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Home My WebLink AboutPermit Building 2005-9-7 . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01221 ISSUED: 09/07/2005 APPLIED: 09/0712005 EXPIRES: 03/0712006 VALUE: . Status: Issued ; 225 Fiftb Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line c SITE ADDRESS: 1120 FAIRVIEW DR SPACE 78 ASSESSOR'S PARCEL NO.: 1703273100600 Springfield TYPE OF Pellet Stove ! PROJECT DESCRIPTION: Install pellet stove TYPE OF USE: New Residential _. ,e \NO\\~ !pUBLIC IMPROVEMENTSI~IlI\\\;. W\\~\I' IS '\-Iv' . '. \ ' "'r- r'-' '-'IS 1'1: ,,\,-11\\ V...'", \, '-: 'J.' \1\ '" ~,r.e\\ '\ \' Side':Valk Type: 'S 1',-'" \.II'V'- ~1\1;o\Vv' '\\\\ \'IO\\\l\;.D r. 0\\ \S r>: Downspouts/Drains 1\\.1 \:-I'~r.:,l:v c.\\IOD, COI'<lI" Df>,~ Ill- 1>.1;0\~ \'O\) ... Owner: JON DRISCOL Address: 1120 FAIRVIEWDR SPACE 078 SPRINGF1ELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Mechanical '() 'jcl1icense c,0\\e5 \)\\\\\~ _. "e _f""$\ . _.-'in ... ~~ . h......~ _r.... ,- I BUflJDINGJNFORMATIONIIO\' 'i,.\-.I\\lf. ooQt~'- 'n05~ ,- Of'<' - ,e5 'o'j 1'-" It! \u\e5 3'e \~S~,\\'\{l:,u<;)'n 0\ \\\e \~\\O\\e !,b'3Q a.\:'0\\ C c ~~f co?\e5 e \e\e? ca.I\O\\ ~IO\\\\C n,".:,'?..\J 'vD.ejot"Heat:,e', \\\ ~loI\\\ \~ Io.,?- '" "I' 0;;.' \\~~ '"I'j \~ ~r "ou \ilWal!'.~arype:(\ $\\ n~l\l\l' ,," , ..c." ..,~i"\U ,,-n.r.. o\J"'V' , <;) \\\n>I~~C''YP'e:o'~'''r.. ca.\\\\\ e\ \BD~r!ll."yatW: (\u\il'O ~1iiikIed Contractor OWNER , # of Units: Primary Occupancy Group: Secondary Occupancy or Primary Construction Type Secondary Construction # of Bedrooms: nla I DEVELOPMENT INFORMATION' Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: . Street Storm Sewer Available: Special Instruction: ',' Notes: I Valuation Descri~tion I Description $ Per Sq Ft or multipfier Square Footage or Bid Amount Type of Construction 1 of 2 Phooe Number: 541-741-0247 Expiration Date Phone LOl Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Value Date Calculated . . CITYOFSP~uNELn Building/Combination Permit. Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line PERMIT NO: COM2005-01221 ISSUED: 09/07/2005 APPLIED: 09/0712005 EXPIRES: 03/07/2006 VALUE: Total Value of Project Fl'l's P:aid I Fee Description -Mechanical Issuance Fe.,... + 10% Administrative Fee + 7% Stale Surcharge MlnimumlAdjuslment Mechanical Pellet Slove/1nsert Amount Paid Date Paid $10.00 $4.50 $3.15 $15.00 $30.00 9/7/05 9/7/05 9/7/05 9/7/05 9/7/05 Receipt Number 1200500000000001314 1200500000000001314 1200500000000001314 1200500000000001314 1200500000000001314 Total Amount $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.ID. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. ~ln.npl'~ Freestanding Pellet Stove: After installation. , By signature, I state and agree, that I have carefully examined the completed application and do herehy certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done m accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaming to the work described herem, and that NO OCCUPANCY wiD be made of any structure withoul 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 readahle from the street, that the permit card is located at the front ofthe property, and the approved set of plans wiD remain on the site at all times during constructi't; ) /2 I-z;.~ ~~ ? ~O5' ~ - Owner or Contractors Signature Date 2 of 2 225 Fifth Street ,. Springfield, Oregon 97477 541-726-3759 Phone . GJ~~~~.~ IIIc Job/Journal Number COM2005-0122 I COM2005-0122I COM2005-0122 I COM2005-0 1221 COM2005-0122 I Payments: TWe of Paymenl Cash Change J,j,/Journal Number COM2005-01221 COM2005-0122 I COM2005-0122 I COM2005-01221 - C'OM2005-0122 I " l'i'Yments: T.We of Payment Cash Change ., c :1 " ~ 'r ,;' . .. , " 9/7/2005 'r RECEIPT #: ~ty of Springfield Official Receipt .velopment Services Department Public Works Department 1200500000000001314 Date: 09/0712005 Description + 7% Stale Surcharge + 10% Administralive Fee Pellel Slove/Insert Minimum!Adjustrnenl Mechanical -Mechanical Issuance Fee- Paid By JON DRISCOL JON DRISCOL Received By djb djb Description + 7% Stale Surcharge + 10% Administrative Fee Pellel Slove/Insert Minimum! Adjustrnenl Mechanical -Mechanical Issuance F eo- Paid By JON DRISCOL JON DRISCOL Reeel ved By djb djb I of I Item Tola1: Lbeck. Number AuUlOrization Balch Number Number How Received In Person In Person Payment Total: ChecK Number Balch Number Item Tolal: Authorization Number How Received In Person In Person Payment Tola!: 2:22:10PM Amoonl Due 3.15 4,50 30.00 15,00 10.00 $62.65 Amount Paid $70,00 ($7,35) $62.65 AmoonlDue 3,15 4,50 ' 30,00 15,00 10,00 $62,65 Amount Paid $70.00 ($7.35) $62.65 -' , , . . , . " ..' ". .,' . 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 Pennil #: C-OVV\ zI,.s- - 0 I 2.-7-1 //Z-O F.41{L{tti.!ll '::.P 7? ~cr Dale: 7 -7-0 r ~ Address: Issued by: 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 be filed with the permit. Fill in the c.pp.vp.;ate blanks and initial boxes I and 2, and either box 3A or 3B: ID-l. @- 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 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 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 Notice to Property Owners about Construction Responsibilities on the reverse side of this form. L c::::' /~ ?~ 7- (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Ci.? r.~~~"Lowner,doc 06-01-04 A.~~nIID~ tal~ !1l11Il" -(Q)WIID G<eIID<eJr~rr C'IIDtlftal~~@Jr? , INFORMATION NOTICIE 10 PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES v' "- 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. JEIlll1l[pHoyer lRespollllsilMmies You will, in most instances, be ruled to be an "employer" 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 employer, you must comply with the following: Oregon's Withholding '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. 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 Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.stale.or.us/formsnav.htmll for the a"".v".;ate fonns, Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to oblain workers' 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' CV"'''~Hsation 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 from employees' wages.._ You will be liable for the tax payment even if you didn't actually withhold the lax. For a Federal EIN number, call the IRS at 1.800.829-4933 or visit their web site at www.irS,l!Ov. (())1I:lln1eIr Rleg~OlffigJilblJinJi1l:Jileg anmll A.Irlean!l OJ[ COlffiiCleIrlffig Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements thaI may be brought to your attention through inspections, Liability and Property Damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint 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, lExpert~se: Make sure you have the skills to act as your own general contractor, to coordinate the work ofrough-in and finish trades, and to notify building officials as the a"".v",;ate times so they can perform the required mspections, 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. Property _ owner, doc 06-01.04