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Home My WebLink AboutPermit Mechanical 2006-09-12spE${cFlgLo Status Issued 225 Fifth Street, Springfield' OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 I nspection Line Building/Combination Permit PERMIT NO: COM2006-01185ISSUED: 0911212006 APPLIED: 0911212006 EXPIRES: 0311212007 VALUE: SITE ADDRESS: 385 2lST ST ASSESSOR'S PARCELNO.: 1703361305100 PROJECT DESCRIPTION; lnstall pellet insert Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential PhoneNumber: 541-513'2926Owner: Address: Contractor Type Mechanical KATHLEEN BERRY 385 2IST ST SPRINGFIELD OR 97477 Contractor AMBASSADOR PIPING INC 121469 Expiration Date 0312712007 Phone s4t-726-5723 nUIl # 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 Dist: # Street Trees Rqd: Paved Drive Rqd: 7o 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: R-3 VN nla Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: Handicapped: Compact: $ Per Sq Ft or multiplier Square Footage or Bid Amount DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Description Type of Construction Page I of2 Value Date Calculated fi\oll:Oregon law ::::511'?,req\ tl eO r fo{h rtion a tyN r0 +Nffi Valuation Description I 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: COM2006-01185ISSUED: 0911212006 APPLIEDz 0911212006 EXPIRES: 0311212007 VALUE: Fee Description -Mechanical Issuance Fee- + l0'h Administrative Fee + 57o Technology Fee + 87o State Surcharge Inspection - Preliminary Minimum/Adjustment Mechanical Pellet Stove/Insert Total Amount Paid Total Value of Project Date PaidAmount Paid $10.00 $9.00 s4.50 $7.20 $4s.00 s15.00 $30.00 $120.70 Receipt Number 2200600000000001272 2200600000000001 272 2200600000000001272 2200600000000001272 2200600000000001272 2200600000000001272 2200600000000001272 9n2t06 9n2t06 9n2t06 9n2t06 9ltzl06 9n2t06 9fi2t06 Fees Pa 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. Preliminary Inspection: Prior to the installation of solid fuel appliance which will be vented through an existing chimney, Pellet Insert: 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 all required inspections are requested at the proper time, that each address is readable from the street, thaithe permit card is located at the front of the property, and the approved set of plans will remain on the site at all ng construction.times or Contractors re Paee 2 of 2 Date f.Y.{ Keourrect lnsDecttons I Construction Contractors Board 700 Summer St I\tE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress: rvww.ccbstg!@&gq Permit#: CO,^ZPoG'O ll E gt ztsY S )-Address: Date:d6 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 and 2, and either box 3A or 38: [| f . I own, reside in, or will reside in the completed structure Issued by:b< L*rtpJ,a-Q,(zt 461 k- K3A 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. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subconfractors who work on the structure 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 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. permit (White copy to Propedy_owner. doc 06-0 I -04 agenq) perunitfile, pink copy to applicant.) hA OQ &*fimffi e$ Yomr $wm Gexxerxl Crntraetor? XNTOR$SATI&N ilSY'CH Ytr PreSPMffiY'Y {}WEiHR& AffiSUT *ST*$Tffi USTIffi N Ktr$P#NSIffi $X-*YIH$ n.t y** ar* aeling e$ y*iJr *x,.n c**ka*t*r t* euxstr::*t e nsw h*:ne #r mak* a substantiai impr*vement {* an existing stft:cture, )r*u {:{rn prev*nt many prob}ems by being awar* of ths f*l}ox'ing responsibilities anci c$&*effi$. K Nxap$*y*r Ke$p*xxs€hi}ftics Y*er will, in n:ost i*s{a::c*s, be ::rled t<: be an "empl*yer" and the s$r:trxi:t*rs yslx conra*t wrth vttl} be "emp}oyees" if, y*{i usc csnlractors ntlf liccnssd rvitk lhe C*nstructic* C*ntract*rs B*ard tr: e}* lab*r in l:*r:skueting *r t* assist i:l th* **ns**ction or i:rrpr*vem*nt of a residentiai sk*ctur*. As *he *mp[oy*r, you mar*t **xrply with t&e f*Iloxing; *r*gox's Witkh*trdimg Yax X-*w: As ax em3:l*yer, )fi-lu rnn$t:virld:*l<* i:t**r:;* texe* *r*rn *m3:1*ye* wages at the t;rnr rrnp3*ye*s are p;ii*. Y*l: wil} be tria}:l* {*r the tex p€r},rn*nts evefi if yex-e d**" a*fual}3, wit}a}:*ld t}:re tax fr*rn y*ur *rrptroy**o" fl*r ffil*r* i*f*x'xr*ti*r:, caltr t}:e *epartm*:rt ef &el'e*x* at 5*3-378498&. ffxx*slaBi*yxxexx* X:asxar*ex*e Yax: As an rlt1p}*yer, yrlu rire r*qi:ir*el to pay * tax for unemploS"ment insulanc$ pltrps$es '. r:n t}:e lqrilg*s *f ali eaxrtrqi*ye*s. .$err n:*r* i*f**nati*r:, *a11 t}:e *r*gcLl Hmptr*3tn*nt $cpar{r:r**t *t 5*3-94?-1488. ?&e Oreg*n B*xin*ss Xd*:ntificatin*'r Nwxber {eiN} is a co*:bin*d n*mrber fcr b*th *regon 'Withholding and Urr*rxp1c3,rx*ltlnsur****Tax"TeifiIef,.orastr},I,ea1l5*3-945-$*$x*rforthe appropnate forrns. W'orkers' Courpensati*m Xnsurance: As an employer, you are subject tc the Oreg*n Wcrkers' Cornpensation Law, and must obtain w*rksr$' eolnpensation insurance for your employees" If yoir faitr ts obtai:: w*rk*rs' corcpensatio:r in$rrnnce, you cculd be subject to penalties and be liable for all claim costs if one of y*ur ernployees is injured sfi the job. For more information, aall th* '$lorkers' Compensation Division at the Deparlment cf, Co*sumer and S*sinsss Services at 503-947-7815" Yj,$* Xmt*rn*l Kevenx* $*a"viee: As *n *mployer. y** must ivithht:ld federa] inc*me tax from cmployees' wasss' Y*u will he triable f*r th* lax payme:rt ev*n if y*x didn't a*tual{y x'it}*r*ld t}r* lxx" F*r * Sed*ra} frIN *ur:?ber, s:*1} the tS-S at 1-80*-829-4933 *r visit their vreb site at x\i.-ryJtg,-gs-y *ther kesp*xlsibflit&es effid Arsas CIf Coslesx'xts C*l*f* Comrpltx***: &* Nh* permit h*lder {*r this pr*jtct, 3.<lu t}re r*s;:**ribl* {i:r rt:s*lving **y failxr* t* m*et *o<1e reqxiren:*:rts lhal rnay h* hr**ght t* yow attentjs)fi tirroxgh insp**ti**s. tiabii{{y x31d FroS:l*x"ty f}a*rtage trn**ra*e*: CCIntaet your insura:r** ,tggnt t* se* if y*u ?rave adequate insr:r*nc* e$v{:r*Se *:r a*sid*r:.ts ;u"isl *misslsi}:ts $i^i*h *s fallir:g t**ls, pxin{ sv(r $plrity} rv*ter da:::age {r*m pipe ptlx}cture$, fir* or u*rk that must he r*iJ*nr .1 Time: &{akr sxre y*u have suffi*ient time tu suprrvlse yorrr empl*yees. Exp*rtise; &{sl<q: sr*re 5'ou have the skllls to aet as y*ur ow* gtnera} e*nka*t*r, t* e*ordinat* the w*rk *f r*ug}r-in *rrJ {irri*}, kad*s, ar:d t* n*tifu huildixg offi*ials as the appropri*te limes s* t}:ey eau Berf,*rxx the requir*d inspeclions' If y*u h*v* ad<iitionxl q**stions **tr} the C**skmeti*n C*xtraet*rs S**rd i5S3-3?84S21) *r:arit* th* agency a{ F{} Box 1414*, $a[*m,0i{ 9?309-5*5?. Prope*y_orx'ner.dr:c {}$-* tr -*4 iV$Itr; I/ris lnf*rma#ofi l/ofirs t* Pr*p*rty Oxr*ers abaut Sonsfruo{ron Responsi$illfies kvss douel*ped hy the Sa*sfri;cfion C*nfr*cfors &oard ix ar,**rdance tlviflr SffS 7CIr"$5${5}, p*ssed *y fi"r* f 98$ Sr*gron d-egislaf*r*. 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone C;' ' of Springfield Oflicial Receipt fl - elopment Services Department Public Works Department RECEIPT #: 2200600000000001272 Date: 0911212006 3:25:25PM Job/Journal Number coM2006-01 185 coM2006-01 185 coM2006-01 185 coM2006-01 185 coM2006-01185 coM2006-01 185 coM2006-01 I 85 Description + 5%o Technology Fee + 8% State Surcharge + l\Yo Administrative Fee Pellet Stove/Insert Minimum/Adjustment Mechanical Inspection - Preliminary -Mechanical Issuance Fee- Amount Due 4.50 7.20 9.00 30.00 15.00 45.00 t 0.00 Item Total:$r 20.70 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid CreditCard KATHLEEN BERRY djb 7l2l5B In Person Payment Total: $ 120.70 -mdm- cReceint I Page I of I 9fi2t2006 *FB*l*6Flltl.o 225 fll-IH STREET o SPRING|IELT), OR 97477 O 7ii:64tn za-3 75ll o ['AX:541)726-3689 CityJob Number (or.t r. 7 ocsG-oll 8J- Job Location:1 11 Assessor's Map:t-7 o33 Lt3 Address: Tax Lot a /('o Phone:Z State:zip:+1City: Wood Stove/Peilet/Insert Permit i $65.35 (includes applicable fees and surcharges)' ,l Contractor Information contractor: ltlq 0r^) cl o.,n# l-{crp{# -)t\) Or 7-{Fran,!-l r{t-tcofi{-fO O A*a 1-(l-{H {t)${O ct) (.''itEtF{ O c '{FlV) Ecc F ''' Phone: -7 Address: Statc: tractor's Re5iistration #:lat ll l"q zip: Expircs:3 7.0 -7 By signing this permit / application,l agree to call for an inspection(s) as required (J26-3769) I state that all inforlration on this application/permit is correct and that I was providecl with the Wood Stove Safety information ior wood burning appliances and preliminary inspection standards as set by the Oregon Departnrent of Environnlental Quality or the_Federal Environmental prbtection,{gency'andl agreeto provide the testing approYal nunrber to the inspector at the time of insp-ection. I also understand that rf I aur requesting a preliminary inspection, the wall covering may be required to be removed' Date:/ttob omcE USE Date Application:/oC,/r, t-tt Checked for Historical Status:Checked for Delinquencies: Shared Drive(T:)lBuilding Fomrs/Wood Stove Pemrit 08-06.doc CITY OF OREGOI{ in OAR 952-001-0010 through Oi on Utlli re tei'cPhone City: rec Center is 1-80 ORK $==t,8$