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Home My WebLink AboutPermit Mechanical 2004-10-27 ~a:;;'" I ~"""""" Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax , 541-726-3769 Inspection Lin,e CITY OF SrKlr\it.1<1ELD' Building/Combination Permit PERMIT NO: COM2004-01333 ISSUED: 10/27/2004 APPLIED: 10/27/2004 EXPIRES: 04/27/2005 VALUE: SITE ADDRESS: 2051 HARBOR DR, ASSESSOR'S PARCEL NO.: 18~3112202500 " ' I es'louto PROJECT DESCRIPTION: F~e,estanding pcl!liN~ I Utili\'l " ; ".., olegon Olegon , d r""lN: . ~'J thA ". ....rth Owner: LORIS ~~~~e.doP""1hoselu\esal"952'OO~' Address: 2051 HARB~\I~~~I9~~~e lules b'l \1l v"r.'~""~~~ ou"';" ~~~\~~:e \,,\,,~,,~:~'1 0090. 'lOU\l\8center.[ tv~."'~R'tNFORMATION , ea\\inQ tOf Ute 01':'.. - -3a2..2.~MI, ~ernter is \-800 License OWNER Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential Phone Number: 541- Contractor Type Mechanical Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy' G~oup: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: .~" . VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Sizc: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R,3, n/a Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION' 'ij,?-'t- ' \\\'i-. 'tl 'ijiffiQUlRED PARKING Overlay Dist: i.'i'\'?-'i-. \\\11\\ f~ ~ Total: # Stree~l~s Rq~\\\>.\.\. \\\\S 'i't: ~'i-.\) <;;'ij'?- Handicapped: P:\\~l;i!~!:lj\: U'(\.<:;;'i-.'?- ~\>.'(\.\)\J Compact: % *l!tl..~~~~. ~ \S ~ t>.\S'i\\?, (. '(\.\, t.~ ,~'i:.,?-\CJ\). I PUBLIC IMPi6"..lfl\d6~'ts, ,.' Sidewalk Type: Street Improvements: Storm Sewer Available: Special Instruction: DownspoutslDrains: Notes: I Valuation Descriotion I Description Type of Construction , $ Per Sq Ft or multiplier Square Footage or Bid Amount Value, Date Calculated Total Value of Project Paee I of 2 \,," {',r "~.. !i. i' " ~_\ , ii '" CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01333 ISSUED: 10/27f2004 APPLIED: 10/27/2004 EXPIRES: 04/27/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I F~~~ Paid I , Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Minimum/Adjustment Mechanical Pellct Stove/Insert" Amount Paid Date Paid $10.00 $4.50 $3.15 $15.00 $30.00 1 0127/04 1 0127/04 10/27/04 10/27/04 10/27/04 Receipt Number 2200400000000001339 2200400000000001339 2200400000000001339 2200400000000001339 2200400000000001339 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, R~ouired Insnections I Freestanding 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 hercon 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 Orcgon pertaining to the work described herein, and that NO OCCUPANCY will he 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 he 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 of the property, and the approved set of plans will remain on the site at all timej)ing construc .~ _ A'J . I ~ 0' /O-dZ'T C/ '1 Owner or Contractors Signature Date Page 2 of2 225 FiftJl Street ,:,.,~. Springfield, Oregon 97477 541-726-3759 Phone a?~,,,,,!,,,!,,,-,,,,!!_,_,, .. '~.. ~!. ~". } r:ity of Springfield Official Receipt Jevelopment Services Department Public Works Department Job/Journal Number COM2004.01333 COM2004-0 1333 COM2004-0 1333 COM2004-01333 COM2004.01333 Payments: Type of Payment CreditCard 10/2712004 RECEIPT #: 2200400000000001339 Date: 10/27/2004 Description + 7% State Surcharge + 10% Administra'ive Fee Pellet Stove/Insert Minimum/Adjustment Mechanical ....Mechanical Issuance Fce.... Paid By LORIS RAY Item Total: Check Number Authorization Received By Batch Number Number How Received djb 050387 In Person Payment Total: Page 1 of I 2:36:58PM Amount Due 3,15 4.50 30,00 15,00 10,00 $62.65 Amount Paid $62,65 $62.65 r ", .. . ' , , . ' "'. ..' '. .' , ' 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 Permit#: COllYlzoO<.{-OI:>'3>-s. Address:. zL!.5 \ )~a..'l,"V'L. ~(l, ~<L Issued by: Dilte: 10 - 2- 7 -0 c( .' " Statement: Information Notice to Property Owners . , About ~_on~tr'uction Responsibilities .. Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who .are not 'licensed with the Construction ContrdCiors 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 appropriate blanks and initial boxes I and 2, and either b'ox 3A or 3B: ~ I. I own, reside in, or will reside in the completed structure. ~ 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 #) .' t . 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! 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 Itiformation Notice to, Property Owners about Construction Responsibilities ,on the reverse side ofthisform, c4L~ . .. . Ir~--6'~ l (SignJure of permit applicant) (Date) . (White copy to issuing agency permit file, pink copy to applicant) Property_owner.doc 06-01-04 -, ,- ' ~ ,,";,.-"'- ( . " ,-',... " ..:\.cting'as'Y1:Jur-'Own"Generai COJIlltractor?, . _.,J,11 J .' -'\IN~O~MA+16~?NoTICE TO,PROPERTY b\ivNERS.:~:' ':' ' AoourCONSTRUCTION,RESPONSIBILlTIES ...,'". ' -'~ ",_~ .:J'-:' --- - -.......- -- --.... " " \,;. '-.J- ,- 5.' "'-J\ ~ ,", \ ~.' ~. \.- ,I! ".'i , ~_, . ~ .. '.'f ' _ NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. : ' ". . .\' ~ . . :'t'" ,,01 ,; ~. - , - "', . , If you are acting as your own' conir~ctor to construct a neW-home ~~ make a substantial unprovement to an existing .. ~ ' , 14"", ',.. . structure, you can prevent.rnany problems by being aware'ofthe,following responsibl1lties ilpd'concems. -, J 'Employer Responsibilities " ~,~ . . " .'..-' \ .' >,~' ;..- ,'.... " . ".: .:. ' \ ',. " -'. ,., ,- . \' , . . ';, . "', ' ,. You will, in,most inshm'c.~s,be l'l!1s.dJ~.be,an "employer" alld,thdcontractors y()'tcoIJ.!ract vo.;ith"will be "employees" if you use'contractors not lice,!sed with tJle Construciion Contractors Board .todp lai,?or,;in constructing or to assist in the . . ,-" ~ ,~. . .' ~ ' " , construction pr irnprove~;nt of a re~~dentj!ll structui-e" Ast/1e.~mployer, YOII must f~mply wi~~ tbe foUowinf: , ,', ....~ " ','.' ~.'. ~ . 'l",~ \ ,':.....,' \. __ ,~., - '.... I Oregon's Witbboiding'Tax La\\;: As an employer, you must Withh61d 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 witphold the tax from your employees, For more information, call the Department of Revenue at 503-378'-'1988: ,; ....', j.-. " ,t. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment i!l.surance purposes' on the wages of all' employees, For more information, call the Oregon Employment Department 'at 503-947-1488. .,.' r" ' ,~'r" " ,', ' '.... I , " ,', ' , ," . ',", 1., ...'. -"'L' ., ' - .' ,#.~,.' ~ _' ," _ ,. _. 4 " , " ... _;, The Oregon Business Identification Number (BIN) is a combinc:d number for Roth Oregon' yti1hholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmll for the appropriate fonns, " , ' ' ' " . ~; ~ -, , ." ., .' . Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must ob\l1in w()rkers' comp~sation insurance for your employees. If you fail to obtain workers' compensation insurance, you co{ild be' sUbject toiierialti~s and'be li~ble for all claim costs if one ofYour employees 'is' injured on the job. For more'infonnation, call the Workers' CompensatioA,DIVision at.the'Oepilrlment'o[ Consumer-and Business Services at 503-947-7815. ' , U,S, Internal Revenue Service: As an employer, you must withhold federal income4aJi: froni employees' wages~ You will be liable for the tax payment even if you didn't actually withhold t4etax. For a Federal EIN number, call the IRS:at'P800c829-4933 orvisif their web site at www.irs,Qov!">,',. ~ ,", '. . , "._, ,. ,~~ . f ~ I ;. ~ . ~'., . ..." . " .. '".other Respc)Dsi'bUiiies and;Areas of Concerns, " , , Code Compliance: As the pennit holder for this project, you are responsible for resoiVing any' faiiure' t'o meet code requirements, that niay be brought to your attention through inspections, ' ~,' # -j..# . '''J~ t's;, ~ .... '.' l~' '.' _ . ._~ -~ . I I;' ., .', ,;" -' r" 1 ' . . . .", -. ',: ",. . Liability and Property -Damage Insurance: 'COIitact your insurance agent to see Jf you ha,:c;, adequate' msurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe pun.,::lures, fi~e or work that'l!lu~t p~ red,one,,.. , ' , " ,"::-.:;, ~ ',' .", " -), -,--" ":~ ' \.""1",,,,, ,....s :--x Time: Make sure you h~ve ;uffi~ie;iimeto supervise your <:mployees, '( , \ >;" -f' - - , . .. ~ - ~ \'~~ ~1' ," 'r-.' ,-,."'. , ", " . ~ ,~, Expertise: Make sure you liave':!He' ski.lls'to aci'as your o\vn"general contractor; to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perfonn 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