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Home My WebLink AboutPermit Mechanical 2006-2-10 ., ~l (QJ .,e' ..L:::..' ~ d\$' < !.l ~) .,)~t ,,--__Ij f'!'" ~l C"'l, ~l <(: ~4 ~j OJ .,e' ..L:::..' ~ ~ ~ f'!', , ~l ~l ~l .......::::.( rr='ll t;~ . ' .-( ~ ~l ~j ~~ 1~lj ............... ~ ~ e>; I;~ ~ .,~ eJ> ~ ~ SPRINGFIELD r-'-- 8 ~ l td'!..~-------/~ ~;,<. .",;,---"( '~<. ' ,/~r ::'," ; .'" .,, ~ 225 FIITH STREET. SPRINGFIELD, OR 97477. PH:(54 1)726,$753 . FAX: (541)726,3689 Cily,lob Number lob Location: COf4,ofz-006-0pr 7b S-bZ-( H-t~ cr,4.,vt-~ 1702... 7 S('OO Tax Lot: o( i'oo SJ Assessor's Map: Owner: ~- ..ICl."'-. ~. LfrWh Address: ')L,:J,i \,\ ~'~ '" Y-,""....Kb City: 4Q~~b'-\~ O.L"'-'- e..L- !'hone: 14l'1~L~ ~ Zip: ..Sln~-n 0,01\e'" l \)\I\I\~ ,~\N Ie _ .~(\o("l . ."I\n ,e9V' \\W- le~- QI' PreIiininary Inspection is $45.00 + 10J6 Administrative Fee (prior to insert>")1 .,leO '0'1 <> IIl\eS ~,?- 9~~'O. 'O\! Wood Stove/Pellet/Insert Penni~$63. !Q.Jineltllles Pennit, Issuance Fee;State SurclUU8e and i&iritinismitive Fee). Q'i~ Illlv Ce("l\el. O\nIOI.l'\ o\\r>" "~o("le ..",('\"(\ ~ (\Q\ _....o\e ~p\e'? ~..n('\ . ,~......\.\\\.......~ '3~'l.~v"" ()'O\'o.\"I~O\e.. \.\,'- \'\O\\\'V- 01'-" 1l~e.'J \el. \ \)\1\1\'1 ..-'. \("1 ~~ .'lo ce("l <::},o("l 2":)....' I Contractor Infognati~>l \'("Ie ~e Ole QQ'":)":)~- Contractor: Af['~ ._ T~1 Ul^f==~ Ce.\\~'nel\O\~OI\S\''O Address: ? = (S' 0 X 7.. h "3 ~ '7 ("Iv" v"'" Phone: City: ~t\ r.:.' ____ Slate: [:!A' Construction Contractor's Registration #: '/ 3 gOb State: t();~ Zip: (J:14 0 "2-- Expires: <::::~/r-of By signing this permit/application, 1 agree to call for an inspection(s) as required (726-3769). I slate that all information on this application/permit is correct and that 1 was provided with the Wood Stove Safety information for wood burning appliances and preliminary inspection standards as set by the Oregon Department of Environil1ental Quality or the Federal Environmental Protection Agency and I agree to provide the testing approval number. to the inspector at the time of inspection. I also understand that if 1 am requesting a preliminary..,~'f- inspection, t7 wall covering may be required to be removed. \~'t. 'l'l\l <;J\ Q t.'I-'?\~'t. \\\'t>\\ \~ ~. ^ Ii ~O,,\C\\'t>\\ ~~~~~ \~\~ ~~~'t.\) 'f\)~ Signature: t'\l1IJI\ (I . "\\-\\<2> '?~~1~ro\}~\\ Ie, ~\i 10 - CJ(.... , \ . t>-\)\ ~\~~~C't.\) c,?'j;~\\)\). I FOROmCE USEBC\J~;,,~\)mt>-'i ....'.. " t>-~'i-'-~-' Z-/C>-Ob Date of Application: Checked for Delinquencies: --'-- Checked for Historical Status: .---- Shared Drjve(T:VBuildios FonnsIWood Slo\'e Pennill-Q6,doc -Wi' Status: Issued . 225 Fifth Street, Springfield, OR 541-726-3753 Phone · 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00176 ISSUED: 02/10/2006 APPLIED: 02110/2006 EXPIRES: 08/10/2006 VALUE: SITE ADDRESS: 5621 HIGH BANKS RD ASSESSOR'S PARCEL NO.: 1702280001800 Springficld TYPE OF I'd let Stove ", _.. PROJECT DESCRIPTION: Install pellet insert ' TYPE OF USE: New Residential Owner: LEAH OWEN Address: 5621 HIGHBANKS RD SPRINGFIELD OR 97478 '~ Contractor Type , Mechanical '. # of Units: . Primary Occupancy Group: Secondary Occupancy Primary Construction Type .:. Secondary Construction , # of Bedrooms: Front yard Setback: Side 1 Sethack: Side 2 Sethack: , Rearyard Setback: , Solar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: Description Contractor TED L HUFF JR ICONTRACTOI~ INFORi\lATIO~J License 73806 I BUILDING INFORMAT,ION, ~.._.-.. C,' . ".'.'n\~gonUtility # or.~torles:" et lort\'l R-3 ... Heightrofcl1es are 5 I' t -1\ venter. .' ~ i.>AR 952,00 . .'1" 1 oc;I:YP.~\or.'H,eat: \ b'/ G~VNJ52'OO' Wate" ~', 'e:")l t\'le ru es , In "ob'''''' _u,,)P \ \'lone 0090. 'Iou rna, ~allg~c1)p'c:e te ep . calling tne centE\ietgy Path:, Notlhcatlon h I \re.~ \ ....... ~urnber lor t e Sprhikl!'dJ2,2344), n/a " ,....~.......tClr IS I~OUU v I DEVEL?~~,~~~~.~:!:.~~~?~~,~lf~'i'I~N . Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: Pbone Number: 541-747-7505 Expiration Date 05/15/2007 Phone 541-338-7550 Lot Slzc: Sq 1'1 I st Floor: S'I Ft 2nd Floor: Sq 1'1 Basement: Sq Ft Garage/Carport S'I Fl 01 her: Ol..'l"lIpanl Load: '. REQUIRED PARKING Total: Handicapped: Cnmpact: N01~LIC 1~1PR~~:I\:EN:'i~E WORK nlls PERMIT SHI-ILL ;HIS 'PERMIT \s~iValk Type: AUTHORIZEEDDUONRD~SR ABANDONED FO~owllspouts/Drains COMMENC ANY 160 DAY PERIOD. I Valua,!!~!1_,~~,~~il2!io~..1 SPerSq Ft or multiplier Square Footage or Bid Amount Type of Construction 1 of 2 ~ Value Date Calculated . . CITY OF SPRIl"'lld<lELD' Status: Issued ":; 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ., Building/Combination Permit PERMIT NO: COM2006-00176 ISSUED: 02110/2006 APPLIED: 02/10/2006 EXPIRES: 08/10/2006 VALUE: Total Value of Project Fees Paid I Fee Description -Mecbanical Issuance Fee- + 10% Administrative Fee + 8% State Surcharge Minimum/Adjustment Mechanical Pellet Stove/Insert Amount Paid Date Paid Receipt Number $10.00 $4.50 $3.60 $15.00 $30.00 2/10/06 2/10/06 2/10/06 2/10/06 2/10/06 1200600000000000144 1200600000000000144 12UU6UUU00000000144 1200600000000000144 12006U0000000000144 Total Amount $63.10 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. wi II he made the following work day. ~lIirrrl 11"'u'('[ions ~ Pellet Insert: After installation ., By signature, I state and agree, that I have carefully examined the completed application and dn hereby certify tbat all .. information hereon is true and correct, and I further certify tbat any and all work perfnrnll'd shall he done in accordance with tbe Ordinances of the City of Springfield and the Laws of thc State of Oregon pertainiug 10 the work described herein, and that NO OCCVP ANCY wiD 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 wilh ORS 701.005 will be used on this project. I further ngree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit cord is located at the front of tbe propcrty, and the approved set of plaus will remain on the site at al~'mes duri onstruction. " ~f\h 2--/0- 0 r Owner 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.ceb.state.or.us Permit#: COVVl Z- 6-0 0 17 b Address: SbZ ( H. ~ 4 0,4Q t:. s ~A Issued by: D(( I Date: z;Jlrc b 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 appropriate blanks and initial boxes I and 2, and either box 3A or 3B: !L--l. tr'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. a---3A. My general contractor isTf:p 1+11\ .fI. 4gc.. s ~.,rES" ~:)~ 738"0 b (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR D 3B. I will be my own general contractor. 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. 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 Respon ibilities on the reverse side of this form. i '0 I '10.. \ 2.-- to - D-' , '" ~a" of permit applicant) (Date) . (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 '. ' . A~~finng ~~ 1Z @llllrr Ownn <Gennell"~n C@nn~ll"~~l1:@ll"? INFORIIIlATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTI.ON RESPONSIBILITIES i' " . " 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 bybeing aware of the following responsibilities and concerns. JEmpnoyer JRespolllsnlbmtnes 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: e Oregon's Withholding 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/formsDav.htmll for the apprppriate forms. . , i" 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 www.irs.l!ov. ' OtRnell" ResJPiorrnsilbiiiitnes,arrndlAreas OJ[ Concerllls 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 orrtissions 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 coordin~te the work of rough-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. P.v....;J_owneLdoc 06-01-04 225 Fifth Street Springfiel~, Oregon 97477 541-726~3759 Phone 'J . ""~RlNa"F1.'!',I> "." " WiL ~ . , . , .. f lliiii.ty of Springfield Official Receipt .velopment Services Department Public Works Department Job/Journal Number , COM2006-00176 CiOM2006-00 176 COM2006-00 176 COM2006,OO 176 COM2006-00 176 Payments: Type of Payment Cash C~ange " JOb/Journal Number COM2006-00 176 COM2006-00 176 COM2006,OO 176 C:OM2006-00 176 " , CpM2006-00176 :r Payments: Type of Payment Cash Change :1 ~ ., " 1 'C - ': , i , , \" , , , , , , ~f.. 1" ': 2/10/2006 RECEIPT #: 1200600000000000144 Date: 02/10/2006 Description + 8% State Surcharge + 10% Administrative Fee Pellet StovelInsert Minimum/Adjustment Mechanical -Mechanical Issuance F ee- Paid By LEAH OWEN LEAH OWEN Recei ved By djb djb Description + 8% State Surcharge + 10% Administrative Fee Pellet StovelInsert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Paid By LEAH OWEN LEAH OWEN Reeei ved By djb djb \ ,t' , .......,..--- '-/; I of 1 Item Total: LueCK t'lumoer Aulnoflzatton Batcb Number Number How Received In Person In Person Payment Total: LhecK Number Batcb Number Item Total: Autnonzatlon Number How Received In Person In Person Payment Total: I' ( ! 11:04:11AM Amount Due 3.60 4.50 30.00 15.00 10.00 $63.10 Amount Paid $65.00 ($1.90) $63.10 Amou nt Due , i 3.60 , 4.50' i 30.00. 15.00 10.00 $63.10 Amount Paid $65.00 ($1.90) $63.10 . ,