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Home My WebLink AboutPermit Mechanical 2008-4-16 CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2008-00525 ISSUED: 04/1612008 APPLIED: 04/1612008 EXPIRES: 10/16/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1995 J ST ASSESSOR'S PARCEL NO.: 1703361201300 Springfield TYPE OF WORK: Mechanical Only PROJECT DESCRIPTION: Extend gas lines to range and bbq TYPE OF USE: Alteration Residential Owner: 1995J LLC Address: 1995 J ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor OWNER License BUILDING INFORMATION. # of Units: # of~/JWs: Primary Occupancy_p~~ffibN'. Ore~ law requ'r~~b\i"W'tructure Secondary Occupa^nc~ Croup,; adopted by the orel~ 1le.~fcJfmlt: . hl'r 'N. rUle", rules ':itnll Primary ConstructJ'on' 1 M15n Center. V\Blose ti!S2.:eelle: Secondary constN'2t~~~9Y~D01-001 0 thrOu.gh ~ iW\eit'b1 # of Bedrooms: In 090 You may obtain COP'?S\hO OO,I;il)~th: 00 . tar (Note. a 'lI:1~~.t.if.t 'ld' / \ling the cen. U\'\'tu Bti\N~wUI mg n a ca .~... n.ongn , I'J mu~' iI.I. ,..iL ~_\" nu Canter is 1-80 LoPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS I NOTICE: EXPIRE 'f THE W01\1C. TH\S PERMIT S~~i~ TH\5 PERM\T \S NOl AUTHORiZED UOR \S ABANDONED FOR COMMENCED ANY 180 DAY PER\OD. Phone Number: 541-513-0974 Expiration Date Phone 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: Notes: I Valuation Description I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Pa2e 1 of2 Value Date Calculated Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2008-00525 ISSUED: 04/16/2008 APPLIED: 04/16/2008 EXPIRES: 10/16/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description ~Mechanical Issuance Fee~ + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Gas Outlets 1-4 Minimum/Adjustment Mechanical Amount Paid Date Paid Receipt Number $20.00 $5.00 $6.00 $2.50 $5.00 $45.00 4/16/08 4/16/08 4/16/08 4/16/08 4/16/08 4/16/08 1200800000000000358 1200800000000000358 1200800000000000358 1200800000000000358 1200800000000000358 1200800000000000358 Total Amount Paid $83.50 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 Reouired Insoections I Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Final Gas: When all gas work is complete. 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 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. ~ ~ .................--=:- --z;/ --:? ~-/ _ _~:::::-- -/ /' .-/ /' g-,;:.-' '0wner or Contractors Signature .? /" L-:;:Y 4 - /~' --- c1ff Date Pal!:e 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 Penmt #. U)VV'200g--00 S2~ /,?Sj T S~ -p:5 Date: Lf/;(/cr / I Address: Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residentzal constructzon permit applicants who are not licensed with the Constructzon Contractors Board to sign the following statement before a buildzng permit can be zssued. Thzs statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applzcants, exempt from licenszng under ORS 701 010(7), need not submit this statement. This statement will be filed wzth the permit. Fill in the appropriate blanks and initial boxes 1 and 2~ and either box 3A or 3B: /121-1. I own, reside in, or will reside in. the completed structure. L:"EJ- 2. 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. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and willnnmediately notify the office Issuing this buildmg 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. , ~ ~ ___--.-.~ () d ---y/ // ~ ~----- 4- - /b'- 1) /1' // (Signature"O'fperrillt applicant) (Date) \../ /' (Whzte copy to issuing agency permzt file, pink copy to applzcant.) PropertLowner.doc 06-01-04 , Acting~._asJY our. 0wn General Contractor? - '-. L ~ 1"' - 't \ ~- INFORMATION NOTICE TO ,PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES J. ....., '\ , , 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. _ _J If you are actmg 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 oUhe following responsibIlitIes and concerns. EmployeIr Re~polf1l~ibilftties You Wll!, m most mstances, be ruled to be an "employer" and the contractors you contract wIt,h wIll be "employees" If you use contractors not lIcensed with the~Constru.ct1on Contractors Board to do labor m construc~ng or to aSSIst m the constructIOn or Improvement of a reSIdentIal structure. As the employer, ymt must comply' w~th the following: Oregon's Withholding Tax Law: As an employer, you must WIthhold mcome 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 reqmred to.pay a tax for Unemployment msurance purposes ',-- on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. ~ The Oregon Busmess IdentIficatIOn Number (BIN) is a combmed number for botp Oregon Withholdmg and Unemployment Insurance Tax. To file for a BIN, call 503~945-8091 or \'I/ww.dor.state or us/formsoav.htmll for the appropriate forms. Workers' Compensation Insmrance: As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must obtain workers' cUH1pen~atIon msurance for your _ employees. If you fall to obtain workers' cvmpensatIon msurance, you could DC subject to penaltIes and be liable for an claIm costs If one of your employees IS mJured on the Job. For more mformatIOn, call the Workers' CompensatIOn DIviSIOn at the Department of Consumer and Busmess ServtCes at 503-947-7815. U.s. IntemallRevenue Service: As an employer, you must WIthhold feden-il mcome tax from, employees' wages. " You WlI1 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 V,l'vW.lrS.l!OV. (())fheIr Re~IPomi~nJl)Un1l:fies.~lf1ld 'AIre~s of Co'lIllCeIrlIJl~ . Co(jje Compliance: As the perolli holder for thIS proJect, you are responSIble for reSOlVIng any fallure to meet code requirements that may be brought to your attention through mspectIOns Liability and Property Damag~dnsurance: Contact your insurance agent to see If you have adequate- msurance coverage for aCCIdents and omiSSIOns such as fallmg tools, pamt 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 skllls to act ~s your own g~neral contractor, t~ coordinate the work of rough-m and fimsh trades, and to notlfy building offiCIals as the appropnate times so they can perform the reqUired mspectlOns. If you have addItIOnal questions call the ConstructlOn 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 Spring(ield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00525 COM2008-00525 COM2008-00525 COM2008-00525 COM2008-00525 COM2008-00525 Payments: Type of Payment Check cRecemtl RECEIPT #: 1200800000000000358 Date: 04/16/2008 DescnptlOn Gas Outlets 1-4 MInimum/AdJustment Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 12% State Surcharge + 10% AdminIstratIve Fee Paid By REX BRITT Item Total: Check Number AuthorizatIOn ReceIVed By Batch Number Number How Received dJb 2017 In Person Payment Total: Page I of 1 10:03:2IAM Amount Due 500 4500 2000 250 600 500 $83.50 Amount Paid $83 50 $83.50 4/16/2008