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Home My WebLink AboutPermit Mechanical 2005-7-27 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00992 ISSUED: 07/27/2005 APPLIED: 07/27/2005 EXPIRES: 01127/2006 VALUE: Status: Issued 225 Fiftb Street, Springfield, OR 541-126-3753 Phone 541-126-3676 Fax 541-126-3769 Inspection Line SITE ADDRESS: 2412 DUMAS DR ASSESSOR'S PARCEL NO.: 1703234400116 Springfield TYPE OF Heating System TYPE OF USE: Addition PROJECT DESCRIPTION: Install furnace, ac, gas fireplace and gas piping Residential Owner: ., Address: THOMAS SMITH 2412 DUMAS DR SPRINGFIELD OR 97477 Phone Number: 541-521-9500 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor License AMBASSADOR PIPING 1NC 121469 . I BUlLDING@IFOFTlON. I ,,! II '. \~ "'4"' ot' u~". # ofUnits: .0t690t\ welOlfl . .\ot\\'. Primary Occupancy G~fI~IO"" Bol>\ed b'i se ~lkj 2.00' Secondary Occupancy ~0'l4 (U\eS Ili~~~t. "(\\0 10U~~ s b'l Primary Construction ~~~a.\\on CIOflOO\O ~ ~Wf.JlfN. ~iOl\6 Secondary ConstructibW ~? gfJ'2;t:J ob~n cO ! ~" .. # of Bedrooms: In 0 0 'ioU tfla.'1 n\et. ~O. ft/ : 009 " \ne ell Otegon..,ppj~' ...a.lllng <_, \ne ,^nO':.;l..... (\UtflOQ' cen\et iOEVELOPMENT INFORMATION I Expiration Date 03/27/2007 Phone 541-726-5723 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nJa Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: S treel Storm Sewer Available: Special Instruction: IPUBLIC IMPROVEMENTS' \NO'?~ .,., :- ,_ _ tOY-I'I\\\:. \~;~~eWitlj(Type: . ' ,.. , Stl",-,- '- I't,,\\ill \ .~ '\ \.'S \"cr\:"\O UNO\:.\\ ,tIIS OO\,\\:.l!olf'.&pouts/Drains ,. . r'\~.L-t 0 Ie i'-\)~\~ '"IIV '-00,," 'l,Gi".\"cI~C.\: :/1'\:.\'1\00. di\)\J\)~ ,\I'll Notes: , Valuation Descriotion I Description Tvpe of Construction $ PerSq Ft or multiplier Square Footage or Bid Amount Value Date Calculated 1 of 2 ,- Status: Issued 225 FIfth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Boiler/Comp Up To 100,000 btu Furnace - up to 100,000 btu Gas Fireplace Gas Outlets 1-4 Minimum/Adjustment Mechanical Total Amount . . CITYOFSPRlNGFIELD Building/Combination Permit PERMIT NO: COM2005-00992 ISSUED: 07/27/2005 APPLIED: 07/27/2005 EXPIRES: 01/27/2006 VALUE: Total Value of Project L.Fees PaW Amount Paid Date Paid Receipt Number $10.00 7/27/05 1200500000000001075 $4.50 7/27/05 1200500000000001075 $3.15 7/27/05 1200500000000001075 $12.00 7/27/05 1200500000000001075 $12.00 7/27/05 1200500000000001075 $15.00 7/27/05 1200500000000001075 $4.00 7/27/05 1200500000000001075 $2.00 7/27/05 1200500000000001075 $62.65 I Plan Reviews , To Request an inspection can 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. win be made the following work day. ~Rpm~ 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. Final Gas: When all gas work Is complete. By signature, I state and agree, that 1 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, nnd that NO OCCUPANCY wiD be made of any structure without permission of the Community Services Division, Building Safety. 1 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~treet, at the permit card ~ located at the front of the property, and the approved set of plans wiD remain on the site a~~;;c~~ 7-;J7r-05 r ' . Owner or Contractors Signature Date 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#: COVVl z..._S-- 00992 Address: Z- ~ 7 2. \J I.A IN1 rr:s :ntZ.. Issued by: d-,~ Date: 7-27-0 I Statement: Information 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 befiled with the permit. Fill in the "pp.up.:ate blanks and initial boxes 1 and 2, and either box 3A or 3B: 01. er 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. D 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure 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 Construction Contractors Board. Ifl 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. I hereby certify that the above information is correct and that I have read and do understand the Information N;m p, - Ow'''~ :C;;"iblli"~" <b, ~~O:~;).J?'&- ( // (Signature. ofpenillt applicant) 6/ ()Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 .. . A<t~llrril~ $l~ 'it @1J1lrr (Q)WIID cG~IID~rr$ln CC@mH1:Jr$l~~@rr'P ul\l;'=O~lI,lArION N:OT~CiE YO P~OPIERTV OWNERS AIE!OUT CONSmiJC1!ON RIES~ONSll3llITiIES .t.\.o" 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 and concerns. lEJIIllljplYilDyerr Re~jplm]~filbfinMJie~ You will, in most instances, be ruled to be an "emploYeT" and the contractors you contract 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 employei", you must comply witli t1!e 1c:!owlng: Oregon's WithholdJing 'fax 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. V::ea!r:oyment TInSI!i"aJ::.ce 'fElt: 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 Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsDa....htmll for the appropriate forms. WOi"f,eJrs' Compensation linsui"ance: As an employer, you are subject to the Oregon WorkeTs' CV'''I',""sation Law, and must obtain workeTs' compensation insurance for your employees. If you fail to obtain workcrs' 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. 'V.S. lioternll.llllevenue Sei'Vice: As an emploYeT, 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 IRS at 1-800-829-4933 or visit their web site at \Vw\V.irs.lwv. Otllnu :JP2.te:;>])lioIIll:;>Ji1biJillJitJite:;> ~IIIlidl AIrte~:;> ojf COIIllCteIrIIll:;> Colle Complilmce: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. lLizb:::ty aEci Il'Tollerty Damage ][nS:l7Zilce: Contact your insurance agent to sec if you have adequate insurance coveragc for accidents and omissions such as falling tools, paint ovcr spray, wateT damage from pipe punctures, fire or \Vork that must be redone. T:::!e: Make sure you have sufficient time to supervise your employees. ~:'::::e:~::5e: :vIake sure you have the slalls to act as your own general contractor, to coordina.e the work of rough-in and fimsh trades. and to notify building officials as the appropriate times so they can perform the requir~d impcctlOns. If you "avc nddit'onal questions call the Construction Contractors Board (503-378-4621) or writc the a:;cncy at PO Box 14140. Salem, OR 97309-5052. Property ov.ner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ........~.."'!'!...~,.~.! Wit' ~ . ...-- '. I . . . , ". .. .: .JiJ.ty of Springfield Official Receipt .velopment Services Department Public Works Department Job/Journal Number COM2005-00992 COM2005-00992 COM2005-00992 COM2005-00992 COM2005-00992 COM2005-00992 COM2005-00992 COM2005-00992 Payments: Type of Payment Check i I. 7/2712005 RECEIPT #: 1200500000000001075 Date: 07/27/2005 Description Furnace - up to 100,000 btu Boiler/Camp Up To 100,000 btu Gas Outlets 1-4 Gas Fireplace Minimum! Adjustment Mechanical + 7% State Surcharge + 10% Administrative Fee -Mechanical Issuance Fe..... PaId By THOMAS SMITH Rece; ved By djb 1 of 1 Item Total: Check Number Authorization Batch Number Number How Received 1322 In Person Payment Total: 8:18:50AM Amount Due 12.00 12.00 4.00 15.00 2.00 3.15 4.50 10.00 $62.65 Amouut Paid $62.65 $62.65