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Home My WebLink AboutPermit Mechanical 2003-11-24Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-726-37 69 Inspection Line PERMIT NO: COM2003-01173ISSUED: 1112412003APPLIED: 1112412003EXPIRES: 0512412004 VALUE: SITE ADDRESS: 1868 YENTA AVE ASSESSOR'S PARCEL NO.: 1703243401000 PROJECT DESCRIPTION: Install gas h2o heater Springfield TYPE OF WORK: Mechanical Only TYPE OF USE: New Residentiat PhoneNumber: 541-747-7213 License Expiration Date Phone Owner: Address: LAWRENCE GINGERY 1868 YENTA AVE SPRINGFIELD OR 97477 Contractor Type Mechanical Contractor OWNER CONTRACTOR INFORMATION BUIL # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # ofStories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 Vlhr nurnber N0TICE: sidewalk rype: TH I S PEBM lT S HAElofiXtrffi{DTl{fisw0 R K AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONEO FOR ANY 180 DAY PERIOD. REQUIRED PARKING Total: Handicapped: Compact: $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Page I of2 DEVELOPMENT INFORMATION Description Type of Construction Value Date Calculated Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line FIELD Building/C ombination Permit PERMIT NO: COM2003-01173ISSUED: 1112412003APPLIED: 1112412003 EXPIRESz 0512412004 VALUE: Fees Paid Fee Description -Mechanical Issuance Fee- + llYo Administrative Fee + loh State Surcharge Appliance Vent Gas Outlets 1-4 Minimum/Adj ustment Mechanical Total Amount Paid Amount Paid Date Paid lu24t03 tU24t03 tu24t03 11t24t03 tu24t03 tu24t03 $10.00 $4.50 $3.15 $6.00 $4.00 $3s.00 Receipt Number 1200200000000002s09 1200200000000002509 1200200000000002509 1200200000000002s09 1200200000000002509 1200200000000002s09 $62.6s Plan Reviews To Request an inspection call the24 hour recording at 726-3769. AII 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. Reouired fnsnections 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 construction. (/t-A7 -zt-5 Owner or Pase2 of2 Date Construction Contractors Board permit *. Lpvuzr -l ^ CItl" 3 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us iE6g Yarla AveAddress: Issued by:bG Statement: lnformation Notice to Property Owners About Construction 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 arrd2, and either box 3.A or 38: .M -v 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 structure is sold or offered for sale before or on completion. tr 3A. My general contractor is (Name)(ccB #) I will insfuct my general contractor that all subconhactors who work on the strucfure must be licensed with the Construction Conhactors 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 to about Construction Responsibilities on the reverse side of this form. /t-</-aJ applicant)(Date) (Whrte copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 _x \-, Actitrg as Your Own Genernl Contractor? INT*RIVIATION T,*ETISH TCI PROFTRTY *WNXRS ABSUT *ff ru$TffiUSTION RHSP*Td$Iffi I LIT;H$ trl*I#: T-*i"e lflforrx#fr*n &.,*lr*e f* FrcB*rty ##ners ab**r/ #*nsfru:efi*n ff*sp*nsr*;lrtr*s was d*v*J*p*d &y fhe #**sfrue#on Cs*fraefors Soard in acc*rda*c* with Otr.S 7S?"$55{S}, passed Sy f}r* f $8$ Or*gon legisJxiur*" if yCIu arc a*ting *ri y$$r swn {:ontractt:r tc} c*nstr$ct a new irorne t":r rnake a substantial imprcve*tc*t t<: an *xisiing slructur*. Ji*r: car"i prev*fit n:any pr*hl*ffis by beirg awar* *f th* l*ll*r,vi*g r*s;:**sihiiiti*s and er:n**rns. f, mpl*y*r Re$ponsibitrities You will, in most iilstances, be ruied ta be an "employer" and the conkactors you cofitract with will be "employees" if you $se ccntractors not li*ensed with the Consffu*tion Contractors tsoard to do labor in construsting or to assist in the eonstruetion or improvement of a residential structure. As the employer, yon m$st mmply with the following: Oregon's Withholdixg T*x Law: As an employer, you must withhsld income taxes from employee wages at the time ernployees are paid. Yr:u wili L,e liable l-or the tax payment$ elren if you dcn't aetually withhold the tax from your en:pioyees. For a $tat* Business I$ nun:ber, call the Business Infannation Center at 503*986-2200. I-)nernployment hsurnxce Trx: As an employer, y$u are required lo pay a lax for unernplo3ment insurance purposgs on the wages of all employ*es. F*r more infarmation, call the Oregon Employrnent Department at 503-947-1488. 'lVorkers' Compensatioa Insuranccr As an employer, you are subject ta the Oregon'Workers' Compensation Law, and must oi:tai* *-orkers' ccmpensation insurance for your emplcyees. If you fail to obtaitr worksrs' compensation insurance, you could be subject to penaities and be liable for a1l ciaim costs if one of yaur employees is injured on the job. For rn*re infonnation, caii the W*rkers' Compensation Division at the Departrnent of Consumer and Business Services at 503-947-78 15" U.S. Internal Revenue Service: As an employer, you must withhold federal inccme tax from employees' wages. You rviil be liable for the tax payr:rent even if you didn't actually withhold the tax. For a Federal EIN nurnber, eall the IR$ at 866-816-2065 or fax them at 801-620-71 15. *ther Responsibilities xnd Aree$ $f Csncerns Code Conrpliance: As the per:r:it l:*lder frr this pmject. ysu arr resp*nsible for resolving any failure f* meei cnde requirernenls that may be brnught t* your afi*ntinn through lnsp*cti*ns. tiahility xnal Froperty l)*mnge }Nsur*nc*; ilqr*lact y*ur insur*nce asent t$ see if yau have adequate insurance c$verage for accid*nts and omissions su*h as falling t*ols" paint over spray, water damage frorn pipe punctures, fire or work that n"rust be redone. Time: Make srne you have sufficient time to supervise your employees. Expertisel Make sure you have the skilis ts act as your *wn general contractor, t* coordinate the work af raugh-in ar:d finish trades, and to notify building afficials as the appropriate'fimes so they can perform the required inspections. If yau have additional questions cail the Construclion C*ntractors Board (503-3?8-4621) rr write the agency at P0 Box 14i40, Salern, OR 9?3S9-5052. Properly*onrer.d$c 0311 I 103 225Fifth Street Sptiogn"ld, Orego n 97 477 sZt-lze-1759 Phone 9,V gf Springfietd Officiat Receipt Development Services Department Public Works I)epartment #:Datel t173 coM2003-Ol173 cou2003-Ol173 coM2003-ol173 coMl2003-O1173 cou2003-Ol173 + 7Yo State Surcharge + l0oh Administrative Fee Appliance Vent Gas Outlets l-4 Minimum/Adj usfinent Mechanical -Mechanical Issuance Fee_ 3. l5 4.50 6.00 4.00 35.00 10.00Item Total:$62.55 Type of Paid By Check LAWRENCE GINGERY Received By Batch Number djb Authorization Number How Received Amount Paid In Person Payment Total $62.6s $62.65 (