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Home My WebLink AboutPermit Mechanical 2003-12-04FIELD Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-01209ISSUED: 1210412003 APPLIEDz 1210412003 EXPIREST 0610412004 VALUE: SITE ADDRESS: 1370 35TH ST ASSESSOR'S PARCEL NO.: 1702303409000 PROJECT DESCRIPTION: Install pellet stove Springfield TYPE OF WORI(: Heating System TYPE OF USE: New Residential PhoneNumber: 541-485-2186 License Expiration Date Phone Owner: Address: DIXIE NENDEL 1370 35TH ST SPRJNGFIELD OR 97478 Contractor Type Mechanical Contractor OWNER CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I 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 oILot Coverage: R-3 VN # of Stories: Height of Structure Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: Type of Heat: Water Type: Range Type: Energy Path: v r E: TI*iIS PER NlitgnlflYEhrnr tF THE wo RK 1ij i flQf{11pffi1ryffi&I#P[RMtT ts NOT OMMENCED OR IS ABANDONED FOB ANY 180 OAY PERIOD. REQUIRED PARI(NG Total: Handicapped: Compact: U $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Pase I of2 PUBLIC Description Type of Construction Value Date Calculated .a q 11Ull:l-rlL\(r ll\ -F tr-t(lYrA r r\rl\ | t( l\.\I€$tlt t Valuation Description 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: COM2003-01209ISSUED: 1210412003APPLIED: 1210412003EXPIRES: 0610412004 VALUE: Fees Paid Fee Description -Mechanical Issuance Fee- + l0oh Administrative Fee + 7%o State Surcharge Minimum/Adjustment Mechanical Pellet Stove/Insert Total Amount Paid Amount Paid Date Paid t2t4t03 t2t4t03 t2t4t03 t2t4t03 t2t4t03 $10.00 $4.50 $3.1s $r5.00 $30.00 Receipt Number 1200200000000002548 1200200000000002548 1200200000000002s48 1200200000000002548 1200200000000002548 s62.65 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 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. t /r- ,/ - //A9 or Contractors Signature Date Pase2 of2 Construction Contractors Board Permit *:(9 u^zoo'3 -91 Lo 7 Address: l3aC =S*L'=L Issued by:\6 Date: 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ryfulg[e.or.us c 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 the following statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from 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 md2, and either box 34 or 38: {, $2. 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. tr 3A. My general contractor is (Name)(ccB #) I will instnrct my general confactor that all subcontractors who work on the structure must be lice,nsed with the Construction Contractors 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 Owners about Construction Responsibilities on the reverse side of this form. /&- (Signature of permit applicant)@ate) (llhite copy to issuing agency perrnitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABCIUT' CONSTRUCTION RESPONSIBI LITIES IVOIEi This lnfarmation Notice to Propefty Oi,vners abaut Canstructian Responsibilities was develaped by the Construation Contractors Board in accardance with ARS 701.A55(5J, passed by the 1989 Orogan Legislature. If you are acting as your ourn contractor to consharct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the follorving responsibilities and concerns. Employer Responsibilities You wi1l, in most instances, be ruled to be an "employer" and the contractors you contract with will be '{employees" if you use contrastors not iicensed with the Consffuction Contractors Board to do labor in consfucting or to assist in the construction or improvement of a residential sfructure. As the employeq, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't aciually withhold the tax from your employees.ForaStateBusinessIDnumber,calltheBusinesslnformationCenterat503.986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Ernployment Department at 503-947-1488. Workers' Compens*tion lnsurance: 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 your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. Internal Revenue Service: As an enrployer, you must withhold federal income tax from employees' wages. 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 at 866-816-2065 or fax them at 801-620-7i 15. Other Responsibilities and Areas of Concerns Code Compliancs: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liabitity and Property Damage Insurance: Contact your insurance agent to se€ if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time; Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as yorr ow'n general contractor, to coordinate the work of rough-in and finish trades, and to notifl, building of{icials as the appropriate times so they can perform the required rnspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at P0 Box 14140, Salem, OR 97309-5052. Properfy_owner.doc 0311 I i03 225 Fifth Street Springfieldo Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Receipt #: 1200200000000002548 Date: 1210412003 10:05:22AM coM2003-01209 coM2003-01209 coM2003-01209 coM2003-0r209 coM2003-01209 + 7o/o State Surcharge + l0Yo Administrative Fee Pellet Stove/Insert Minimum/Adj ustment Mechanical -Mechanical Issuance Fee- 3. l5 4.50 30.00 15.00 10.00 Item Total:$62.6s Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check DIXIENENDEL djb In Person Payment Total: $62.6s $62.6s asfililGFtst"l}