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Home My WebLink AboutPermit Mechanical 2004-02-26Status Issued 225Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line CITY O SPRINGFIELD Building/C ombination Permit PERMIT NO: COM2004-00227ISSUED: 0212612004APPLIED: 0212612004EXPIRES: 08/26/2004 VALUE: SITE ADDRESS: 1038 7TH ST ASSESSORTS PARCEL NO.: 1703351203300 PROJECT DESCRIPTION: Install gas line Owner: LAND MICHAEL R & SANDRA J Address: 1038 7TH ST SPRINGFIELD OR 97477 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Alteration Residential License Expiration Date PhoneContractor Type General Contractor owf[ER CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-1 Street Storm Sewer Special Instruction: Notes: VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot s Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Other: Surface Area: ,os PARJ(ING $ Per Sq Ft or multiplier Square Footage or Bid Amount Type: Total Value of Project Pase 1 of2 Description Type of Construction Value Date Calculated ,1, Ul-l-Ull\ (, rN r UIt.LYrryl SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Solar Yaluation Descriptioil Building/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541 -7 26-37 69 Inspection Line PERMIT NO : COM2004-00227ISSUED: 0212612004APPLIED: 0212612004EXPIRES: 0812612004 VALUE: E ees Pa Amount Paid $r0.00 $4.s0 $3.1s $4.00 $41.00 $62.6s Date Paid Receipt Number 2200400000000000187 2200400000000000187 2200400000000000187 2200400000000000187 2200400000000000187 Fee Description -Mechanical Issuance Fee- + l0Yo Administrative Fee + 7%o State Surcharge Gas Outlets 14 Miscellaneous Mechanical Total Amount Paid 2t26t04 2t26t04 2t26t04 2t26t04 2t26t04 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. 1 Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. 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 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 OCCIPANCY 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. ^A(,/olOwner or Contractors Signature ;*T / Pase2 of2 Kequlreo lnsDecuons I Construction Contractors Board pennit *. Co5(q--.)a. ^ do 2z\ 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ry[1!g[4 Address:\ogo ?-f ^.\28-F; Issued by:-Js(Y Date: O'L-Z5-o4.- Statement: Information 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 and2, and either box 3A or 38 g l. I own, reside in, or will reside in the completed structure tr 2. I understand that I must become licensed as a conskuction conhactor 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 confiactor that all subcontractors who work on the structure must be licensed with the Constnrction Contactors Board. OR E 38. I will be my own general confiactor. 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 Responsibilities on the reverse side of this form. J c o permit )) (lthite copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/l I /03 Acting as Your Own General Contractor? INTORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES A/Offi This lnformafrbn JVofrce to Properiy Owners about Canstruction Responsibilitrbs yyas develaped by the Construction Contractars Board in accardance wlth ORS 7U.A55(51, passed by the 1989 Oregan Legislature. If you are acting as your own contractor to conskuct a new home or make a substantial improvement to an existing structure, yoll can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the oontractors you contract with will be "employees" if you use contractors not iicensed with the Construction Contractors tsoard 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: Oregor's Withholding Tax Law: As an employer, you must withhald income taxes from employee wages at the time employees are paid. You will be iiable 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 lnformation Center at 503-986-2200. Unemployment Insurance Tax: As an employer, you are required tc pay a tax for unemployment insurance purpose$ onthewagesofallemployees. Formoreinformation,calltheOregonEmploymentDepartmentat303-947-1488. Workers' 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' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on thejob. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Serv-ices at 5A3 -947 -7 815. 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 eyen if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-71 15. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirernents that may be brought to your attention through inspections. Liability and Property Dnmage 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 pmctures, fire otr 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 conhactor, to coordinate the work of rough-in and finish kades, and to noti$ building officials as the appropriate times so they can perform the required inspections. 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. Property*owner.doc 03/l I /03 225 Fifth Street "i Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department 1 coM2004-00227 col|.[2004-00227 coM2004-00227 coi|,.{2004-00227 coll2004-00227 Gas Outlets 14 -Mechanical Issuance Fee- Miscellaneous Mechanical + 7Yo Slate Surcharge + lloh Administrative Fee 4.00 10.00 41.00 3. l5 4.50 Item Total:$62.65 Type ofPayment Paid By Received By Batch Number Authorization Number IIow Received Amount Paid Check MICHAEL R LAND lmp 4235 In Person Payment Total: $62.6s $62.6s rmilltftr &&