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Home My WebLink AboutPermit 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 .- .., Notes ~<\r." ._..,.~...~__ Page 1 of2 -ii: ~ 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 .JJ/~f'~~ Jd--/T-C)/ Owner or Contractors SlgnJture Date Paee 2 of 2 225 FIfth Street Sprmgfield, Oregon 97477 541-726-3759 Phone ~.~~Q~; 4'1J' 'f ~ ~ ~' 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 - 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 ~1 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. "i__ 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 " .' .... \.~ , , ~... 'i-_ ;.. '" Acting as Your ewn General Contractor? I ..-, - , .... 'INFORMATION'NOTICE TO PROPERTY OWNERS .. _ABOUT CONSTRUCTION RESPONSIBILITIES ~ .~\ > 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 ~ .J \ ... ...... Time. Make sllre you have suffiCient lime to sllpemse yonr employees , ,I.. , \ ./ 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 " Property_owner doc 06-01-04 ~I ~i ~ .'~i t~ ~> .~ ~ -,1 'r-l~ " II ~\ ~4 ~ ~~i - (j I ~I ~j ~ .,~, 12) ~ ~) f7'0, ~I l!(!11 ~I ......:::.1 Ij'='{ ~ ~ \'J'd)l ~I ......:::.i ,l ~ ~ ~) l~ rtlil1 ~ Q etJ ~ . :Criy OF:S'PRfN~E)'EI;h;o~EG'0N'~~ . -';::'. . ,__;-' _ -.J. "'0 .. F'" _ - R __ SPRINGFIELD' U~^I'~~ ,-- ---=.. - -~~ L __~ ~ 225 FIITH STREFT . SPRINGFIELD, OR 97477. PH (54 1)72('-375~ . FAX (541)726-3689 C7-/670 "/4""" .t:;d5/~~~( CIty Job Number Job LocdtlOn n r-l-l 5hr/.1.Jit J /'.- , 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 /J__ 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 / i Checked for Deltnqueneles Cheeled for H,;toncal Status ~ -W/,ro Shared Dnve(T )fBUlldmg FormslWood Sto,e Permll 11 07 doc