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Home My WebLink AboutPermit Mechanical 2007-1-16 ~l ~ - City Job Number ." r,.--'I Job Location: ~I,'~.', -- Assessor's Map: ,!) ~. .,~i ~i Owner: ~itk ()w/Aj(;t-/YJ~Ai;h V e;;"l Address: -b S~ /(I'/.9) 13/t/(j / Phone: <(t City: Sf)r/~/;C Slate: C?e ~r r ~ 5: Preliminary Inspection is $55.35 (p~rt). . ~ . Wood Stove/Pellet/Insert Permi~$65.35Jilil:ludes applicable fees and surcharges). -L f",,_I~ I~ (Q; ~ f:!!'" ~~ . Ci/ill ~: ~, r-,\ I~ ~i CV) . rflill . !jt I, I~ ............... ~ ~ (0) 1...21 rtli1J "q; 0; ~ ~.-::;;. Date of Application: ....-- Checked for Delinquencies: SPRINGFIELD '"-';:]'" ".1 ~ . j . ::"j" . f'f.t"-" ,., '.. _~_"."" ,..''"t-,.. /.....i.',_ ~/"1 "'1 "".""" '"t' ',' ~.' -: '''.~,-. ,. \ ;:~.... -~.......ii.......:.~.t":'~.i_:":::_.::'f(Z" '~;"~i . '~,'l~'::"1~'"7<. . . *t.'''j ,...:."" ,. 'h' f"" ~".1,r' ,....,.....,'".... .'\ ",' <<;"".:." :-...... " -...:._~ . )~- ....~...... ., """ , 225 miH STREET. SPRINGFIELD, OR 97477. PH:(541)726-375:' . FAX: (541)726-3689 CQ...v\ z...C:::>O"7 ~ c.;>O 0 b 'J 6 ~s- ut{ V (l/"d 17DJ3S"Z.:S ( ~ Tax Lot: O/LfOC' S'~/- ,%'I ~oa21 Zip: ~ 7'1?? .' . \\'\C \NO\\~ "(. ~c' _& ~",,\QI' II' " "0\ \\\0 \ Gontractos~gtOJlnatiO~r.\\\'JII\ Iv I~ Contractor. DLY Nr:-lI..- .,.\.\\s, ~c~\'JII~ . ,,\"I'~ \\,\1'2> _ n.\t:1I B1B-- Address,~\\\\'\O~\Lt.:'n~~Q IS ~~ . rhone: City: r.o\'JIWlt\'l':..~QO, Construction Contractor's Registration #:~~t"i'" .. Zip: . Expires: ~OU tv ' . . h' . / I' . II f '.. ,'::>Ol~leS ~i\i\\jd (-?6 3-60) By Slgmng t Ispernllt app Ical1on, I a:?ree. to ca ~~'~f ~1~pect!0~v~,,,,~~re'~1l5\\\ 1- - 1 '-' . I state that allmformal1on on thiS apphcatlon~Rei"1l11l-1s"H)I~feGtSlna tliakhwas'RQovlded With the Wood Stove Safety information for wodNbtll:ll'ing:lapP.lla~ies !lrla~p'~C\ljfl\ifialy:inspection '. ,,)\"'t'\\~'_.O.l' n. '1~~\:Jr I \~SU standards as set by the Oregon Departm.ent of En,\IJ:omnt:l1fl\oQua Ity W\f.lelFeaeral Environmental Protection Agency and !.:..agl\ee?fa':P.r~Ii.iCltPtl!~~\Y~ti1,l~at?E~'9xll;1\"lluWIRer to the inspector at the time r- inspection. I aIW',i1~r~.~~~:tJtR~i~1 ~QlI~\.tf*IJg\8~pilflilninary inspection, the ~ Jail c ',ering m be 'eqRir&i to 15~~nfu~6~..goll \)\111 i3AA). , rf 1 \ ca\\\lI9 \01\"6. "BOQ"'33Z-.. . )' . lIUllioelcell\ellS ~ . I / . Signature: . I , . , , I Date: iii;; /;; ? l~"':-' .., '1'",;. ""~"''''~;.-,. :t'iJI;72,rrm?= ,.;".,..'''"''.,...,,":'i''\--:;;....r\.;l.''',f,':.'5i;'..'i.''':~''''....l.''~<'-i.-;;.~~, P:~.~ .;:-:","~ ~~. :,.,.r.1~~:"-~\;;~~::~~A~",..~t;;,,~.~,'~J~J,9..~!;E:~~~ ~..;.~~<~~.t{ ~t'br~,,: :~.::t.~.;;, ;--'i~:::'~-:~, '::'~ ::. ~t:; '.' I /- /f:, - ZC:>O-I' V-' ~-_. Checked for Historical Status: Shan:d Drive(T:)lBuilding. FunnslWood Slove Pemlit 08-06.doc . .CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00069 ISSUED: 01/16/2007 APPLIED: 01/16/2007 EXPIRES: 07116/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 655 KELL Y BLVD ASSESSOR'S PARCEL NO.: 1703352301400 Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential PROJECT DESCRIPTION: Install pellet stove Owner: DOWNEY-MCCARTHY JOHN P & ROSEMARIE Address: 655 KELLY BLVD SPRINGFIELD OR 97477 Phone Number: 541-556-0829 I CONTRACTOR INFORMATION I Contractor Type Mecbanical Contractor OWNER License Expiration Date Phone VB I BUILDING INFORMATION I N/~--'nt~ #'of Stories: Lot Size: T,J-Ieigbtof\,Structure Sq Ft 1st Floor: ALT);PfJ~~H~~/t:~HALL EXPIRE Sq Ft 2nd Floor: co~~~i~u>\;': UNDER THI IF THE 1S<i1!\t\Basement: A ff~o~e;ryp.e: OR IS AS S PERMIT ISs,~(n.Garage/Carport NEnergyLP,~rbf.>r=DI ANDONED FO Sq Ft Other: Sprinkled Buildin2D. nla ROccupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: A T~'~1~~ett._-];~~e~,.~9Id: tol/cPaved DrivelRqd:On iaw fe4Ull ~_ Y ,,"" r' Ill:::~ :"r1nn...,...,.,J t... ....... au lu NotitirYOtof I.:ot. Coverage:JY the Oregon U . . . a .un t,;enter Th t,IIly In OAR 952-nn1.nn:^ :.ose rUles are set fn... i P~BLic'IMPROViEME~.T.S:I;~' ;;;AH 952-00 I '" ...~ "'''''rer (N t the rule", b rlUmber 'or 'h O' 0 e: the (Sidewalk Type: . I . e regon Ut'/'t ;-'":,":,,vlJe Ce t . " Y ~D".L.. ID . nAP::: 1.Pn(1_",,, ^.,~ A OWOSpO!l.I~ raIDs: . . -<.......). Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I Description Type of Constructioo $ Per Sq Ft or multiplier Square Footage or Bid Amonnt Value Date Calculated Paee 1 of 2 . .CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00069 ISSUED: 01116/2007 APPLIED: 01116/2007 EXPIRES: 07116/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspectiou Line Total Value of Project [..Fees P~UU Fcc Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Minimum/Adjustment Mechanical Pellet Stove/Insert Amount Paid Date Paid Receipt Number $10.00 $4.50 $2.25 $3.60 $15.00 $30.00 1/16/07 1/16/07 1/16/07 1/16/07 1/16/07 1(16/07 2200700000000000057 2200700000000000057 2200700000000000057 2200700000000000057 2200700000000000057 2200700000000000057 Total Amouut Paid $65.35 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. L.Reolliretl \rsne~tions I Freestauding Pellet Stove: After installation. By signature, I state and agree, that I 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 certir that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further re 0 ensure Ihat al~eqUired inspections are requested at the proper time, that each address is readable from the street, tha th I er it car I 10 t~t the front of the property, and the approved set of PZlns ill remain on the site at all times duri g ( 0 Is1 ion ~ " . \ \ l I~ (J) Owner r ontractors Signature Date I I Paee 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 I). i \, / ". .,' '. .' . . . pennit#:COW\~O~- 000 b~ Address: bSS- 'C..td/~ 0 r V d "J>!{ I Date: 1/tt,/o7 / f 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 app.up.:ate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. tt- 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. . 0 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 8r' 3B. I will be my own general contractor. I heret\v c . y that ~e tl e information is correct and that I have read and do understand the Information Notice fol r ~y (~"l \,1 out Construction Responsibilities on the reverse side of thi fnrm. /\ .\ t , (Signature ofpe 't applicant) I J U If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! 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. (White copy to issuing agency permit file, pink copy to app icant.) PropertLowner.doc 06-01-04 . . . AdnlID~r ~~ 1{@1!#It' (Q)WIID GelIDell"~n C(fj)IID~ll"~tC~(fj)ll"? . 1 ,--~ '. 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 cpntractor 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. JEmpnoyell" lResponnsnbiJljtit:s 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. A's tbe employer, you must comply witb tbe fonowing: Oregon's Withbolding 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/fonnsnav.html1 for the apy"vJ-'..~ate forms. 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 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 WW\drs.l!o,-::. Othell" lRespolllsibillities amI! Areas of COlllcerlils 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. Liahility 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 s'ufficient time to supervise your employees. Expertise: Make sure you have tJie skills' to act as yok oWn' g~ri~ral' contractor, 'to coordinate the work of rougli~in and finish trades, and to notify building officials as the appropriate 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 Fi(t~ .street Spriu'gfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-00069 COM2007-00069 COM2007-00069 COM2007-00069 COM2007-00069 COM2007-00069 Payments: Type of Paymenl Check cReceioll RECEIPT #: cAr Springfield Official Receipt D"""lopment Services Department Public Works Department 2200700000000000057 Date: 01116/2007 Description + 5% Technology Fee + 8% State Surcharge + I 0% Administrative Fee Pellet StovelInsert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Paid By JOH PATRICK DOWNEY MCCARTHY Item Total: L'heck Number Authorization Received By Batch Number Number How Received djb 965 In Person Payment Total: Page I of I II :08:25AM Amount Due 2.25 3.60 4.50 30.00 15.00 10.00 $65.35 Amount Paid $65.35 $65.35 1/16/2007