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Home My WebLink AboutPermit Mechanical 2003-09-22F Buildin g/Co mbin atio n Permit PERMIT NO: COM2003-00945Status: Issued 225 Fifth Street, Springfield, OR 541-7263753 Phone 541-726-3676Fax 541-7 2637 69 I nspection Line SITE ADDRESS: 4334 SMITH WAY ASSESSOR'S PARCEL NO.: 1702322400900 PROJECT DESCRIPTION: Install pellet stove Owner: JAMES JASON L &ELTZp^BETH A Address: 4334 S]\{ITH WAY SPRINGFIELD OR 97478 Phone Number: 541-7 46-8614 License Expiration Date Phone ISSUED: APPLIED: E)GIRES: VALUE: Springfield TYPE OF TYPE OF USE: 09t22t2003 09t22t2003 03t22t2004 Pellet Stove New Residential Contractor Tvpe Mechanical Contractor OWNER CONTRACTOR INFORMATION FORMATION # of Buildings: # of Stories: Primary Occupancy Group: R-3 Height of Secondary Occupancy Type of Heat: Primary Construction Type Vlhr Water Type: Secondary constructiogN I r u r,r. w r e g o i i i aw, "q rEs5n ftB^"'# of Bedrooms: '-\ I tollow rulcs adopteo Oy tne Ord{Ufiffittlft$: Those rules are set forth in OAR 952-001-0010 Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: Frontvard s"tur" I*ca I I il;;'il;"*-n-um $ Per Sq Ft or multipfier Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains REQUIRED PARIilNG Total: Handicapped: Compact:Side 2 Setback: Rearyard Setback: Solar Setbacks: Street I HIS PERMIT SHA Vo ofLot Coverage: storm SewerAvaitabte: .rH0RlzED UNDER THIS PERMIT lS NoT Special Instruction: r'iJl''ll/ENCED 0R lS ABAND0NED F0R \NY l BO DAY PERIOD. Notes: Total Value of Project lof2 Description Tvpe of Construction Value Date Calculated ILT ! SETBAdre$. You maY obtain Drive Rqd: Valuation Descriotion 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: COM2003-00945ISSUED: 0912212003 APPLIED z 0912212003 EXPIRESz 0312212004 VALUE: Fee Description -Mechanical Issuance Fee- + l0o Administrative Fee + 7%o State Surcharge Minimum/Adjustment Mechanical Pellet StoveAnsert Total Amount Paid Amount Paid $10.00 $4.50 $3.1s $1s.00 $30.00 $62.6s Date Paid 9t22t03 9t22t03 9122t03 9122t03 9t22t03 Receipt Number 1200200000000002184 1200200000000002184 1200200000000002184 1200200000000002184 1200200000000002184 Plan Reviews 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. 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 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 atl 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. or Signature Date Pase2 of2 Iees raro I l(equrreo rnsDecttons Construction Contractors Board permit *:(Atu&:<>. AO?LI i 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Address: '133'/ !a r*L LJ'> Date:7-zz--63 X Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential 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 will befiled with the permit. Fill in the appropriate blanks and initial boxes I ard2, and either box 3A or 38 S t. 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. 3A. My general contractor is (Name)(ccB #) I will instruct my general conffactor that all subcontractors who work on the structure must be licensed with the Construction Conffactors Board. OR 38. I will be my own general contractor. 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 notiff 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 Responsibilities on the reverse side of this form. q/aa/o\v-(Signature of permit applicant) (Date) (lYhite copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 Issued Uv, )-( Actimg e$ Your Own General Contractor? INFSffiT|4,ETION TCSTICffi TO P&SPTffiTY OWNER$ ,qm*u? fr 0ftI$TRUcTlCIN Rr$pCIN$lffi ll-!TIfr$ *f#Iff: I&ls Jr:f*rma/ion N*fice t* Fr*p*ify Ow**rs a&*uf C**sir**fir:* &*sp**st*illfr*s was dru*J*ped *y *i;* ***sfrsetion C*nfr**fors Soard in aecerrdar:ce lrydf; StrS 7S?.SS5{5J, passed t:y the f $8$ Sregon logisf*fure" If you ar* nr:ting as y$t;r *wn contract*r t{} conshrct a nerv hcme cr make a substantial irnproverneltt to an *xisting stru*ture. y{}Lr can pr:*v*l:t m:rny pr*}:l*rns by h*ing arvar* *f the f*i}*rvi*g re s3:*nsihii'ities *nd **ncer:ts. ffi mpl*yor Re$ponsibilities Yau wilI, in m*st instances, be ruied tc be an *'effipisyer" and the contract*rs you cr:ntra*t with wili be "emplcyees" lf yorl ttse ceintractors n*t licensed with the Construclio* Crmtractors B*ard to dt> labcr in constructing or to assist l* the c*nstruetion or irnprovement *f a residential stzucture. As the ernployer, you m$st eomply with the following: Oregon's r#ithholding Tax tary: As an ernployer, you rnust withhold income taxes from employee wages at the tirne employees are paid. You will be liable f*r the tax payment$ even if you don't actually withhdd the tax fram your employees" For a State Business II) number, call the Business Information Clenter et 503-986-2200. Unemployme*t Insur*nce Tax: As an employer, you are required tc pay a tax for unernployntent insurance purpsses on the wages *f all ernployees. For more infr:rmation, call the Oregon Employrnent Department at 503-947-1488. Workers' Compens*tion fn*urance: As an employer, you ara subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for yow empioyees. If you faii to obtain tvorkers' compensation insutrance, you could be subject ta penalties and be liable for.all claim cosls if one of your employees is injured on the job. For more inforrnation, call the Workers' Cornpensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S" Internal Revenu* $ervice: As ar ernployer, you must withhold federal income tax from employees' wages. You will be liable firr the tax payment even if yor.r didn't actualiy withhold lhe tax. For a Federal EIN number, call the IRS at 866-816-2S65 or fax them at 801-62S-7115. #ther Kespcnsibiliti*s rnd A"ree$ sf Csnc*r*s Cod* Cr*tpliance: As the penxit hq:ider fur this project" ysu are respansibl* far r*salving any failure to meet **de req*irernents that may be brnught ta your att*ntion thr*ugh inspe*ti*ns. Liability xnd Fraperty $xrn*ge l*suranee: C*nta*t y*ur i*sur*m*e *gext {i} see if yau have *dequat{: insurancf sfiverago for accidents and omissians such as falling t*ols, pai*t over spray, water qlamage from pipe punctLres, fire or wcrk that must be redone. Tirnel Make sure y*u hnl* sufJicient time to supcrvis* your emplcyees" Exper{isc: S{ake sur* y*u have th* skjlls tn act es your orlyr general c*ntract*r, to c*ordin*te the vrork ofr*ugh-in ard finish trades. and t* n$ti& iruilding o{ficials as t}re appr*priate times sc they can perfarm the required inspections. If you have additional questions call the Ccnstn:cti*n Confractors Board (503-3?8-4621) or write the agency at P0 Box 14140, Salem, OR 973CI9-5052" Properfy*avrner.doc 03i I 1i03 225Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt I)evelopment Services Department Public Works Department #: 1200200000000002184 coM2003-00945 coM2003-0094s coM2003-00945 coM2003-00945 coM2003-00945 + 7Yo State Surcharge + l0o/o Administrative Fee Pellet Stove/Insert Minimum/Adj ustrnent Mechanical -Mechanical Issuance Fee- Item Total:$62"6-5- 3.15 4.50 30.00 15.00 10.00 Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid CreditCard JASON JAMES djb 000175 76t424 In Person Payment Total: $62.6s Ii6Z.65