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Home My WebLink AboutPermit Mechanical 2004-12-9 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . e- CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-01508 ISSUED: 12/09/2004 APPLIED: 12/09/2004 EXPIRES: 06/09/2005 VALUE: SITE ADDRESS: 6772 Jacob Lane . ASSESSOR'S PARCEL NO.: 1702341109200 Springfield TYPE'OF WORK: Heating System PROJECT DESCRIPTION: Gas fireplace TYPE OF USE: Owner: JASON GENCK Address: 6772 JACOB LN SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor License AMERICAN GAS APPLIANCE SERVICE IN 77621 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: # of Stories: R-3 Height of Structure Type of Heat: VN Water Type: Range Type: NOTICE'. Energy Path: lHI~ PERMIT S\~.IU:!l!~!'!J)~~~~.~':!.E.~~~~a AUTHOrl;DEViiI;OPW;NiJ~iFQ~iho}; I COMtvltIN~J"~.. ! , ANY 180 DAY PERIOD, . Overlay Dlst: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: ATTENTION: Oregon 1<M1~ijM{ilUhu~MENTS I follow rules adoptl:Jd t,.. . ! - Street Improvements. .' . Cente~ Those rules are set forth Notification. OAR 952-001- Storm Scwer Avail'\WeAR 952-001.001?thrO~gh Special Instruction: 0090. You may obtain copies of the rules bV calling the center. (Note: the tele~ho~8 Notes: number for the Oregon Utility Notification "M'O' I.. 1_Rn0-332-2344). I v' aluation Descriotion I Description New Residential Phone Number: 541-349-0592 Expiration Date 10/3112006 Phone 541-954-4686 Lot 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: Sidewalk Type: DownspoutslDrains: $ Per Sq Ft or multipller Square Footage or Bid Amount Type of Construction Total Value of Project Paee 1 of2 Value Date Calculated . . CITY OF ~.rK1NuNJ<..LU Building/Combination Permit PERMIT NO: cOM2004-01508 ISSUED: 12/09/2004 APPLIED: 12/09/2004 EXPIRES: 06/09/2005 VALUE: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line l.F""s PairI I $10.00 $4.50 $3.15 $15.00 $30.00 12/9/04 12/9/04 12/9/04 1219104 1219/04 Receipt Num"er 1200400000000001719 1200400000000001719 1200400000000001719 1200400000000001719 1200400000000001719 Fee Descrintion -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Gas Fireplace MinimumlAdjustment Mechanical Amount Paid Date Paid Total Amount Paid $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.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I, R,"ouir"rI~ Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical 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, and that NO OCCUPANCY will be made of any structure without 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 readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. ~ owne~ntr.ctors Signature ['&/ Ci,( 61 Date I I Paee 2 of2 r.. . -. . . \ ,1 ", .' '. ." . .' Construction Contractors Board 700 Summer St NE Suite 300 PO BOI 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: COWl -z..4 - 0 I SO 8' 677 z... "J A c.o t3 u./ 1\11 Date: /2-'7-0 Y 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 befiled with the permit. Fill in the at't',vt',;ate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. I)f 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 (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. IfI 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. ~ ___~~'-- /'-.. l7jG-!UY G. ' (Signature of permit applicant) , ~ (Date) ~ (White copy to issuing agency permit file, pink copy to applicant.) P__r..~j_owner.doc 06-01-04 A(C~finn~ ... . ~~Jl @lUll!" (Q)wnn GenneIr'~n CC([j)nntIr'~(Ctt([j)Jr? ' '''~ INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBiliTIES 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. JEmjpnoyer Re!ijpoHn!iibilitie!i 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 Withholdiug Tax 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.state.or.us/formsoav.htm11 for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Cv,.........sation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain 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' Compensation 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 tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site at www.irs.l!Ov. Otllner Re!ilPonnsnlbnllntnes 2lnnidl Are21s of Conncernns ' Code Compliance: 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, 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. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notil)> building officials as the ,,!'!'W!', ;ate times so they can perform 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. Property_owner.doc 06-01-04 225 Fifth Street Spr.mgfiefd, Oregon 97477 541-726-3759 Phone . J7~~ Wit. ay of Springfield Official Receipt Wvelopment Services Department Public Works Department Job/Journal Number COM2004-0 1508 COM2004-0 IS08 COM2004-0 1508 COM2004-0 1508 COM2004-0 1508 Payments: Type of Payment CreditCard 12/9/2004 RECEIPT #: 1200400000000001719 Date: 12/09/2004 Description + 7% State Surcharge + 10% Administrative Fee Gas Fireplace Minimum! Adjustment Mechanical -Mechanical Issuance Fee- Paid By JASON GENCK Item Total: Check Number Authorization ReceIved By Batcb Number Number How Received djb 177669 In Person Payment Total: Page I ofl 3:10:19PM Amount Due 3.IS 4.S0 IS.OO 30.00 10.00 $62.65 Amount Paid $62.6S $62.65