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Home My WebLink AboutPermit Mechanical 2003-09-24Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-367682x 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2003-00960ISSUED: 0912412003APPLIEDz 0912412003 EXPIRESz 0312412004 VALUE: SITE ADDRESS: 245 19TH ST ASSESSOR'S PARCEL NO.: 1703364201500 PROJECT DESCRIPTION: Replace wood stove. Owner: RONNI NIGH Address: 245 N 19TH SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Mechanical Only TYPE OF USE: Alteration Residential PhoneNumber: 541-913-9938 License Expiration Date PhoneContractor Type Mechanical Contractor OWNER CONTRACTOR INFORMATION PARKING{.o o{ BUILDING INFORMI # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Street Improvements: Storm Sewer Available: Special Instruction: Notes: R-3 VN # of Stories: Height of Structure of Heat: Type: Type: Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: $ $ Per Sq Ft or multiplier Square Footage or Bid Amount Sq \o\ Type: Downspouts/Drains: Area: Total Value of Project Pase I of2 DescriDtion Tvpe of Construction Value Date Calculated Valuation Descriotion I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00960ISSUED: 0912412003APPLIEDz 0912412003 EXPIRESz 0312412004 YALUE: Fee Description -Mechanical Issuance Fee- + l0oh Administrative Fee + 7oh State Surcharge Minimum/Adj ustment Mechanical Wood Stove Total Amount Paid Amount Paid $10.00 $3.80 $3.85 $15.00 $30.00 $62.6s Date Paid 9t24103 9t24t03 9t24t03 9t24t03 9t24t03 Receipt Number 2200200000000001571 2200200000000001571 2200200000000001571 2200200000000001571 2200200000000001s7r 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. 1 Wood 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 OCCUPAIICY 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 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 I Owner or Contractors Signature Date tltr Pase 2 of 2 J r ees raro I t(eourred lnsDecuons 225 FIFIH S'|REET . SPRINGTIELD,OR 97477 o PH:(541)726-3753 o IAX: (54i)726-'.1689 City Job Number f-otrA Lcc?-ocq 6 O *t1 Job Location City Owner Address +4 Phone ? t ,Z9r3S State /) /?zip 9zqzz Stove/Insert,'l?aa - (please circle appropriate appliance) Preliminar.v lnspection is{i4,H}0 {prior to insert} trtr/ood $tovelPellet/lnsert Permit is $62.65 {includes Perrnitr lssuance }'ee, St*te Surcharge & Admin lree.} alue of Wood Ci Address 7jn Construction Contractors Registration # Expires By signing this permit/application, I agree to call for an inspection(s) as required (726-3169). I state that all infomation on this application /permit is correct and that I was provided with the Wood Stove Safety information for wood burning appliances and preliminary inspection standards as set by the Oregon Deparlment of Environmental Quality or the Federal Environnental Protection Agency and I agree to provide the testing approval number to the inspector at the time of inspection. I also understand that if I am requesting a preliminary the wall covering may be required to be removed Signature- _Date Q-zz-c3 Date of Annlication For Office Use Checked for Delinquencies Checked for Historical Status- o@r8 Shared Drive(T:)/Building Forms,/Wood Srove Perrnit l -03.doc Assessors Map Tax Lot C o ntr ilt:t*t" I n fb r matt o rc dir{n\# r.yn{# ,q*ru$ r 1x{ tq -rtnt*{11,H <d\ r".tp'qA\J *6{# (} (}ni-qwrlFqFT #t( () w f''tF4l..r{. (} /a\J {-iro t?-4\Jn\rr'n.\J,a,f Phorre Construction Contractors Board 700 Summer St ltlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:ryfolgle.or.ug Permit #: Address: Issued by: .5C> 2-&s t-t - oo160 \q{E Date:O1 -2+ -Oj 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), neednot submit this statement. This statementwill befiledwith thepermit. Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38frl -sz. 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. 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR -N 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. that the above information is correct and that I have read and do understand the Information Owners Construction on the reverse side of this form. permit (Date) ffiite copy to issuing agency peftnitfile, pink copy to applicant.) I Property_owner. doc 03/ I I /03 ol -77.-A3 Acting as Your Own General Contraetor?, INFSRMATISN ruOYICT T# PRSPffiKTY #WNXR$ ABSUY GSNSTRI,'OTION RH$PSN$ISI I-ITI*$ tV0trS: Tltis {n{*rmafron ffaff*e *o Prap*rfy Own*rs a&o*i Ocnsfrucfi*ri ffesponsr*ii;fies lvas d*yeiop*d *y fhe Csnsfftrcf,CIn Csrfracfors &aard in accardanca with Off$ 70?"SS5i$j, passed &y ftre f 9S9 Oregcn leglsf*ferre. }f you are a*ting as )rl:u{ *wn contractr:r to conslruct a new h*m* or nrake a substanrial irrprovement t* an *xrsting $tructure, you *an pr*vrill r::any proi;l*ms hy h*ing ara,ar* *f th* f*lj*r.vurg re strr*nsibilities and c*uc*rns. Employsr Respom*ibilities Y*u will, in most instances, be ruled tei be an 'o€rnpioyer" and the contraetors you *cntract with will be "employecs" if, y$u use contractors n*t iicensed with the Conskuction Contractars Board t* do iab*r in constructing *r to assist in the consiruction or improvement cf a residential $tructure" Ar the employer, ysn mil$t *cmply with the following: Oregon's lYithholding Tax Law: As an employer, you rnust $rithhold incorne taxes trom empk:yee wagss at the time empioyees are paid. You will be liatrle for the tax payment$ even if you don't actually withhald the tax fram your ernpioyees. For a State Xlusiness II) *umber, cali the Business lnformaticn Center at 5S3-986-2?00. Ilnemployulent fnrursnce Tax: As an employer, you are required to pay a tax for urernpla3nnent insurance purposes , on the wages of ail ernpioyees. For more information, call the Oregon Emplayment Department at 503-947-1488. lVorkers' Cmrpensation lnsurancer As an errployer, you are subject ta the Oregcn Wcrkers' Compensation Law, and must oirtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for ali ciaim costs if one of your employees is injured on the job. For more information, call the Workers' Cornpensation Divisicn at the Department of Consumer and Business Services at 503-947-?81 5. U"S. Internal Revenue Service: As an ernployer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actuaily withhold the tax. For a Federai EIN number, call the IRS at 866-816-2065 CIr fax them at 801*S?0-7i 15. , Other Responsibilities and Area$ of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meel code requirements that may be brought to your attentior through inspections" Liability and Property $rmnge fnsuranc*: Contact your insuranee agent lo see if you have adequate insuranc* coverage for acciqlents and ornissions such as falling tools, paint ov€r spray' water damage frorn pipe punetures, fire or work that must be redone. Time: Make sure you have suf{icient tims to supervise your employees. [xpertise: Make surc you have the skills to act as yc]ur ofi'n general ccntractor, to coordinate the w*rk of rcugh*in and finish kades, and to notify building officials as the appropriate times so they can perform the required inspections. If you hal'e additional questions call the Construction Contractors Board (503-378-4621) or write the agency at P0 Box 14140, Saiem, OR 97309-5052. Property,ownrr.doc 031 I I 103 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springlield Official Receipt Development Services Department Public Works Department # z 220020000000000 I 57 1 Date: 0912412003 2:13:54PM coM2003-00960 coM2003-00960 coM2003-00960 coM2003-00960 coM2003-00960 Minimum/Adj ustment Mechanical -Mechanical Issuance Fee- Wood Stove + 7%o State Surcharge + l0%o Administrative Fee 15.00 10.00 30.00 3.85 3.80 Item Total:$62.65 Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check RONNI NIGH Jmp 2277 In Person Payment Total: $62.6s $62.6s ( (