HomeMy WebLinkAboutPermit Mechanical 2005-11-03F
Building/C ombination Permit
PERMIT NO: COM2005-01562Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-7 26-37 69 Inspection Line
ISSUED:
APPLIED:
EXPIRES:
VALUE:
ty03t200s
11/03/200s
05/03/2006 ffi
SITE ADDRESS: 2146 9TH ST
ASSESSOR'S PARCEL NO.: 1703261201012
PROJECT DESCRIPTION: Install pellet insert
Springfield TYPE OF WORJ* Pellet Stove
TYPE OF USE: New Residential
PhoneNumber: 541-736-8132Owner:
Address:
Contractor Type
Mechanical
GREGORY MCCAULEY
2146 9TH ST
SPRINGFIELD OR 97477
Contractor
THERMAL RESOURCES INC.
License
16t946
Expiration Date
10t29t2006
Phone
54r-343-1131
s You to
# of Units:
Primary Occupancy GrouP:
Secondary OccupancY GrouP:
Primary Construction TYPe
Secondary Construction TYPe:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street ImProvements:
Storm Sewer Available:
Special Instruction:
Notes:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
o/o of Lot Coverage:
fot low rtd{loltiptecl by the O Lot Size:
R-3 Notificatfin$rt of Structure Sq Ft lst Floor:
n oAR gr-Weo1 Heat:Sq Ft 2nd Floor:
vN oo9o.
Sq Ft Basement:
Sq Ft Garage/CarPort
Sq Ft Other:
num nla OccuPant Load:
RBQUIRED PARKING
Total:
Handicapped:
Compact:
Sidewalk TYPe:
Square Footage
or Bid AmountDescription Tvpe of Construction ,lff[,?#tilt
Page 1 of2
Value Date Calculated
r T
LT']\IITALTUK
Utilitv
Status fssued
?71 \ifth Street, Sprin gfi etd, oR
541-726-3753 phone
541-726-3676Fax
541-7 2G37 G9 Inspection Line
B uilding/Com bination permit
PERMIT NO
ISSUED:
APPLIED:
EXPIRES:
VALUE:
: COM200S-01562
71/03/200s
11/03/2005
0s/03/2006
Fee Description
-Mechanical Issuance Fee-
+ l0oh Administrative Fee
+ 77o State Surcharge- Minimum/Adjustment Mechanical
Pellet Stove/Insert
Total Amount Paid
Amount Paid
$10.00
$4.s0
$3.1s
$1s.00
$30.00
$62.6s
Total Value of Project
Date Paid
tu3t05
tU3t05
11/3/05
11/3/05
tu3t05
Receipt Number
2200500000000001535
2200500000000001s3s
2200500000000001s35
2200500000000001s35
2200500000000001535
Plan Reviews
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.
Pellet Insert: After installation
Reou
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.
trld=lo
Owner or Signature
Pase2 of2
Date
5
225Fifth Street
Springfield, Oregon 97 477
541-726-3759 phone
-City of Springlield Official Receipt _,velopment Services Departmentpublic Works Department
RECEIPT #:2200s00000000001535 Date: 11103t2005 1t:05:05AMJob/Journal Number
coM2005-01562
coM2005-01562
coM2005-01562
coM2005-01562
coM200s-01s62
Description
+ 1Yo State Surcharge
+ l0% Administrative Fee
Pellet Stove/Insert
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
Amount Due
3. l5
4.50
30.00
15.00
10.00Item Total:$62T5
Type ofPayment Paid By
\
CreditCard NANCY
Received By Batch Number Number
djb I 10583
How Recelved Amount paid
In Person
Payment Total:
$62.65
$62.6s
1U312005 Page I of I
*ff$!l&srg."o
Construction Contractors Board
700 Summer St NE Suite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-3784621
Web Address: www.ccb.state.or.us
Permit #:
Address: zi ,16 7f ^ s I
Issued by:b,6
z.ov i- o/ s6 Z
Date:ll-s sr
tr
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibil ities
Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not
licensedwith 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 permtt.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 38:
\\_
-K t I own, reside in, or will reside in the completed structure.
2. I understand that I must become licensed as a construction contactor if the structure is sold or
offered for sale before or on completion.
A 3A. My general contractor is a hr*rr^.nl ?rqa o.-fC€;S l,/.c t6( ?q6
(Name)(ccB #)
I will instruct my general contractor that all subcontractors who work on the stnrcture must be
licensed with the Construction Contractors Board.
OR
tr 38. I will be my own general contractor.
If I hire subcontractors,I will hire only subcontractors licensed with the Constnrction 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 io rroplrty owners about Construction Responsibilities on the reverse side of this form.
It O7
of
(White copy to issuing agency perrnitfile, pink copy to applicant')
)
Property_owner.doc 06-0 I -04
Couvt
Acting as ttur Own Generat Cb'ntractor?-
INFORMATI.ON NOTICE TO PROPERTY OWNERS
ABOUT GONSTRUCTION RE$PON$IBILITIES
If you arc acting es yorr own conkactor to ccnslruct a new home or rnake a substai.rtial improvement to an existing
structure, you can prevent many problems by being aware of the following responsibilities and,concsrns.
Employer Responsibilities
You will, in most instatces, be ruled to be an 'uemplsyer" and the contractors you contract with will be "eruployees" if
you use ccnhactors not licensed with the Corstruction Contractors Board to do labor in consffucting or to assist in the
construction or improvement of a residential structure. As the employer, y$u must comply with the followlng:
Oregon's Withholding Tax Law: As an employ"r, you must witirhold income'taxes from employee wages at the time
employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from yoyl
employees. For more information, call the Depaffinent of Revenue at 503-378-4988. ';'
Unemployment Insuranee Tax: As an employer,'iou are required to pay a tax for uneimploymantinsurance r"*i$-
on the wages of all enrployees. For more information, call the Oregon Employment Department at 503-94?-1488. ..-ux*The Clregon Business Identification Number (Bbl) is a combined number for both Qregoq Withholding arrd
Unemployment lnsurance Tax. To fiIe for a BIN, call 503.945-8091 or y,ww,dqt$tate.or.US/iormspay.htnll for the.approp6lgutqpmg.-' . i i .,,r ,, . 5--
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 y8trr empfOyix is injr:red on thejob. For more informalion, call the Workers' Compensation Division at the Departirientbf Coniumer and Business
Services at 503-947 -7815,
U.S. Internal Revenue Service: As an employer, you rnust withhold federal income'tait ftorr ernployees'^fuages.
-:
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 dt 1-80O4294933 orvisit their web site at ww.w.irs"qpv
Other Responsibitities and Areas of Concerns
Code Compliance: As the permit holder for this project, you are responsible for resolving irny failure fo meet code
requirements that may be brought to your attention through inspections.
Liability and Froperty llarnagti'Insulan'cej 'Contact Sur ind*ance igent to s6e if you hn,e ideqtate,iiretrrarridr
coverage for accidents and omissions such as failing tools, pairt over spray, water damage from pipe punchrres, fire or
work that mustberedons.
,
Time: Make sure you have sufficient time to supervise your employees. ', ,.; f.. i
Expertise: Make sure you have it* ti"it;'to act as your own general confractor, to ioordinate the work of rough-in
and finish trades, and to notiS building officials as the appropriate times so they can perform the required inspections.
If you have additional questions call the Consrruction Conkactors Board (503-3?84621) or write the agency at PO
Box 14140, Salerq OR 97309-5052.
property_onnrer.doc 06-01-0 4 ''{l it)-*it ir' '! ' " : ''-{' ':i'is':lnrq
NaTE: This lnformation Notice to Property Oi,vners about Construction Responsibilities yyas develaped by the
Construction Contractors Board in accardance with ARS 7U.A55(5), passed by the lg89 Aregon Logislature.