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Home My WebLink AboutPermit Mechanical 2004-06-18Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line SITE ADDRESS: 627 S sTH ST ASSESSOR'SPARCELNO.: 1703353406300 PROJECT DESCRIPTION: Install woodstove Owner: SARAH HALSEy Address: 627 S sTH ST SPRINGFIELD OR PERMIT NO: COM2004-00727 $ Per Sq Ft or multiplier Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains: Residential PARJ(NG Springlield TYPE OF WORIC Wood Stove TYPE OF USE: New PhoneNumber: 541-913-1889 dt? Expiration Date Phone$e ISSUED: APPLIED: EXPIRES: VALUE: 06n8t2004 06n8t2004 12n8t2004 Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: ( Compact: Contractor Type Mechanical OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: 'Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Paved Yo of Lot R-3 VN nla Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: DEVELOPMENT INFORMATION Description Type of Construction Total Value of Project Value Date Calculated L A,- w \$ Valuation Description I Status Issued 225Bifith Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00727ISSUED: 0611812004APPLIED: 06/1812004 EXPIRESz 1211812004 VALUE: ['ees Pa Amount Paid Date Paid Receipt Number 1200400000000000936 1200400000000000936 1200400000000000936 1200400000000000936 1200400000000000936 Fee Description -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7%o State Surcharge Minimum/Adj ustment Mechanical Wood Stove/Insert Total Amount Paid $10.00 $4.s0 $3.15 $1s.00 $30.00 6n8t04 6n8t04 6n8t04 6n8t04 6n8t04 $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. Wood 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 Springlield 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. Owner or Contractors Date Pase2 of2 Keourreo rnsDectrcns I Construction Contractors Board permit *:Clt rt U>o -.. - O OaZ-l 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us 6z-t S t+L sfAddress: Issued by:b6 Date:Q1 ?'ott 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 ard2, and either box 3A or 38 2(1. 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. 3A. My general contractor is (Name)(ccB #) I will instruct my general confractor that all subcontractors who work on the stnrcture must be licensed with the Constnrction Confractors Board. OR 38. I will be my own general conhactor. 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 noti$/ 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 reyerse side of this form. 4 o applicant)@ate) (llhite copy to issuing agency pennitfile, pink copy to applicant.) Property_owner.doc 03/ I I /03 tr oO,nnO,n-\- Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CON$TRUCTION RE$PONSIBILITIES NOIA This lnformation Natice to Propefty Oryners about Construction Responsibilitie.s was deue/oped by the Consfrucfion Contractars Soard in accordance with ORS 7A1.A55(5J, passed by the 1989 Oregon Legislature. If you are acting as your own contractor to eonstructa new home or make a substantial improvement to aa existing structure, you can prevent many problems by being aware of the follorving responsibilities and conceras. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction 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: Oregon's Withholding Tax Law: As an employer, yot riiust wit}hold income taxes from employee u.ages 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 II) number, call the Business Information Center at 503-986-2200. :' Unemployment Insurance Tax: As an employer, you are required tq.pay a tax for unemployment insurance purpo€as on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. Workers' Compensation Insurance: As an employer, you are sub.ject to the Oregon Workers' Compensatiofl 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 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 IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Area$ of Concerns Code Compliance: 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 and Property Damage fnsurance: Contact your insurance agent to see 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 your own general contractor, to coordinate the work of rough-in and finish trades, and to notifu building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property*owner.doc 03ll I /03 225 IIFIH STREET . SPRINGFIELD, OR 97477 o ?H:(541)726-3753 o FAX: (541)726-3689 ciryJobNumber COu'teOOcl - 60-721 IJob Location:Gz-3 t+t^ s Assessor's Map:l?o33 s3 q Tax Lot:o 6f oc.: p Cc^ rz>3r^.a '( Dh t-iF-{crfi+Js () r pr{ t-{g A}J.{ F4)-{ Owner: Address: in te Imspection is $45.O0 Permit is State: Construction Contractor's By signing this pernrit / applicatrou, I agree to call for I state that all inforutation on this applicatron/ the Wood Stove Safety information for wood standards as set by the Oregon Departntent of Environurental Protection Agency and I agree to inspector at the tiure of inspectiott. I also understand inspection, the wall covering may be required to be Phone:q t3- t8 cp fee, State Surcharge and Administrative Fee) ulred (726-3769). I was provided with nspection or the Federal approval number to the requesting a preliminary f fLl / SCity: {J O () A.aF4 +.-{ lr{ {-) $< C)a 1-ttEt F,r{ () c:pa Eoca7 Contractor: Address: City: Signature:Ox&SG|,^{Date FOR OTTICE USE Cr, (?r-oqDate of Application: v-(-/ Checked for Historical Status:Checked for Delinquencies: Sharcd Drive(T:)/Building Foms/Wood Stove Pemrit 3-04-04.drc CITY OF OREGOIY zip, qa q 7 ? u-t E-c{ 225Fifth Street Springfield, Oregon 97 477 54:l-726-3759 Phone -'y of Springfield Official Receipt - rvelopment Services Department Public Works Department RECEIPT#: 1200400000000000936 Job/Journal Number COtvI2004-00727 coM2004-00727 coM2004-00727 coM2004-00727 coM2004-00727 Description + 7%o State Surcharge + l0% Administrative Fee Wood Stove/Insert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Amount Due 3. l5 4.50 30.00 15.00 10.00 Item Total:$62.6s Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid CreditCard HEATHERHALSEY djb 000415 075903 In Person Payment Total: $62.65 -$6t^6-f 6t1812004 Page I of I *atLrSD Date: 0611812004 2:23:03pM