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Home My WebLink AboutPermit Mechanical 2005-10-18Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-01460ISSUED: 10/18/2005APPLIED: 10/18/2005EXPIRES: 0411812006 VALUE: SITE ADDRESS: 2388 9TH ST ASSESSOR'S PARCEL NO.: 1703261201006 PROJECT DESCRIPTION: Install pellet stove insert Springfield TYPE OF WORJ(: Pellet Stove TYPE OF USE: New License Expiration Date 04t19t2006 \S t0R Owner: Address: Contractor Type Mechanical SMITH FAMILY TRUST 2388 9TH ST SPRINGFIELD OR 97477 Residential Phone 54t-942-2941 Contractor JAMES ALLEN 'R-3 AuI NTY # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o oILot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: VN nla Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: on law requlres you to f o I low ru les ad opted SQHuOriIgoE: Uti t ity N cti{i cati o n Ce nter. Thqnru*lnAngmnAlJg,th in cAR 952-001-0010 througli oAR 952-001- 0Lr3C. You may obtain copies of the rules by cariiing the center, (Note:the telephone umber for the Notification REQUIRED PARI(NG Total: Handicapped: Compact: $ Per Sq Ft or multiplier Square Footage or Bid Amount CONTRACTOR INFORMATION DEVELOPMENT INFORMATION Description Type of Construction Pase I of2 n uti Value Date Calculated vatuation uescripiioi' I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-01460ISSUED: 10/18/2005 APPLIED: 10/18/2005EXPIRES: 04/1812006 VALUE: Total Value of Project Date PaidFee Description -Mechanical Issuance Fee- + l0Yo Administrative Fee + 1Yo State Surcharge Minimum/Adj ustment Mechanical Pellet Stove/Insert Total Amount Paid Amount Paid $10.00 $4.50 $3.1s $1s.00 $30.00 $62.6s 10/r8/0s 10/18/05 10/18/05 r0/18/05 10/18/05 Receipt Number 2200s000000000014s8 2200s000000000014s8 2200s000000000014s8 2200500000000001458 2200s000000000014s8 Plan Reviews 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. Pellet Insert: After installation Reouired Insnect 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 wiII 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 at the front of the property, and the approved set of plans will remain on the site at all iD -/tr -os or Contractors Signature Paee2 of2 Date B PPS YAI(l Construction Contractors Board Permit #,CottlLt -f - o Address: Z3&3 tq6 o si- Issued by:b( Date: lo-tg-af 700 Surnmer St hIE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us 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 and 2, and either box 3A or 38: E. R 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 2l*\'o-'..*l wyWAA contractor or on completion. is J&r.^,reS Atl-^ Ylt\QLW tt/ q 33A. (Name)(ccB #) I will instruct my general conffactor that all subcontractors who work on the structure must be licensed with the Construction Confractors Board. OR n 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 notiff the office issuing this building permit of the name of the contractor. I hereby that the above is correct and that I have read and do understand the Information to Responsibilities on the reverse side of this form. (s o (Date) (White copy to issuing agency permilfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 /d "--k- Ac*&mg e$ t*ur Swn GexNeral Cd-ntractor? $r{rsKntATl0l{ wsYl0g T* pR*pHKTY *mrNxRS &&sur **'$$TRusYlffiN Rffi.$p$N$1ffitL[Ttgs td$IEi lirls lr:f*rmaflolt ldofice t* Pr*pe*y Oiryners a&ouf Sorsfruc#*n Responsi&ilffie$ was devef*ped by the Consfruefior: Sonfraefors *oard in accordsn*e with SRS 70?.05$f5J, passed by ttt* f 9S9 Oregon L*gislature" If'yeiu ar* actixg ;3$ yt>r.is *rrurll c**tr*etclr t* consrrucl * ncw h*mc *r rnak* a s*bstantial impr*vcmen{ t* a:n extsling strc*txrc, y#la *an prev*l:.t ffiany prcblems by beixg *ware *f the {blioiving resp*r:sibiiities and e{:$1o*I"?}$. ffi xxxB}*y*r XA*$p*ms*h{ &&{ies Y*u wili, in mclsl instar:crs, i:e rutre*3 t* be ,rlr 'oell?p3oyer" and the sontractors ys:J s*ntract wtth will be "ernplcyees" i{ y*u u$tl cuntract$rs n<ll licen*cd rrith the C*nstructi*n C*ratractors B*ard t* dn trab*r in *o:ls&ucting *r ttl assist in the e*nslru*ti*n or ir::pr*v*rnesr{ *f a resideritia.}. stni*lur*. As the *ru*p}oyer* yo* mx*t comply with tk* follnwingl Oreg*n's WithholqXing Yxx }-awl As an *n:ployer* y{:}1} :xl.r*t withkcld income tax*s {iom e*pl*yee wage$ at the time eixptr*y**s xre paici. Yr:E i /ill b* liable f*r the tex polyfi*nts even if y** don't astually withkotrd the tax **rn your empl*yees" For:xore i*f$fir:iaticm, *all th* Ilepartment *f R*venue at 503-3784988. U*omploymeirt trxrslrx'*mee Txxl As a* ernpl*yer, you are requir*d to pay a tax for unemployment iasurance purpn**)\ on the wages of all exrpl*yees. F*r ffi*rs ixf*rmati*n, extl ttrt* *reg*n fir*plcament ilepartrn*nt ** 503-947-1488. ?h* *r*gon Busin*xs ldentification Nun'lb*r (BIF{} is a eombined nrxnber for both Oregon lYithhalding and Unenlplolanent l*surax*r Tax. ?* fiI* f*r * BIN, eali 5*3-945-8*91 sr yvx:y.d${.-slate"or,uslfrtry$pay.}rl:pl1 for the appropriate forrns. 'trV*rkers' C*rnp*msaficn Insarranee: As a* ernpk:yer, you are subject tn the Oregon Warkers' Campensation Law, and must *btain workers' co::npensaticn insuraree f*r y*ur employees. lf you fail to obta*: q/orkers' compensation insurance, you could be subj*ct t* penalties ar:d be Iiable for all clairn costs if oxe of yow emplayees is ixjured on the j*b. F*r m*re inf*rmafion, e*in the Workers' Cornpensa|ion Division at the $epartment cf Consumer a::d Business $ervices at 5*3-94?-?81 5. L;,S, [:lt*rm*X &.ev*mu* Servic*; As ax empl*yer, ynu rnast wit]:r]r*ld federal ineome tax frcm empioyees' wages. Y** wili ?:* liabk hr tbe iax p;ly*n*nt *vrn if y*u didn't actu*ltry w*thhold th* tax. F*r a Federai SIltr nurnber, caltr ths I&.S *t 1-800-829-4933 or visit their web s:ite at yxx;;$*gsl,'" **her Kesponsibilities and Arca$ of Crncerns C*de C*xarplixx**; As the p*rmit h*lder fbr qhis pr*j*et, ystl aro r*sp*n*lbl* f*r r*s*lving any fxilur* to me*:t code requircments that;riay be br*r"lght t* y*ur att**tion *:rcugl: insp*ctieixs. {-ixbi}ity *xaci $r<*p*rty X}ax*mg* Xr*srrx"axlee: C*ntaet y*r:r inxur*n** ageilt to see if y*u have adequate insxrarrce ff*ye ;rge *ir inc*ic3*"rts and *r:":issi*ns su*h x* Lalling t**trs" pai:it sver $prayl wxter tlamag* f?*rn pip* pun*{t;res, {ire er rvork ti"lat rnust be redor:*. Time: Make s*re you h*ve sufficient time to supervise y*ur en:ployees. Sxpertise: h{ake sur* yr:u have the ski}is to ael a$ your owyr general conractor, to coordinate the work of r*ugh-in and flnish trades, and t* notify building *ffi*ials as the appropriate times so tirey can perf,orm the required irspectiorls" trf y** h*ve *dditi*natr quee{i**s eali lhe C*:rsfru*ti*n fl*nkact*rs l}r:ard {503-378-'l{t2ii *r write the *geacy a1F{) ilox l4l4{J. Salcm" Olt 9?309-5CI52. Fropert'y_*r"r::er.d*c {iS-t} } -$,{ 225 Fifth Street Springfield, Oregon 97 477' 541-726-3759 Phone Qity of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT #: 2200500000000001458 Date: 10/18/2005 11:02:49AM Job/Journal Number coM2005-01460 ,.coM2005-01460 coM200s-01460 coM2005-01460 coM2005-01460 Description + 7Yo State Surcharge + l0% Administrative Fee Pellet Stove/Insert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Amount Due 3.l s 4.50 30.00 1s.00 10.00 Item Total:$62.65 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check JOHN SMITH djb 1096 In Person $62.65 PaymentTotal: ffi l0/l 8/2005 Page 1 of I rrufl3o,