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Home My WebLink AboutPermit Mechanical 2006-05-23Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line FS Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 0512312006 APPLIEDT 0512312006EXPIRES: 1211212006 VALUE: SITE ADDRESS: 1510 MOHAWK BLVD ASSESSOR'S PARCEL NO.: 1703253102300 PROJECT DESCRIPTION: Replace rooftop heatpump Springfield TYPE OF WORK: Heating System TYPE OF USE: Repair Commercial Owner: Address: Contractor Type Electrical Mechanical HARLOW GEORGE R & ARTIE M 2433 MARCOLA RD SPRINGFIELD OR 97477 Contractor License OWNER ANDY'S HEATING AND AIR CONDITIONIN 164497 PhoneNumber: 541-746-4061 Expiration Date Phone 07ny2007 54r-461-1282 CONTRACTOR INFORMATION BUILDING INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo orLot "o"'uf,fbTlcEt REQUIRED PARKING Total: Handicapped: Compact: DER THIS PERMIT IS N C0MMEN0$Be0fftS$flu$NDONED FOR ANY 1 S 0 DdY##ilSDro.ains: RIZED UN Notes: Page 1 of3 d BK lsl Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 0512312006 APPLIEDz 0512312006EXPIRES: 1211212006 VALUE: Description Type of Construction Fee Description + l0o/o Administrative Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add -Mechanical Issuance Fee- + l0'h Administrative Fee + 87, State Surcharge Heat Pump Minimum/Adj ustment Mechanical + l0o/o Administrative Fee + 57o Technology Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid Total Value of Project Date Paid Value Date Calculated Receipt Number 1200600000000000694 1200600000000000694 1200600000000000694 1200600000000000694 1200600000000000844 1200600000000000844 1200600000000000844 r200600000000000844 1200600000000000844 r200600000000001613 1200600000000001 613 1200600000000001613 1200600000000001613 1200600000000001613 $ Per Sq Ft or multiplier Square Footage or Bid Amount Amount Paid $4.60 $3.68 $43.00 $3.00 $10.00 $4.s0 $3.60 $12.00 $33.00 s4.60 $2.30 $3.68 $43.00 $3.00 $173.96 5t23106 st23t06 5t23t06 5t23t06 6n2t06 6n2t06 6n2106 6n2t06 6n2t06 tu6t06 tu6t06 tu6t06 tU6t06 tU6t06 F poc Pnid Plan Reviews SUB Review 06t0u2006 06t06t2006 APP JF 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. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. SUB Final: After alt required energy inspections have been requested and approved. SUB Mechanical: Following Cify Rough Mechanical inspection approval and prior to any cover. Rough Mechanical: Prior to Cover Paee 2 of3 Reauired Insnecfions U Valuation Description I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 0512312006APPLIED: 0512312006EXPIRES: 1211212006 VALUE: Final Mechanical: When all mechanical 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 durin g construction. Owner or Contractors Signature Date Page 3 of3 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Cif" T f Springfield Official Receipt Dr ^opment Services DePartment Public Works Department RECEIPT #: 1200600000000001613 Date: 1110612006 1l:27:40AM Job/Journal Number coM2006-00614 coM2006-00614 coM2006-00614 coM2006-00614 coM2006-006r4 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5olo Technology Fee + 8%o State Surcharge + llYo Administrative Fee Amount Due 43.00 3.00 2.30 3.68 4.60 Item Total:$s6.s8 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check HERITAGE ELECTRIC djb l 898 In Person Payment Total: $56.5 8 -$s6-s-B. cReceint I Page I of I 1U6/2006 tFn**a*Fltr.s Cify Job Number C,orY176 APPLICATIONo6 - oo 6rt{ : (541)726-3689 Date /(-( lnuc-' -,s-Bkl,"'S sP'' , ,ji:,., W, -o6 - 225 FIF'TH STREET o SPRINGFIELD, OR97477 o PH;(541)726-3753 o FAX ELECT:RICAL PERMIT I LEGAL DESCRIPTIONI7o3ZS7l oe36q>Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof JOB DESCRIPTION Permits are non-transferable and expire if work is Each Manufact'd Home or not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder Amps or less 20 lslo vr^or{Awg -e[vl 3 A. $106.00 $ 19.00 $s0.00 Address lb 7 L t*$ 63.00 $ 75.00 $ 12s.00 DLr rlOfle 7Zr -/so,Over 1 Reconnect Only less ttro$HA,bf huNB,FR 8% State Surcharge l0% Administrative Fee TOTAL $ 163.00 $37s.00 $ 50.00 Alteration or Relocation EXPIRE I-FTHEW $ CI Bfpo TH I S PEF-NiJTIE IJOJD.oo $ 43.00 $ 3.00 )32-2 Cify / Supervisor License Number Expiration Date C /o/ r/c i{ffiIH$J} T'UFff#MI flbIilq8M6 50.00 Constr. Contr. Number 67(37 /r/oPExpiration Date Owners Name Address Si gnature of Supervi sing Electrician Over 600 Amps or 1000 Volts see "B" above. D. 'l$#$0ilt{y.f,iliiCIn New Alteration or Extension Per Panel One Crrcuit t Each Additional Circuit or with Service or Feeder Permit / q7 rc s6t2 Vbo &/- /t, 7Gro City SPF\ Phone Z'{ L - ,1 E. Pump or irrigation $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 270 Inspection Request: 726-37 69 4. Shared Drive(T:)/Building Forms/Electrical Pemit Application I -06.doc )CONTRACTOI{ INSTALI.A:TI ON ONLY or Relocatiou; ScrviCes or fi'eeders Electrical Contractor ??; - s Miscellaneous not *-3ffi- City of Springfield 225 Fifth Street, Springfield, OR97477 541-726-3759 Phone 541-726-3676 Fax November 22,2006 HARLOW GEORGE R & ARTIE M 2433 MARCOLA RD SPRINGFIELD OR 97477 Job Number: Location: coM2006-00614 1510 MOHAWK BLVD Project:Replace rooftop heatpump Dear Permit Holder: The Springfield Buitding Safety Code Administrative Code provides that in order for a permit to remain valid, the work which has been authorized by the permit must begin within 180 days of the date of issuance, and an inspection must be requested at least every 180 days. According to our records, you obtained a permit for a project at 1510 MOHAWK BLVD which is set to expire ot 1211212006. Our records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notify you that your permit(s) will be expiring shortly' If you are ready to request an inspection for your project, please phone the inspection line at 541-726-3769- If you do not request an inspection prior to the expiration date, your permit(s) will expire and additional permit fees will be required in order to complete your project. If you have any questions, please feel free to phone me at 541-726-3790. Sincerely, Lisa Hopper Building Safety Management Analyst Us) Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 54L-726-37 69 Inspection Line FIELD Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 0512312006 APPLIEDz 0512312006 EXPIRESz 1211212006 VALUE: SITE ADDRESS: 1510 MOHAWK BLVD ASSESSOR'S PARCEL NO.: 1703253102300 PROJECT DESCRIPTION: Replace rooftop heatpump Springfield TYPE OF WORK: Heating System TYPE OF USE: Repair Commercial Owner: Address: Contractor Type Electrical Mechanical HARLOW GEORGE R & ARTIE M 2433 MARCOLA RD SPRINGFIELD OR 97477 Contractor License OWNER ANDY'S HEATING AND AIR CONDITIONIN I64497 Expiration Date Phone 07nu2007 s4t-461-t282 CONTRACTOR INFORM # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: 14). i.o\O[ REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains:, - 0 i\ PUBLIC IMPROVEMENTS Notes: Page I of3 ES.l I'UILI-,I1\U II\T I-'IAIYTA T It-,I\ I {\Ul I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 0512312006APPLIED: 0512312006 EXPIRESz 12/1212006 VALUE: Description Type of Construction Fee Description + l0oh Administrative Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add -Mechanical Issuance Fee- + l0oh Administrative Fee + 87o State Surcharge Heat Pump Minimum/Adjustment Mechanical Total Amount Paid Total Value of Project Date Paid 5t23t06 st23t06 5t23t06 5t23t06 6n2t06 6n2t06 6n2t06 6n2t06 6n2t06 Value Date Calculated Receipt Number 1200600000000000694 1200600000000000694 r200600000000000694 1200600000000000694 1200600000000000844 r200600000000000844 1200600000000000844 r200600000000000844 1200600000000000844 $ Per Sq Ft or multiplier Square Footage or Bid Amount Amount Paid $4.60 $3.68 $43.00 $3.00 $10.00 $4.s0 $3.60 $12.00 $33.00 $117.38 Fees Paid Plan Reviews SUB Review 06t0u2006 06t06/2006 APP JF To Request an inspection call the24 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. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. SUB Final: After all required energy inspections have been requested and approved. SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Reorrired Insnections Page 2 of3 Valuation Descrintion Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 0512312006 APPLIEDz 0512312006 EXPIRESz 1211212006 VALUE: 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 Safefy. 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 ofthe property, and the approved set of plans will remain on the site at all times during Jq rue ,oC or Signature Date Page 3 of3 E "I 225 F'ifth Street Springfield, Oregon 97 477 541-726-3759 Phone Ci'' of Springfield Official Receipt t clopment Services Department Public Works Department RECEIPT #: 1200600000000000844 Date: 0611212006 e:33:4EAM Job/Journal Number coM2006-00614 coM2006-00614 coM2006-00614 coM2006-00614 coM2006-00614 Description + 8% State Surcharge + lloh Administrative Fee Heat Pump M in imum/Adj ustment Mechan ical -Mechanical Issuance Fee- Amount Due 3.60 4.50 12.00 3 3.00 10.00 Item Total:$63.10 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check ANDYS HEATING AND AC INC djb I 185 In Person Payment Total: $63. I 0 $63.r0 cReceint I Page I of I 6n212006 aFmt.l.E SPF'- -F'ELD ZON INITIALS DATE SOU o h,225 FIFTH STREET . SPRINGFIELD,OR97477 . PHz(541)726-3753 r FAX: (541)726-3689 ELECTRICAL PEKMIT APPLICA Ciry Job Number -oo 1. LACATION OF INSTALIA 3.CALTPLETE FEE l{to /4-h^. k LEGAL DESCRIPTION 1703 zr3 /OZioc> JOB DESCRIPTION c-( r- Date S A. Nerv Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder 200 Amps or less, 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only TOTAL Dl,t Residential - Single or lVlulti-Family per dwelling unit. ,.-,. s r 06.00 $ 19.00 $s0.00 City Permits are non-transferable and expire if work not started within 180 days of issuance or if work is Suspended for 180 days. 2. g0NTRACTOR INST:ALryTTON Olrl,l' Electrical Contractor Address Phone Supervisor License Number Expiration Date D Constr. Contr. Number Expiration Date Signature of Supervising Electrician B. Sen'ices or Feeders - Installation. Alteratiotts or Relocttion: $ 63.00 $ 75.00 $ 125.00 $ 163.00 $375.00 $ s0.00 owners *u^" f?oL-.l- /ut.ilo,L Installation, Alteration or Relocation 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 401 Amps to 600 Amps $100.00 Over 600 Arnps or 1000 V "B" above. D. New Per Panel Nt0 / s+r.oo qS Circuit or with $ 3.00 3 SFeeder Permit E. N{iscellalegus,(Service/feeder not included) -Eachlnitallation L\., CO\ Address )qort /lrlaia City S,rtt / " OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. pnon"a3A 3!Q L Pump or irrigation SigniOutline Lighting Limited Energy/Residential $ s0.00 $ s0.00 $ 25.00 b (60 sv,g Aao? hNY Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Ovynqps Signature:&ru^ 4. STJBTOTAL OF ABOW 8% State Surcharge l0% Administrative Fee Inspection Request: 726-37 69 Shaled Ddve(T:)/Building Fonns/Electrical Pennit Application l -06.doc BELOW 1a'J re ce .1Xi-o;rf"j"\; ". 1s0 T5& Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 0512312006 APPLIEDT 0512312006EXPIRES: 1112312006 VALUE: SITE ADDRESS: 1510 MOHAWK BLVD ASSESSOR'S PARCEL NO.: r703253102300 PROJECTDESCRIPTION: Replace rooftop heatpump Springfield TYPE OF WORK: Heating System TYPE OF USE: Repair Commercial Owner: Address: Contractor Type Electrical HARLOW GEORGE R & ARTIE M 2433 MARCOLA RD SPRINGFIELD OR 97477 Contractor OWNER License Expiration Date Phone BUILDIN( # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: F \T-I nla HEv,l9 r]K NDO NtD r0R REQUIRED PARKING Total: Handicapped: Compact: 0101tt H\S P tRt'l\\.I \b P AU H0 r U M\l\EN R\ODPE $ Per Sq Ft or multiplier Sidewalk Type: Downspouts/Drains: Square Footage or Bid Amount DEVELOPMENT INF( Description Type of Construction Page I of2 Value Date Calculated a nunlrJ ll \ Valuation PeseuBtton l Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00614ISSUED: 05123/2006APPLIED: 05/2312006 EXPIRESz 1112312006 VALUE: Fee Description + l0'h Administrative Fee + 8%o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid Amount Paid Total Value of Project Date Paid 5t23t06 5t23106 5t23t06 5t23t06 Receipt Number l 200600000000000694 I 200600000000000694 1200600000000000694 1200600000000000694 $4.60 $3.68 $43.00 $3.00 $54.28 Fees Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. wilt be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Rough Electric: Prior to Cover Final Electric: When all electrical 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 Safefy. 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 du ring construction. n,{ Owner or Contractors Signature Pase 2 ol 2 Date z? ru, Kequrreo tnsDecuons I Construction Contractors Board 700 Summer St ltlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us (Signature of permit applicant) permit #: COtMZc ."- oo6t4 Address: I Sl O tt4o hz+,-L Issued by:N(Date:Z3 0 Statement: lnformation Notice to property owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not Itcensed with the Construction Contractors Board to sign thefollowing statem-eit before a building permit can be issued. This statement is requiredfor restdential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement wilt befited with the permit. Fill in the appropriate blanks and initial boxes I and 2, md,either box 3A or 38: p' t. I own, reside in, or will reside in the completed structure. & 2. I understand that I must become licensed as a construction conhactor if the structure is sold or offered for sale before or on completion. tr 3A. My general contractor is O{*r")(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Conhactors Board. OR tr 38. I will be my own general conhactor. If I 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 fnformation Notice to Property Owners about Construction Responsibilities on the reverse side of this form. s/z: /o @ate) (White copy to issuing agency perunitfile, pink copy to applicant.) Property_owner.doc 06-0 1 -04 f-u fr4 Actimg es ktmr ffiwxl GexNerat Cb-ntractor? INFORMAYION NOTICH ?O PNSPHKTY SWNHR$ &S&UT *ON$TRUSTISN frH$POI{SISILITIES l{orrj. This lnforrnati*n Natica{a prCIperfy 0ryn*rs abaut oonsfructron Responsrbilffres was developed bythe Consfruc#on Confracfors *aard ln accordance r.vr'f,l O&S r0r"055{5}, passed &y tfte ?989 Oregon L*gisfature' ;f y*a *r* ;l*t.ing &s y*Br *xm cq:aka*t*r t* *onsln:st e ::sw h**:e eir make a substantial lmprovement to an existixtg st's*ture* yq}}"l *;an prer-en{ many protrtr*r:s by being arvarc nf thr fcllowing rcsponsibiiitie* a*d {&n*c{:l$" $)xNxplwyer Kespwxasibilitics you wi1l, in most i*sta***s, b* ru}ed to be an u'&ffiplsystr" *nd th* so$k"act*rs yctl: c*ntra*t witli wilt be '*&mplsyees"" if yor] r]$s oontraolsrs n*t li*ensed with the Cq:nstrui*.orr C*nkactors B*ard t* d* lab*r im c*nstruslting *r t* assist in the eCI*xtrueti*x tlr irrprov*ment *f a r*sidential $tru*ture" As tke ex**plcy*r, y*u xrxst *ornply with t&s f*l}ewimg: ()reg*r*rs Witkk*lq*img Kax Lxw: .&s an *mpI*:yer, y*u rnxst x"iihhotd i*coma t*xes f'rein"r empt*yer: wasc* *t thc tivne u*pl*yu** xre paid. {q:x ,,vitrI b* }iable {i:r tire t{}x payx::efits evan if y*u d**.'t x*tuatrtry urit}rhold the tax fr*m y*r:r orxptrcy**s" For *:*r* ir:&nnation. ea1} tl:* $epxrtrn*r:t Lf R*o*rro* at 5*3-3?8-49S8" [In*r*lpioyxrext Kxslerame* Yax: As af} *rqp]*yer, ysu *re required to pay a tax fi*r rinemploym*nt insurance purposes- o* tlie wages <lf all *mpl*ye*s" F*r n':ore infclrynati*fi, *all the sr*g*n Hmpl*3m*nt **p*rtmext at 5*3-s47-1488" Th* Sreg*n E*si:ress Xd*ntifi*ati*r: Nurnber {$nN} is a **mbined mrmber far both Oregon Withh*}ding ar:d Unernpir:3r*e*t nnsura&r* Tax. T* *r1* far a Hxld, catrl 5{i3-945-E{i91 *r y:vlt:.rlqr.+ilt . .!:{m11 fur the *rppr*priat* f*nns. W*rker*, Compens*tipu Xnsurn*ee: As ar: empS*yer, y*r; are subjer;t t* th* &"eg*n"W'*rkers' C*nrper:s*lii:n Law, and mxst obtain rvsrkers' e*mpensati*r insuranc* f*r y*ur employees" If y*lr fail to *bt&il? wsrkers' compe*xati*n ins*rance, you could b* subjeci t* pe*alti*s *xd b* triable frr atrI ctraim ecsts if one *f your employe*s is injured o* the j*b. F6r m*re !n{i:rrm.ati*n. cali the $fcrkers' Cornpensatior: Dirrision at the $*partr:re*t of, Ccasumer and &r:siness Serviees at 5*3-?4?-78 tr5" U"$. Xmt*rma} Revemu* S*rvice; As *n *rnploycr, y*u mr}st rvithhcld fle*ieral inc*me tax {rom emplayees' wages. you will be liabls {*r th* nex pa}ryxe&t *vey: if y*:x didn't **tira}ly :ryiti:tr*id lhe ixx. F*r a Federal E{N Nurxber, cxll the lRS a? i-&00-829-4933 *r visit their web site *t xrygdlr,gqv' $ther Kespoxtsibilit*es emd Areas cf Cmxrcera$ C6d* C*rm;llixme*; As ihe pcrmit k*trder {i:r ttlis pr*j**:t, }"*r: ar* respcnsihl* fur res*lr"ing a:ry lailure t* meet **ei* requir*rnr:nts t!:at rnay be }:r*xght to y*w attentio* thr**gi:l insp**ti*:l*' Lixhitri*y xxd Fr*p*rty Ilxmag* trns*r*xce: C*ntact y*r:r in*rra*oe asent t* se* if y** have adequatc {r:s*ran*e *oruoug* {*r acci<jents an*} *::rissi*ns sxe}: *s falling t**ls, paixt {-:}vcr sX}ray} l*iiter damag* fr*rn pipe 3:*x*rures, fir* *r wnvk tf:al rz:ust be r*d*ne. n ?inee: fof*ke sxr* y*x hav* suffi*ie*t ti.*":* t* s*p*:vis* ymmr emy:ir"ryees. Hxp*r{ise; &{ake sure y*u kave th* skj}ls tt:l aet as y{:}ur *wn general contract*r. t* c**rdinat* the v,,ork *f rough-in ar:d frnish ka<Ies- avrd t*::*tity bxildi::g *ffieinls xs the *ppr*priate tiru:es s* they *an perf*rrn th* r*quir*d l*spe*ti*ns. trf you have additi*n*l questi*x* eaI} th* Cons*:rc.ti*rl C*ntract*r.s B**rd {5e3-3?$-452tr} *r *yitc t}':e agen*y at F* tsox 1414S, Salem" {}R 973*P-5*S2. Property-owner.tioc 06-0 I -04 Cit- of Springfield Official Receipt L ,lopment Services Department Public Works Department 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone RECEIPT #: 1200600000000000694 Date: 0512312006 e:42:08AM Job/Journal Number coM2006-006r4 coM2006-006r4 coM2006-00614 coM2006-006r4 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 8% State Surcharge + l}Yo Administrative Fee Amount Due 43.00 3.00 3.68 4.60 Item Total:$54.28 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Check HARLOW REALTY INC djb r 073 In Person S54.28 PaymentTotal: ffi cReceintl Page I of I st2312006