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Home My WebLink AboutPermit Mechanical 2005-12-20Status: Issued 225 Fifth Street, Springfield, OR 541:726-3753 Phone 541-726-3676Fax 541:1 26-37 69 I nspe ction Line F PRIN Buildin g/Co mbination Permit PERMIT NO: COM2005-017 57ISSUED: l2l20l2005 APPLIEDT 1212012005E)PIRESz 0612012006 VALUE: SITE ADDRESS: 2555 WAYSIDE LN ASSESSOR'S PARCEL NO.: 1703224401800 PROJECT DESCRIPTION: Install wood insert Springfield TYPE OF TYPEOF USE: Wood Stove New Residential Phone Number: 541-747-8908Owner: Address: Contractor Tin e Mechanical CURTIS SUMMERS 2555 WAYSIDE LN SPRINGFIELD OR 97477 Contractor TED L HUFF JR License Expiration Date 05115t2007 Phone 541-338-7550 # of Unib: Primary Occupancy Group: Secondary Occupancy Prim ary Construction Type Secondary Construction # of Bedrooms: Frontyrrd Setback Side l Setback: Side 2 Setback: Rearyard Setback: Solar Setbacls: Street Storm Sewer Available: Special Instruction: Notes: \t \s 73806 of Heat: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Load: ,ts Water Type: Range Type: Enerry Path: Sprinkled Overlay Dist: # Street Trees Paved Drive Rqd: o/o of Lot nlz .tO\ PARKING U) go o'r$ .gu $ Per Sq Ft or multiplier Square Footage or Bful Amount DEVELOPMENT I NFORMATION Description Type of Construction lof2 Value Date Calculated LLi tls Valuation Description I F PRINGFIELD Buildin g/Co mbination Permit Status: Issued 225 Fifth Street, Springfield, OR 541.:726-3753 Phone 541-726-3676Fax 541:7 26'37 69 I nspe ction Line PERMIT NO: COM2005-01757ISSUED: 1212012005 APPLIEDT 1212012005E)PIRESz 0612012006 VALUE: Fee Descriptbn -Mechanical Issuance Fee- + l0%o Administrative Fee + 1Yo State Surcharge Inspection - Preliminary Minimum/Adj ustment Mechanical Wood Stove/lnsert Total Amount Amount Paid $r0.00 $9.00 $3.1s $4s.00 $1s.00 $30.00 $112.15 Total Value of Project Date Paid 12t20t05 12t20t05 12t20t05 12t20t05 t2t20t0s 12t20t05 Receipt Number 1200500000000001836 1200500000000001836 1200500000000001836 1200500000000001836 1200s00000000001836 1200500000000001836 Plan Reviews To Request an inspection call the24 hour recording at 7264769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Preliminary Inspection: Prior to the installation of solid fuel appliance which will be vented through an existing chimney. Wood Burning Insert: After installation. Reouired fnsnections By signaturer l state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certi$ that any and all work performed shall be done in accordance with the Ordinances of the City of SpringfieH and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCT PANCY win be made of any sfiucture without permission of the Community Services Division, Building Safety. I further certif 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 'wt/fronstruction Owner or Contractors Signature 2of2 Date tL-zo - o{ \I' r ees raro I Construction Contractors Board 700 Summer St I\E Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us permit *: COaaZOoy- O tA t7 Address: z sss L,/ta Issued by:bK Date: lZ-Zo -O-r Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requtres residential construction permit applicants who are not licensed with the Constructton Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechantcal and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will beJiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: t1 .B' 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. .ff :n. My general contractor is -Td fl-," r?2 T2-73tro6 (Name)(ccB #) I will instruct my general conhactor 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. 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. tZ-Zo af (Signature of permit applicant) @ate) (Vlhite copy to issuing agency perrnitfile, pink copy to applicant.) ioperty_owner.doc 06-0 l -04 4//LI Act{xrg es \Kur Owxt ffimmeral Contraetor? rNFoftr$Afishl r.l0Ti*E T* pffispffimTY swlxnR$ &ffi gl,tt *srusYRt",sTIs$* refr sP*NSlffi tL'Ylg$ Ar$fg: Tttis lnfarrna$on ld*fice to Prop*rly Owrer* *&orf Sorsfrucfion &*sponsrbilffies was devel*ped by the Cons*rr*fion Co*fracfors B*ard iir aceordanc* wit{t OeS 70r.055{5J, pa*sed fry ffe '1989 Oregor* L*gislature. n;t y*u *r* **ti;rg ils yrlrlr ow:r ***tract*r tq:r *orxtruet ;l new h*rrr* *r make a sui:stantial i*rprove*teal t<l an existing str*etxr*, y*l! ff&n prevon{ many pr*b}ems !:y bei*g aw*r* af the fcilow,rng responsibilities and conce!-$s. ffi Nxaplmyer &#$p$xns*bili*ies Yax will, in mest instanc*s, b* rulcd t* b* a:: uoetrfiplsyer"' anil the contractor$ you coRtract with will be "em3:loyees" if y*u u$s c{:,ntractor$ n*t li*.ensed rvith the Constr{iction Ccnkact*rs Boar*! to e}o labor in constructing or tc assisl itr t}:e construction or i::rprovemenr of,a r*sedential slruclure . As the employtrn you rnusf comply with the following: {}r*gx;*lx's Wittrxhel}*{*ng T*x Law'; As ar: emplaycr, y{i$ r'r"urst with}r*ld inc*r'rTe taxes *}am emptrelyee wage$ at the tim* *n:p}*y*rs *ire paid. Y*u witrl 1:* liabl* fbr thcs tax g:ayments evem if y*x d*r:'t il*fi;atrtry rnr{thh*ld th* txx fr*m ynar **p}*y*u*. For m*n: ixf*r:rx*ti*x, *atrlthe Department of Revenue *t 5S3-3?84988" Un*x*pi*y*l*nt Sxscrs"xxce Ymx: As *x employer, ysu are requirecl t* pay a tax fslr lrnernptroStnsrit iRsurance purposes' an the wages *f aX *r*pl*y**s. F*r:x*r* i*formati*n, ea}l t}:e Or*gerl fimp3*3mtnt X)*partment at 5Q3-$47-148*. T'h* *r*6** Eusin**s }d*mtifiq;a{i*n Nxrxbq:r {StN} {s a **mbined rrumher f*r bath Sregon Withholdixg and {Jxe*pl*3n::ent tnsurana* Tax. Tq: {i}e f*:r * }}I}{, catri 5S3-945-8$9X $r }:&ly_C*x.$!Sjg.eli"t$l{lrenpaX*t:*11 fi:r t}le appropriat* {crms. Wprkers' C*mrpeweation XxlsxrraNra*; As an e:xpl*y*r, :rol..l are su'!:je*t t* tlt* ilr*go* W*rk*rs' Compensaticn L*'ur', and m*st r:bt*in w*rker$' fi$mp*fisati*n ins*ra*c* for y*xr erypl*yees. trf, ycu {bi} to *btain work*rs' ***tpe::xaticn i*surance, y*u e*uld be sxbje*t t* p*xaltics axd be Liable f*r all *lain: c*sts {f on* cf your employees is injured ol: ihe j*b. Fcr :nore ixf*lxnation, *xll lh* W*rkers' il*rnpexsati*n Sivisiein at t!:e D*p*rtrnent of Consurner and Business Se rvicer al i0-]-947-7815. U.$. Xmtermai &cv*crlx* S*x"viee: ,&s an *:mp}*y*r, y*rl n:ust ix/ith&*l{l fuderal ineo*r* tax from *rnptoyees' wages. Y*u wilt he l{abl* fur t}re {ax pe}x1ent *ve* if ycu didn't ie*{era}}y wit}rir*l*i the tax. For a }lederal HIN :lumb*r" e*}l the ffi"S at 1-80{}-8?3-4933 or visit th*ir rveb site at $tuvlls.8gv" $ther &esponsib*Xiti*s emd Areas cf Cmneern$ Cudr ()orrlplianec; Aq rh* plrmlt hcki*r fr:r thrs proldr't, )o* ilrr r*Ip{)nsrbl( tbr resolr"ing any fai}ure t* meet cocle r*quircme*ts that rnay b* ?:rr:ug?:t to yr:ur attentj*n tkr**gh i*sp*cti**:s" }-i*bitrity xxd Sn*perty tr)*xxl*g* fx:sa*rx:ree; Co::t**t y*ur irl*urano€ age$t ta see il'you have adeqxate insurarce cor;erafr* {q:r ar:eirle::.ts and *r*issicxrs such *x fall{ng l**1*, pai:at *vcr $pray} wat*r dar*nge fr*m pip* p$ficturel}, frr* *r r.r'ork that must be r*dtrnc. ?ixr*: &{ak* sure yeiu have su{ficient tirxe t* rxp*r"v"is* y*rr *mptreiye*s. Xxpertis*: &{ake sxrc yau have the skills t$ i}{:t as ysur *wn general q:*nka*t*r" to c*ordinate thc rvork*f r*ugk-in a:rd finisi? karnes, and 1* xr:tiiy huitre3{ng *f&eials *s th* appr*priat* ti*l*s sq> they r:ax perforrx th* required inspeeti*es. If y*u hav* aclsiiti*n*l q*esti*::s estl thc C*nstr**ti*::: C,$ntra{:tfirs B*ard {5{}}-3?846}1} *r writc th* ag***y at }l* 3*x 3414{i, $ate:':r, *R 9?3SS-5$52" Propefiy_*rna*r"*1*e 0S-* I -$4 225 Fifth Street Suringfield, Ore gon 97 47 7 541:126-3759 Phone aity of Springfield Official Receipt evelopment Services Department Public Works Department RECEIPT#: 1200500000000001836 Date: 1212012005 1:16:0ePM J,,5/Journal Number cbvrzoos-orzsz c:0M2005-01757 c0M2005-01757 c,cM2005-01757 coM2005-01757 coM2005-01757 Description + lYo State Surcharge + l0% Administrative Fee Wood Stove/Insert Minimum/Adj ustment Mechanical -Mechanical Issuance Fee- Inspection - Preliminary Amount Due 3.l s 9.00 30.00 15.00 10.00 45.00 Item Total:$1r2.15 Payments: Tlpe of Payrnent Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid Cash Change PAIGE SUMMERS PAIGE SUMMERS djb djb In Person In Person Payment Total: $l15.00 ($2.8s) $112.1s Jrb/Journal Number coM2005-01757 coM2005-01757 coM2005-01757tll c.pM200s-01757 cigM200s-017s7 c)M200s-017s7 Description + 7Yo State Surcharge + l0% Adminishative Fee Wood Stove/Insert Minimum/Adjustnent Mechanical -Mechanical Issuance Fee- Inspection - Preliminary Amount Due 3.l s 9.00 30.00 15.00 10.00 45.00 Payments: Tlpe of Payment Paid By Item Total: Received By Batch Number Number How Received $112.15 Amount Paid Cash Change PAIGE SUMMERS PAIGE SUMMERS djb djb In Person In Person Payment Total: $l15.00 ($2.85) $112.15 tl 0 th ri .til 12t20/200s lofl 5a