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Home My WebLink AboutPermit Mechanical 2003-07-18Building/C ombination Permit Status Issued 225Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00637 ISSUED: APPLIED: EXPIRES: VALUE: 07n8/2003 07n812003 01/78t2004 r SITE ADDRESS: 6199 Thurston Rd ASSESSOR'S PARCEL NO.: 1702342403700 PROJECT DESCRIPTION: Add gas fireplace, run gas line to vent. Owner: JOHN E SARGEANT Address: 6199 THURSTON ROAD SPRINGFIELD OR 97478 Springfield TYPE OF WORK: Heating System TYPE OF USE: Addition Residential PhoneNumber: 541-746-6325 ate Phone s4t-746-6325 541-746-6325 Contractor Type Contractor License Erpiration D Applicant JOHN E SARGEANT -i".+\ IMechanicat JoHN E Qh,SEAI{T .\o-{}-}o-B a # of Buildings: Primary Occupancy Group: Secondary Occupancy Primary Construction Secondary # of Bedrooms: Frontyard Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: VN Water Type: Range Type: Energy Path: Overlay Dist:'\C # Street Trees Rqd: Paved Drive Rqd: oh ofLot Coverage: a Surface Area: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: DownspoutslDrains Notes: Page I of3 I rL I flUlLLrIl\ \, lI\-tr lrIrUYlA t lt rl\ Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR S4l-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2003-00637ISSUED: 0711812003APPLIED: 07/1812003EXPIRES: 01/1812004 VALUE: Valuation Descrintion Description Type of Construction Fee Description -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7o/o State Surcharge Appliance Not Listed Appliance Vent Gas Outlets 1-4 Minimum/Adj ustment Mechanical Total Amount Paid Total Value of Project Date Paid Value Date Calculated Receipt Number 1200200000000001784 1200200000000001784 1200200000000001784 1200200000000001784 1200200000000001784 120020000000000r784 1200200000000001784 Amount Paid $10.00 $4.s0 $3.1s $9.00 $6.00 $4.00 $26.00 $62.6s $ Per Sq Ft or multiplier Square Footage or Bid Amount 7lt8l03 7n8t03 7tr8t03 7n8t03 7n8t03 7lt8l03 7n8t03 Fees Pnid 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. I Rough Mechanical: Prior to Cover 2 Final Mechanical: When all mechanical work is complete. Reorrired fnsnecfinns Page 2 of3 D \ Building/C ombination Permit Status Issued 225Fifth Street, Springfield, OR 54l-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2003-00637ISSUED: 0711812003APPLIED: 07/1,8/2003 EXPIRES: 01/1812004 YALUE: 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 or Contractors Signature Paee 3 of3 U 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 phone \ City of Springfield Official Receipt Development Services DePartment Public Works DePartment I Date:lt coM2003-00637 coM2003_00637 coM2003-00637 coM2003-00637 coM2003_00637 coM2003-00637 -Mechanical Issuance Fee- Appliance Not Listed Gas Outlets l-4 Appliance Vent Minimum/Adj ustment Mechanical + 7Yo State Surcharge + ljYo Adminishative Fee 7 10.00 9.00 4.00 6.00 26.00 3.15 4.50 Item Total: Type ofPayment Paid By Check JOHN E SARGEANT Received By Batch Number Jmp 2586 Authorization Number How Received In Person Payment Total: Amount Paid $62.6s Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:rys,1!g!4g 6111 T*tz*rr-^12r, ef-r Permit #: Address: 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 requtredfor 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: X l. 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 sfirrcture is sold or offered for sale before or on completion. 34. My general contractor is Nr_r)(ccB #) I will instruct my general contactor 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 contactor. 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 notifo 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 about Construction Responsibilities on the reyerse side of this form. ,/ o /n= of permit applicant) (White copy to issuing agency permitfile, pink copy to applicant.) W Property_owner.doc 03/ I I /03 Issued by: _ Date: Acting as ,- -\. ij- t'"-\/' Ybur Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNER$ ABOUT CONSTRUCTION RESPONSIBILITIES ffOIE: Tltis tnfarmation Nofrce to Propefty Awners abaut Construcfion Responslbilrtr'es was deveJoped by the Constructian Cantractors Board in accordance with ARS 7U.A55(5j, passed by the 1989 Aregon Legislature. lf you are acting as your own contractor to construct a new home or mdke ir substantial improvement to an existing skucture, you can prevent many problems by being aware of the following responsibilities and concerns' Employet' Responsibilities You will, in most instances, be ruled to be an "emplcyer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Consh'uction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregonrs \Yithholding 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 actually withhold the tax from your employees. For a State Business ID number, call the Business Information Center at 503-986-2200. - :,' Unemployment Insurance Tax: As an employer, you are reqt"lired to pay a tax for unemployment insurance purposes on the wages of all employees. For more infbrmation, call the Oregon Employment Department at 5A3-947-1488. \{orkers' 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' compansation 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. i , U.S. lnternal Revenue Service: As an employer, 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 Other Responsibilities and Area$ of Concerns Code Compliarice; 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. Liability aud Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverags for accidents and omissions such as falling tools, paint over spray, water damage &ompipe punctures, fire or work that must be redone. Time: Make stse you have sufficient time to supervise your employees. t - ,- l' ) . Expertisel Make sure you have the skills to act as your own general contractor, to coordinate the work of rough'in *j firirh trades, and to notifu building officials as the appropriate fimes so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at P0 Box 14140, Salern, OR 97309-5052. Property*owner.doc 03ll 1 103 225 FrFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 Cify Job nr*b"DateOJ - lb *oz E 1 & 2 Family Dwelling or Accessory tr Multi-Family tr Commercial/Industrial Job Address Gl'l1 TrturCS i^ou nN Construction tr tr Improvement teration/Replacement Demolition Other tr tr [Loag Bldg No. Suite No Tax Map/Tax LotLot Project Name Block Subdivision Description of Work/location on premises/special conditions U Property Owner Name Mailing Address Ciry Phone Owner Representative lnrta Phone Fax t&sbsrnilyDurelling sQFt X $/SQFI Total Value C o nnn e r ei al fi ndus t r i al fil'I ult i - I' annily SQ Fr x $/SQ Ft il Value New Dwelling Area State O fL z;p 17478 Garage/Carport Area Fax Other Structure Area Value tr Applicant Name Snuao ,as BAJE Mailing Address Cify State _ Zip Fax Total ValuePhone n ArchitectlDesigner/Engineer Name Address Ciry Existing New State zip Occupancy Group(s) Const. Type(s) Contact Person Phone Fax Number of Stories CCB#Expiration Date Phone # tr Contractor(s) Contractor's Name General (')ttttlf t, Plumbing Mechanical Electrical n cornmerci.,J/rndustri,olProjeets tr Resirlenti.rprojects Has site review application been submitted?fl ves E No ! Nza If so, Name of Planner Journal Number Heat Source: Primary Water Heater Range Do you require any of the following for this project? Over-width or Second Driveway Secondary Energy Path nyes nNo Temporary Power YesNotice: All contractors & subcontractors are required to be licensed with the Construction Contractors Board of the under ofORS 701 and be to be licensed in the urisdiction where work is BUILDTNG PERMIT APPLICATION INo State of Oregon Fot,Usc- PLAN CHECK FEE RCPT#!206?- t'is4 l-DATE BY Shared Drive(T:)/Building Fonns/Building pennit Application I 0-02.doc GFIELD, OREGONCITY.,GF Existing Building Area New Building Area