Received By Batch Number Number How Received
dim
2503
In Person
Payment Total
Page I of I
I 16 04PM
Amount Due
2000
3300
1700
250
400
500
$8150
Amount Paid
$81 50
$8150
12/18/2007
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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
Pemnt# C7- /fJJ7tJ
Address Lt4 ~ C; l!: "T,
Issued by ,f1/1fiJ~ Date J~~ 7
.Statement: Information Notice to Property Owners
About Construction Responsibilities
Note Oregon Law, ORS 701 055(4) requires resldentwl constructIOn permIt applzcants who .are not
lzcensed with the ConstructIOn Contractors Board to sIgn the followmg statement before a bUIldmg
permit can be Issued This statement IS required for resldentwl buddmg, electrzcal, mechamcal and
plumbmg permits Licensed architect and engmeer applzcants. exempt from lzcensmg under
ORS 701 010(7), need not submit thiS statement This statement will be filed with the permit
FIll m the appropnate blanks and rrutIal boxes 1 and 2, and eIther box 3A or 3B
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j2(2
I own, resIde m, or wIll resIde m the completed structlue
I understand that I must become lIcensed as a constructIOn contractor If the structlue IS sold or
offered for sale before or on completIOn
o 3A My general contractor IS
(Name)
(CCB #)
I WIll mstruct my general contractor that all subcontractors who work on the structlue must be
lIcensed wIth the ConstructIOn Contractors Board
OR
~ 3B I wIll be my own general contractor
If! hIre subcontractors, I wIll hIre only subcontractors lIcensed wIth the ConstruclIon Contractors
Board If I change my mInd and Inre a general contractor, I WIll contract wIth a contractor who IS
lIcensed WIth the CCB and WllllInmedlately notIfY the office Issumg thIS bUlldmg permIt of the
name of the contractor
I hereby certIfy that the above mformatIon IS correct and that I have read and do understand the InformatIon
NotIce to Property Owners about Construction ResponsIbilItIes on the reverse SIde of tlus form.
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IQ~_ / cf ~ol!,,( ~/:J-/8'-dJJd7
V '(Slgnatur~perk(~p;ftalltr' (f (Date)
(While copy to Issumg agency permit file, pmk copy to applzcant)
F.~t'..;/_owner doc 06-01-04
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Acting as Your ewn General Contractor?
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'INFORMATION'NOTICE TO PROPERTY OWNERS
.. _ABOUT CONSTRUCTION RESPONSIBILITIES
~
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NOTE This InformatIOn Notice to Property Owners about Conslructlon Responslbllrlles was developed by the
Construction Contractors Board m accordance wrlh ORS 701 055(5), passed by the 1989 Oregon Legislature
If you are actmg as your own contractor to construct a new home or make a substanlIallmprovement to an eXlstmg
structure, you can prevent many problems by bemg aware of the followmg responslbIlllIes and concerns
" ,
You Will, m most mstances, be ruled to be an "employer" and the contractors you contract WIth wIll be "employees" If
you use contractors not hcensed With the ConstructIOn Contractors Board to do labor m constructmg or to assist m the
constructIOn or Impiovement of a reSidentIal structure As the employer, you must comply with the followmg:
,- ~.
Oregon's Withhoiding Tax Law: As an employer, you must WIthhold mcome taxes from employee \vages at the lIme
employees are paId You WIll be hable for the tax payments even If you don't actually WIthhold the tax from your
employees For more mformatIon, call the Department of Revenue at 503-378-4988
EmpRoyer Responsibilities
, . '
J]nemployment Insurance Tax: As an employer"you are reqUIred to pay a tax for unemployment msurance purpose~
on the wages of all employees For more mformatIon, call the Oregon Employment Department at 503-947-1488 ' ~
The Oregon Busmess IdentIfic~tlOn Numb~ (BIN) IS a combmed ~umber for both Oregon W'lthholdmg an~"
Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or www dor state or us/formsoav html I for the
apt'. Vpllate forms
Workers' CompensatIOn Insurance: As an employer, ydu are subject to the Oregon Workers' CompensatIOn Law,
and must obtam workers' compensatIOn msurance for your employees If you fall to obtam workers' compensatIon
msurance', you could be subject to penaltIes and be hable for all claim costs If one of your employees IS mJured on the
Job For more mformalIon, call the Workers' CompensatIOn DlVIslOn at the Department of Consumer and Busmess
Services at 503-947-7815
,
US Internal Revenue SerVIce: As an employer, you must Withhold federal mcome tax from employees' wages",
I
You Will be hable for the tax payment even If you dIdn't actually Withhold the tax For a Federal EIN nUJIlber, call the
IRS at 1-800-829-4933 or VISlt their web site at W\VW liS QOV " - ~
Other Responsibilitftes annd Areas of Concerns
Code ComplIance' As the penmt holder for thiS project, you are responSible for resolvmg any failure to meet code
reqUIrements that may be brought to your attentIOn through mspeclIons
LiabIlity and Property Damage Insurance: Contact your msuranee agent to see If you have adequate msurancc
coverage for aCCidents and OnuSSIOllS such as fallmg tools, pamt over spray, water damage from pIpe punctures, fire or
work that must be redone
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Time. Make sllre you have suffiCient lime to sllpemse yonr employees
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Expertise: Make snre you have the skllls to act as your own general contractor, to coordmate the work of rough-m
and fimsh trades, and to nottfy bUlldmg offiCials as the appropnate lImes so they can perform the reqUIred mspectlOns
If you have addllIonal questions call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO
Box 14140, Salem, OR 97309-5052
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Property_owner doc 06-01-04
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. :Criy OF:S'PRfN~E)'EI;h;o~EG'0N'~~ . -';::'.
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SPRINGFIELD'
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225 FIITH STREFT . SPRINGFIELD, OR 97477. PH (54 1)72('-375~ . FAX (541)726-3689
C7-/670
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CIty Job Number
Job LocdtlOn
n r-l-l
5hr/.1.Jit
J
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Assessor's Map
Tax Lol
Owner
BplI F. DpL", /4t:..4U (~ "
"-lY'3 J]!! S'/~~"J -.l
So,.. /"-'3 CU, )('1
bp
Address
CIty
Phone
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State
Prelmunary InspeetJon for wood burnIng Inserts IS $61 50 (pnor to Insert)
Wood Stove/Pellet/Insert Permit IS $81 50 (Includes appheable fees and surcharges)
Contractor Information
Contractor
Address
L) v..; 1..) E7tt
Phone
CIty
ConstructIOn Contractor's RegistratIon #
State
Zip
Expires
By slgmng thiS pelllltt/applIcatIon, [agree to call fOl an m;pectIon(s) as requlled (726-3769)
I state that all mfOlmalIon on thiS applIcatIon/pel nut IS correct and that [ was plovlded wIth
the Wood Stove Safety mfOtmatIOn tor wood burnmg applIances and prelmunary mspeclIon
standards as set by the Otegon Department of Envllonmental QualIty 01 the Fedelal
EnVIronmental ProtectIOn Agency and 1 aglee to plOvlde the testmg applOval numbel to the
mspectOl at the lIme of mspeclIon 1 also undel;tand that If [amlequcstlllg a plelullInalY
IllSpectlon, the wall covellng may be reqlllred to be lemoved
SIgnature
(\ r
~&~~ /' d--A'..,t
Date
/.2 - /F oJ'
FOR OffiCE USE
Ddteof Applteal10n /;)~ 'j(/[,r
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Checked for Deltnqueneles
Cheeled for H,;toncal Status
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Shared Dnve(T )fBUlldmg FormslWood Sto,e Permll 11 07 doc