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Home My WebLink AboutPermit Mechanical 2006-09-25Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2006-01232ISSUED: 0912512006 APPLIED: 0912512006EXPIRES: 0412512007 VALUE: SITE ADDRESS: 580 l2TH ST ASSESSOR'S PARCEL NO.: 1703351405900 PROJECT DESCRIPTION: Pellet Stove. Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New ALLEN JEFFERY L & LORI J 580 I2TH ST SPRINGFIELD OR 97477 Residential 1 Owner: Address: Contractor Type Mechanical Contractor OWNER Oregon UtilitY les are set lorti obtain coples ol the rul€s (Note: the telePhone ne 1 ] INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load:nla REQUIRED PARKING Total:Overlav Dist nqaN0TlGE:# Street Trees Paved Drive Rqd: Jfll$ PERMIT S oh oILot CoveragelgTH0R1ZED UNDER THI D OR IS ABA HALL EXP Sidewalk Type: Downspouts/Drains: ,EeiBllflt\n/o S PERMIT IS N RK OT NDONED FOR ffiB0DAYPERI -$ Per Sq Ft or multiplier Square Footage or Bid Amount OPMENT INFORMATION Description Type of Construction Page I of 2 Value Date Calculated { Valuation Description I LD Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -726-37 69 Inspection Line PERMIT NO: COM2006-01232ISSUED: 0912512006APPLIED: 0912512006EXPIRES: 0412512007 VALUE: Fee Description -Mechanical Issuance Fee- + lOoh Administrative Fee + 57o Technology Fee + 87o State Surcharge Minimum/Adjustment Mechanical Pellet Stove/lnsert Total Amount Paid Amount Paid Total Value of Project Date Paid 9t25t06 9t25t06 9t25t06 9t25t06 9t25t06 9t25t06 Receipt Number 2200600000000001 345 220060000000000 r 34s 2 20060000000000 I 345 220060000000000 I 345 2200600000000001 345 2200600000000001 345 $ r 0.00 $4.s0 $2.25 $3.60 $1s.00 $30.00 $65.35 Plan Reviews To Request an inspection call the 24 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. Freestanding Pellet Stove: After installation. eouired Insoections By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all inlbrmation 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 t turther 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 tiont of the property, and the approved set of plans will remain on the site at all times during construction. Owner or ature Pase 2 of 2 Date Bees Pard I 225 |IFIH STREET . SIRINGFIELD,OR97477 o tH:(541 26-'..753 o IAX; (541)726-3689 CityJob Number Wvtso .-O13i3 51..j t2"f}f 5f €Fit> o'{LJob Iocation Assessor's Map:Tax Lot: L 6NOwner: Address:50c)i ST;Phone: 141 -4?nL zip, 2J 4-11City:State:op Preliminary Inspection is $55.35 (prior to insert). Wood Stove/peiletllnsert Permit ia $65.35 (includes applicable fees and surcharges) Contractor InformationS.rf f-l-{cr pr{ {-} $3 () . r-l F{ A"(4,t-t (1F{ OrF{ {-) O(f e.(a -1)-i frF{ +)*< CJa e'lt-tlqi C) c+)(n FfLJ ()c F Contractor: Address:Phone: City:State:zip: L--onstruction Contractor's Registration #Expires: By signing this permit /application,l agreeto call for an inspection(s) as required Q26-3769). I state that all infognatiori on this appication/ pernnt is correct and that I was provided with the Wood Stove Safety information ior wood burning appliances and prelirninary inspection stanclards as set by thl Oregon f)epartment of Environmental Quality or the_Federal Environmental protection.{gency'andl agree to provide the testing approval number to the inspector at the tipre of inspiction. I also understand that if I am requesting a preliminary inspection, the wall covering ruay be required to be rentoved. Date:b Date of Application: TOROFrICEUSE Checked for Historical Status:Checked for Delinquencies: L Shared Drive(T:)/Building Foms/Wood Stove Pemrit 08-06.doc Signature: 225 Fifth Street Springfield, 0regon 97 477 541-726-3759 Phone *t,n${Frf,r..l C:+v of Springfield Official Receipt . zelopment Services Department Public Works Department RECEIPT #: 2200600000000001345 Date: 0912512006 e:57:l3AM Job/Journal Number coM2006-0t232 coM2006-0 r232 coM2006-0 r232 coM2006-0 r232 coM2006-01232 coM2006-01232 Description Pellet Stove/lnsert M in imum/Adj ustment Mechanical -Mechanical Issuance Fee- + 5%o Technology Fee + 87o State Surcharge + 10o Administrative Fee Amount Due 30.00 1 5.00 10.00 2.2s 3.60 4.50 Item Total:$65.35 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid ClreditCard JEFFEREY ALLEN ddk 165964 In Person Payment Total: $65.3 s -$6s-S cRecernt I Page I of I 9t2512006 Issued KELLY Statement: lnformation Notice to Property Owners About Gonstruction Responsibil ities Note: Oregon Law, ORS 701.055(4) requires residential constructton 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 requtredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engtneer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. the appropriate blanks and initial boxes I and 2, and either box 3A or 38: . I own, reside in, or will reside in the completed structure. n 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 ge,neral contractor is (Name)(ccB #) Construction Contractors Board Permit #: COI{2006-0r232 700 Summer St I\"E Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-37E4621 Web Address: www.ccb.state.or. us Address: 580 12T1{ STREET d D*e.912s/2006 ,rrrr il1 I witl instruct my general contractor that all subcontractors who work on the structure must be , licensed with the Construction Contractors Board. OR 38. I will be my own general conffactor. 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. applicant) Property_owner.doc 06-0 I -04 copy to issuing agenq) permttfile, pink copy to applicant.) Acfimg as Your Own *eneral Cdntractor'? rNp'*RMA?lSN ffiSTISH T* p&*pf;A?Y *VlrI\IrK$ ABCI*JT *SftSTRt"' *TISN ffi nSp*H$tSr &-r?l xs ffSft:j l&is lnfornafrbn ld*fico f* Prop*rfy Ownerc abaut Coffsfruc#sn ResponsifiiJffie$ vv&s develap*d by tha So*sfnrcffon eo*fracfors Soard in ascordance with SRS 7Sr"CI$5{5J, passed by the ?9S9 Oregnn L*gisfatura. .$.iy*u *r* aeting *$ y*Lir **,lr **ntrea*t*r t* *#ns{ft:ct a nelv }t*rn* *r malee a s*hr{*ntiai i:npr*ver::*nt tr; *n rxisting struetr$*- yilu *a* pr*vffit rflany pioblems by being aware of the follouing rerponsibilities and concems. Km*p&eyer K*$poxasihi}*tlem yr:u will, in n:cst inslanc*s, &e r*lerl to bc an '"exnplsyetr'* and the conkac{ors y*u c*nkact witk wil} be *'emp}sy*es" if, ysu Lrs* cr:nlract*rs not license{tr with t}ie Constr-uiJti*x C*ntr**t*rs Ecard t* si* lab*r in c*nstrueting or ti: assist in the constr-ucricxx or imFrt:vement of a resirS*atial skxchxe. &s tht emptoyar, you rxust ccrnply witk t&* following: Sregoars lditkh*Iding Tax Law; As an cmplciy*r, y*u rxust $rithlt*lci incr:rn'e t*xes f,rom emplcyee wages at the time **ploy*** are pair3" **r: :viltr he liahi.* fi:r the tax peym**ts e1'e$ {f y*u don't *c{xally withhctrd t}re tax from yr:r:r empl*y**s" ilor mor* ir;fCIrma*i*n, enll th* $cpartrne*t clf R*v*nue at 5$3-378-498S. tlnrmplayment Xnsurmree Tmx; As ** rr*pi*yer, yitu ere reqr:ired *:) p*y * tex for xn*mplcamr*nt insurance purposes on the wag*s *f all en:ploye*s. F*r rc*re i::f*rmati*:r, eal} ti:e Oreg*n llmpl*y'ntent $epartn:ent at 5*3-94?-1488" The (kegon Business ld*ntification hiumber {BIN) is a c*mtrinrd number for both Oregon lVithholdi*g and [In*mplm_1"r*e*t ]nsuram.q:* Tax. ?m iTie f's]r r[ B;N. *atrtr 5*3-$45-8S91 or X:ttf*d8L$i?!€pr.u*llbma&aX,higdl for the appropriate forms. Workers, Comp*nsati*n nnsxr*xee: As an e:xployer! )isu are subje*t t* th* ()r*go* Workers' Compensation }-aw, arrd rxu*t clbtain '*v*rkers' compems*ti*n insurance f*r yow exrpl*yees- lf y*u faitr tc) obtain wsrkers' *ornpe*sation insurance, y*u eaul<1 be subje*t to penalties a:rd bs liable for a1l claim costs if*ne ofyour ernpioyees is injured on the job. F*r more infora:ati*n, eall th* XY<lrkers' ff*:npensation Sivisi*n *t the $epartment ef Consurnar and Business Servi*es at 503-*47-781 5. L1"$, Xmternal R^*venc*e Serviae; As *n *:xp!*yer. )i*u ,nust rvithtr*ld f,eder*l income tax fr*rn empl*yees' ,vages, y*u will be liab;* for the txx payt:rsrrt €veri if y*u {iid"xt'l *etuai}y $/iNl*l*}d the t*l.x. For * F*dera} EIN numb,er" **11 the IRS at 1-800-829-4933 or visit their web site at g*&srl$.gg-y- (}ther X{esponsibitities and Areas sf Concerns Code Ccmrplianee: ,{s lhe perxrit !:*lder {*r this pr*ject, you are resp*nsibk f,*r resch'ing any failure to rn*et e*de reqair**rcl:ts t*at r:uey he }:r**ght t*.v*xr attentj*n thrr:ugh insp**licns- - Linhilify axd Pr*perty Damage Insurauc*: Con aet y*xr insurance agent to see if you have adequate insurance sovereg* f*r ac*ic}*nt* xnd cm*ssians *uch as falling t**ls, pai*t ovcr spray, rvater elarnage fr*m pipe pun*tures, firc or work that n:ust be redc*e. Time: Make sr:re you have suflicient tilne to supervise yoxr emptroyees. Sxp*rtlse: Make srye ycu have the skills tr: a*t as your owr] general conkaetor" t* coordinatc the work of r*ugh-in and finish kaelrs* ar:r3 t* natify huilding olficials as th* appropriate times so they ea:r perf*nn the required inspecticns. If you havc additicnal questiens caltr the C*nstrx*lio:l C*xtractcrs Snard {5CI3-3?S-4621} cr writs the *gency at P0 3oN 1414CI, Satrem, {)K 97309-5052" Property*owner.dcc $S-i) i -04