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Home My WebLink AboutPermit Mechanical 2007-1-3 ,\ . fJ~1 ...._1 el.' ~, .,)..~t L'.I ~, '"~ t)l ,~ .; .('"-I~ "..,_,11 f:J""\" ~I , f:J""\" ~i <(: ~i el ~ e., .;_I~ l~ .CQ; ~ ~, '"'" ~ ~!..Il ~\ ~1 I, 11 1,,0 ~\ f.V,", ~ r;~) ~: el I~-H ~. f.h'\; ~ ~ CO) l,,:'~ rtPlJ, ' ~\ ,-!) ~ ~ ~ SPRINGFIELD !;I'i1:::~' v;" n .ii. '" ' A' It . f!;~i;{ic~,g;;('t~~!il>jd'" bj~ F:'1f'..); ~l" ..,,~-,lc;:.Wt 'J:!lf'" , "'i"'!A t4;~',"it "':;r ~ .., ....~r1 _~. '_",01 ..-- ... 225 FIfTH STREET. SPRINGFIELD, OR 97477. PH:(541)726.375:; . FA.....:: (541)726-3689 City Job Number Job Location: Ccel^2-Go7 ~'oooZO Z '3, 77 C!6'kL- JuI.~ /703Z7f7 Tax Lot: 0'3 '70<::) L-,J Assessor's Map: Owner: \,\\C',^'h + ~ ,\<> ~(1 Address: ,;;) '?," J 9 (\) ~ V,,.p ~ City: <::;~~,", \,)., '\ '\" Phone: 'W-/- 7'11 -'II{ ( <, Zip: q / <f', -, State: \Y\, . _'n~_"_' ~~.. _.1 ,,~~_.U"~"_'.' __._,....... " 'Preliminary Inspection is $55.35 (prior 10 insert), Wood Stove/Pellet/Insert Permit is $65.35 (includes applicable fees and surcharges). Contractor Information Contractor: Address: s~ Phone: , Zip: . u,) ,,-, ' ExpireSII;\\es'I \ \\\\\\'1 , , \'0-'1'1 \ \;'-'1 \e~O\' .. ~ \0'" , _ ' .0>,,910\ 1""leO ",eSe_ "\\', , ," ' _'".' , \~\"\~~~-:;60~\e~;~se\U;O~~~~~~s'Oj By Slgt1tng this pernllt/ appltcatJon, I agree to call for\~lltJt;lSpeCt~f/tll(~) (Cj\~\'Ittttj)1e.cb(te%-~6!ia): I state that all information on this application/pernli"mBjl1i>~t\YI.oth\t-d ~~wr(\'&P\~~lO'" the Wood Stove Safety information for wood burnirl@~~i(lT?eeS,i'll~~\~\li\'fu~X\\ir\'l~E~lOn ' standards as set by the Oregon Department of Envll:olQ11en{4~3l>Y"\!ir ~h'3Il1~~~!'3AA~. Environmental Protection Agency and I agree to prov.rEfe'1~~~~Hl~9t~.wj\n1rinber to the inspector at the time of inspection, I also understand thll'f#;'\!Jeftt-Pl'l\\We'Stlng a preliminary inspection, the waif covering 'may be required to be renm~ed. eel, ' City: Stale: Construction Contractor's Registration #: 'Sisnature: ~ A," ~ " Date: ! ) 3/0?/-,;'~(!\'(-.r. ~a:~ , ..~. \. '\:.'j,.?\ \- "~\-11\\ \';:) C;!i'];'~~\!t<J'S\ti\\,,,,::i'~ii%il1;1i1!f:{W;:)j}l;<""'''''~"'''' 'c"'''\1'"''''''l>i",,~\)~\V,,''''~n\T~SJ;\J':\:'''O'~1\'(-.\S?t. c" ta~ ;7~M~i'~m:;1iJ"",s~~f:".~?'l1~~Y;' F9~R.S1,.WSE !J:~~""';:'~~~~\S,?JW~t\f\\~\)S?\;.~ ~R~\)a~\-u , np . ,\)1\'(-.a~\t c\) Cl~ \S t>: . ~ "'\:.~C\- ~\a\). Date of Application: I. :J ZOO ( .('.0\-11'" 0" r.'1 ?t:. !\~'{ -"till ':' ,........- Checked for Historical Status: V Checked for Delinquencies: ~ Shared Drive(T:)/Building Fonl1s!Woorl Stove Penllit 08-06.doc . .ITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00020 ISSUED: 01/0312007 APPLIED: 01/0312007 EXPIRES: 07/03/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspeclion Line SITE ADDRESS: 2379 CLEAR VUE LN ASSESSOR'S PARCEL NO.: 1703271203900 Springfield TYPE OF WORK: Pellel Stove TYPE OF USE: New Residenlial PROJECT DESCRIPTION: Install pellet stove Owner: ROSSO SUE A Address: PO BOX 72071 EUGENE OR 97401 Phone Nnmber: 541-741.4413 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor OWN~R License Expiration Date Phone BUILDING INFORMATION I VB # of Stories: LoISi,.,\.l tV \Cl1\~""'J "'hI HeighlofStructure ..' ,,'-''' .<":>q F6~stJF1loor; Type of Heal:. . \V\"o..Jl'~"'~ b,,\11eQ;g'FtJnf!J'FIii1iV: \~,,,. OO?\eu' \~",,\~~ ", Waler Type:- {Ules a. l\1ose (u Sq Flfl_a~~mcnl: Range <r:y~~~ \IOn centef. O\\1{OUgtSqltliardg~~'rporl Energy,fath:(J. "52..00t.oot. co?le'SQlFtOlh,~5(\e Sprin~!~d~Bili\dii1e:(T\a.'1 ob\l:'rt?aNO\e.,~ec\,'f)f.l{ L8!\\ln ' ...n. 'IoU _.0.1' n ....... Mnt\l\li I DEVELOPMEN'i-iNFORMA:T:iON{lI;on.~32:i344). n\lf(1UP'cen\er1s ,-000 REQUIRED PARKING Overlay Disl: Tolal: # Streel Trees Rqd: Handicapped: Paved Drive Rqd: Compact: % of Lol Coverage: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Constrnction Type Secondary Construclion Type: # of Bedrooms: R-3 Fronlyard Selback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Slreellmprovements: Storm Sewer Available: Spedallnstruction: .......n\! I PUBLIC IMPROVE~EiWs I '\ S[\I\LL EY-I'IRE IF \ ~~ \~ N'~i i[\\S t'ttll'J\\ Sidewalklt"'1,pERM ORIIEO u"iJ~" ~OONEO FOR 1\\11[\ ENCELP.9~nsp.M1~Dra,"s: COMMBG Ol\'{ I'ERIOO. I\N'{ '\ Notes: ,I Valuation Descriotion I Description Type of Conslruction $ Per Sq Ft or mulliplier Square Footage or Bid Amount Value Dale Calculated Paee I of 2 Issued 225 Fifth Streel, Springfield, OR 541.726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description -Mechanical Issuance Fee-- + 10% Adminislrative Fee + 5% Technology Fee + 8% State Surcharge Minimum/Adjustment Mechanical Pellet Slnve/Insert Tolal Amounl Paid . Total Value of Project Fees Paid I ' Amount Paid Date Paid ~1l1' OF ~rKll'\iuJ:<l"'LD. Building/Combination Permit PERMIT NO: COM2007-00020 ISSUED: 01/03/2007 APPLIED: 01/03/2007 EXPIRES: 07/03/2007 VALUE: Receipt Number 1200700000000000008 1200700000000000008 1200700000000000008 1200700000000000008 1200700000000000008 1200700000000000008 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. $10.00 $4.50 $2.25 $3.60 $15.00 $30.00 1/3/07 1/3/07 1/3/07 1/3/07 1/3/07 1/3/07 $65.35 I Plan Reviews , I Rl'lllJired Tnsuections,1 Freeslanding Pellet Slove: After installation. By signature, I slate and agree, that I have carefully examined the compleled application and do hereby certify that all informatinn hereon is Irue and correct, and 1 further certify that any and all work performed shall be dnne in accordance with Ihe Ordinances of the City of Springfield and the Laws nfthe Slate of Oregon perlaining 10 the work described herein, and that NO OCCUPANCY will be made of any structure wilhoul permission of Ihe Community Services Divisinn, Building Safety. 1 further certify that only cnnlraclors and employees who are in compliance wilh ORS 701.005 will be used on Ihis project. I further agree to ensure tbat all required inspeclions are requesled at the proper lime, that each address is readable from Ihe streel, that Ibe permit card is located al the fronl of Ihe property, and Ihe approved set of plans will remain on Ihe site at all times during construction. ~-A/~ Owner or Contractors Signature Paee 2 of 2 lis l:;&, Dale . . " . . 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 Pennit#: Co",^~o.':""bOOz..O Address: 237 q cJGML VlAlF Issued by: [) 6 Dale: (/Y07 e, . . . . . . . . ". .. . , Statement: In(ormation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4) requires residential construction permit applicants who are 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 701.010(7), need not submit this statement, This statement will be filed with the permit, Fill in the app,vp,;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: B-l. b- 2. I own, reside in, or will reside in the completed structure, I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion, o 3A. My general contractor is . ,." .n'1"iroc: \lnll to (Name) ATI l:.1\l i IU,".V"08""'- ,.',' '{~O.Ijl:'ll}y follow rules adopted by the Orel} , .I , , ~'"Ijfir",tion Center. Those rule,:; are s_et forti I. Will mstruct my general c~ntractor that all Subco?tra~~~~8a'l~~'RJ1tth!l~l<1llFC ffiUsD6e licensed With the ConstructIOn Contractors Board. ~o~o. You may obtain copies of the rules ~ OR calling the center. (Note: the tele.~ho~e ~ . numberforthe Oregon Utility Notllicatlon ~ 38, I will be my own general contractor. Center is 1.800-332-2~44). In 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 of the contractor. NirdCE: I hereby certify that the above information is correct and that I have ~e:f'd\~ifd:db\ttfiieH't:i'rfdlfh"[,ftlli~~'~~rlion Notice to Property Owners about Construction Responsibilities on'th'eJ~V:er:se.iillle:6fthila'omn.MIT IS NOT COMMENCED OR IS ABANDONED FOR f /I ~ - A ANY 180 DAY PERIOD. '/::J / .~ - (rxTcK-h )/-.Ji/OJ (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06.01.04 Acting "as:.~~tOWn General C'ntractor? ",Ij "INFORMATION ~OTICETO PROPERTY oWNERS :., . , 1 ABOUl:' CONSTRUCTION RESPONSIBILITIES, . . . . . . ~. :..t....., _.~ \', \, ~ - ", - \-'- , , ",.' '. ". . I' 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 substmiiiiil' improvement to an existing structure, you can prevent many problems by being aware of the folloWihg:'responsibilities and c.oncems. Employer Responsibilities " . \ ,\ '---t:,. .,"",-'-;". )1 You will, in most instanc.es, j:>eruled to b!,: an "empl?y~"'~d the contra~iors.you contrac~ wit~.~ll be '''e,mployees'' if you use contractOl:s not I~censed with the Construction C,onqact!)rs Board to do labor in constructing or to assist in the construction or improvement ofa residential structure, As the employer, you must comply with the followiJig': , '. ' .~. .. . . . '. . ,.... ~. ., - _. - . -. ...1 .... - ,..:;-'",,' _ ..' . . ~'" . \ " ". . ., . - Oregon's Withholding Tax Law: As 'an employer, you ~ust withhold income' taxes fnirit'employee wages at the time employees are paid. You will be liable for the tax payments even .if you don't a9tually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. '. .,' , '.' .... I Unemployment Insurance Tax: As an employer, you lire'requifea to pay a tlii for Unemployment-insurance purposes"-- on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. "";> r. .1 ",' :..,. .. The Oregon Business Identification Number (BIN) is a combined number (Qr both ;Oregon Withholding and' Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.slate.or.us/fonnsoav.h.tmll for the appropriale fonns. . ,. ',', . \" . Workers' Compensation'Iilsurance: As an emp]oyer,'you aie subject to the Oregon Workers' Compensation Law, and must.ob'tain workers' compensation in,surance for your employees. If you fail to obtain workers' compensation insurance, ~Oli could be subject to pena!ii'es and be iiable lor'allclaiin dJsts ifone ofYIJlir employees is injured on the job. For more infOl;hation, cali the Workers' Compen~ation Division at the Department of'Consumer arid Business Services at 503~947,78)'5: . ' ' ',' . I '.- '" - U.S. Internal Revenue Service: As an employer, you must withhold federal income taicft'om 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 th~ IRS at 1:800-829-4933 orvisit theinveb site at www.irs!l!ov. .,' ,. ,"i' , " ....i. , . ~ '. _' - \. . : . ~., - . . . '1 . l'" . ',. ~ ~ . Other l;{esponsibilities .and Areas of,CQllceri;ls. " Code Compliance: As the permit holder for th.is project, you are responsible for res~fving 'imy failure to meet code requirements that may be brought to your attention tlu:ough inspections. ._..... . ".. ........ ',;..' ,.- .' . .','''' l.' . , . Liability ~nd Prop'e~tY Dam'age insurance: Contact yi>Uf insurance agent to :see if you have adequate insurante' coverage for accidents and omissions such as falling tools, painl 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... ". " ' ';' , ..' 1 " .' _ .\ .' '-. " t',....;.. . _ ... ...., ~ ,", ". ~ - : , _. . . " ... Expertise: Make sure you have the skills to aCt as your own general conti-actor, to coordinate the work of rough-in and finish trades, and to notify building officials as the app,vp,;ate times so they can perfonn 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. '\{ . IH, ;",. "',," .,'," Property _ owner.doc 06.01-04 225 Fifth Street . . . . Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00020 COM2007-00020 COM2007-00020 COM2007-00020 COM2007-00020 COM2007-00020 Payments: Type of Payment CredilCard cReceiotl RECEIPT #: . SP. !'I,Nc>.,_"_"'-'>,' . ~'" -,' , . .", -, ",' ~"'".,; ~,~.,' " C\liIiIef Springfield Official Receipt ~opmcnt Services Department Public Works Department 1200700000000000008 Date: 01/03/2007 Description + 5% Technology Fee + 8% Slale Surcharge + J 0% Administralive Fee Pellet Stove/Insert Minimum/Adjustmenl Mechanical -Mechanical Issuance Fee- Paid ,By SUE ROSSO -, Item Total: (;heck Number Authorization Received By Batch Number Number How Received djb 006877 In Person Payment Tolal: Page I of I 1:53:21PM Amount Due 2.25 3.60 4.50 30.00 15.00 10.00 $65.35 Amount Paid $65.35 $65.35 1/3/2007