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Home My WebLink AboutPermit Mechanical 2005-08-23OF Building/Combination Permit PERMIT NO: COM2005-01117ISSUED: 0812312005APPLIED: 08/1712005EXPIRES: 03/0112006 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line SITE ADDRESS: 2234 32ND ST ASSESSOR'S PARCEL NO.: 1702302101200 PROJECT DESCRIPTION: Replace heat pump and air handler Springfield TYPE OF WORK: Heating System TYPE OF USE: Repair PhoneNumber: 541-726-4860 License Expiration Date Phone 06t27t2007 54r-726-0100 Residential Owner: Address: DOUG MASON 2234 32ND ST SPRINGFIELD OR 97477 Contractor Type Electrical Mechanical Contractor OWI\ER COMFORT FLOW 460 CONTRACTOR 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: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo ofLot Coverage: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: VN nla REQUIRED PARKING o \(\\tNotes: Pase I of3 ,.tRt ."1t\ )"\N t-rrl Y tllJlJrlYltll\ l' r1\r t-rKrYrArr(rt\ | F Building/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: COM2005-01117ISSUED: 0812312005APPLIED: 0811712005 EXPIRES: 03/0112006 VALUE: Description Tvpe of Construction Fee Description -Mechanical Issuance Fee- + l0%o Administrative Fee + 77o State Surcharge Air Handling Unit Up to 10,000 Heat Pump Minimum/Adj ustment Mechanical + l0o/o Administrative Fee + 7%o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Total Amount Paid Total Value of Project Date Paid Value Date Calculated Receipt Number 1200s0000000000122s 1200s00000000001225 1200s00000000001225 1200s0000000000122s 1200500000000001225 1200s0000000000122s 220050000000000120r 2200s0000000000120r 2200500000000001201 2200500000000001201 $ Per Sq Ft or multiplier Square Footage or Bid Amount Amount Paid $10.00 $4.50 $3.1s $8.00 $12.00 $25.00 $4.60 $3.22 $43.00 $3.00 $1r6.47 8t23105 8t23tos 8t23105 8t23t0s 8t23t05 8t23t0s 9nt05 9nt05 9nt05 9ntos Fees Paid 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. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Paee 2 of3 - Valuation Descrintion I Keourred lnsnecttons I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2005-01117ISSUED: 0812312005 APPLIEDz 0811712005EXPIRES: 03/0112006 VALUE: 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 during construction. Owner or Contractors Signature Date Paee 3 of3 225 FIFTH STREET . SPRINGFIELD, OF.g7477 . PH:(541)726-3753 'FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number Cort t zibf- o///7 Date .Nf 3 A. New Residential - Single or Nlulti-Family per drvelling unit' LEGAL DESCRIPTIONl7oz-30L I c2( ?Qo JOB DESCRIPTION a.l-&\\ Permits are non-transferable and expire if work is " not started within 180 days of issuance or if work is Suspended for 180 daYs. CONTRACT O R INSTALLATI ON ONL'' Service Included 1000 sq. ft. or less Each additional500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $ 106.00 $ 19.00 $50.00 )B. C. ATTEDTNI follow40l Notific E. s 43.00 $ 3.00 q7 Electrical Contractor Address Phone $, Supervisor Licehse Number Expiration Date Constr. Contr. Number 0 Expiration Date Signature of Supervising Electrician ownersName Dou fi1 Address aa3q 3a S+"€r.t City phone labqtLC OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 AmPs Over 1000 AmpsA/olts Reconnect Only Installation, Alteration or Relocation 200 Amps or less $ 63.00 $ 75.00 $125.00 $ 163.00 $375.00 $ 50.00 $ s0.00 uires YoTtO-- $ 69.00 $100.00 are sErtorth- lv City Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial Minimum Electric Permit Inspection Fee is $45.00 * Surcharges s s0.00 $ 50.00 $ 2s.00 $ 4s.00 1. SUBTOTALOFABO\'E {L Zz?7Yo State Surcharge l0% Administrative Fee TOTAL << gz Je- r60 Inspection Request: 726-3769 Shared Driv(T:/Building FormVElectrical Permil Application I -03.doc \. 1. LOCATION OF INSTALLATION t3z*L s )-Z z3c{ k{a-Z-h COMPLETE .kf ta , ca Construction Contractors Board Permit #:Coyuz-Av6- O///1 700 Summer St I\tE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:ry!6!31!4g Z-Zaq sz*L SAddress: Issued by:6 Date:0r 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 eitherbox 3A or 3B: E' l. I own, reside in, or will reside in the completed structure. A 2. I understand that I must become licensed as a construction conhactor if the structure is sold or offered for sale before or on completion. tr 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subconfiactors who work on the structure must be licensed with the Construction Contactors Board. OR E 3B. 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 immediatelynotiff 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. 0f (Signature of permit applicant)@ate) (White copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 06-0 I -04 Acfing ss tour Own Gemeral Contractor? },'IFORMATION NOTICE TO PRSPERTY OI'VNERS ABOUT CONSTRUC?ICIN RTSPST{S;BILITIE$ NOf€i This lnformafion lrio#co to Praperty Ownerc about Constructian Responsi0l/#ies was develaped by the Constructian Conlracfors Eoard in accordance wittt ORS 70r.0S5{5J, passed by the tg89 Oregon Legislature. if y*x ar* aeting ilri y{}Lir *al:r c*ntract*r i* ccnslru*t a new h*:'rre *r make a substantial i:npr*vement t* an existi*g strxctxr*, y*u sa:l pr*vent many problems by being aware of the following responsibilities and concerfi$" ff mployer Responsibilities You wiil, in most instances, he ruIed to be an "ernployer" and the contractors you contract with will be "employees" if you u$e co:ltractcrs nc| lisensed with the Canskuctio:r Contract*rs Board t<l d* labor in constructing or to assist in the **nstructio:r or improv*ment +:f a residentiai str*cture. As the employ*r, you must comply with t*e following: $regon's lVithhsld*ng T'xx Lnw: As an empioyer, you *txst withhold income taxes from employee wag*s at ths time ernployeer *re paid. Y*x rrritrl i:rs liabLe fcr th* t{tx piiy:}"}eflts evex if yeru d*n't a*tually wit}ri'l*trd ti:e tax &om your emplery*es. F*r mor* i*f*mnstion, call the lleparhne*t cf Revenue at 503-378-4988. {.lu*mrployxlent }*smrarlee T*x; As at: ernp}*yer, you ars required to pay a tax for unemployment insura*ce purposefi; *:r t}:e we&es cf ail *:xtployees. For m*re infbrmati*n, *a11 lhe Orogon Hmploym*nt Separtment at 503-947-1488. Thc Oregon .Busrnes,l ldentrfication Nurnber GfN) is a combined number for both Oregon Withholding ani-Unemployxnent}.*sura*ceTa,(.Toii}e{brasIF{,*a}l5*3.945-809xorforthe appropriate forms. Workers' Cornpens*tisn Xns*ranc*: As aa empl*yer, ysu are subject {o the Oregon Workers' Cornpensation Law, and must obtain workers' compensatir:n insurance for your employees" If yorr fail to obtain worker$'cornpensatiox insurance, you co*ld be subject to penalties and be liable for all claim costs if o*e of your employees is injured <:n the j<lb. For rnore in{brmation, call ih* Workers' Compensation Division at the Dcpartment of Ccnsumerand Business Serr.ices at 503-947-7815. Li,$, Imter*x{ Rev*xtate $*r'vice; .&s ax emp?*yer, yo* must withheild federal ine*me taz &*m emp}cye*s' wages-\ Y*l.r wiltr &:e }i*bic {*r t}:e [*x i]e]ment fiv*n if y*r: *lidn't actxally:vitk]r*]ci t]"1* tax. F*r a Fed*r*3 HIX{'nulxber, call t}:e IR.$ al 1-80$-$294933 sr visit their web site et XxnyJILgOy-. #ther Resp*nsibilities mnd Areas of Concerns Cods Coxllpliaxrc*: As ih* permit h*1e3*r f*r this pr*j*et, 3*ii *r* resp*nsibl* f*r resolving *ny f*iiure to r&eet code r*quirements that r*xy be hr*ught t* 3'*ur attq*li*n tlrough inxp*cti*ns Liabliify xltd Sr*p*r*y Ilamage Insursnce : C<intact your insurance {rgenf t* sec if you have adequate insurance sov*xege 1?:r c**isf*nts a;ld *tnissi*:ls sxck as kllil:g to*ir" paint *v*r $pray, rvater dac?:age frerrn plp* puncture$, fir* sr rvnrk *ret must bc r*dtx:r:. fim*: Mak* s*.r* y*u have sxffr*lent tiix* *t: sup*rv{se vrixr *rxpl*yees. Xxp*rtiu*: hi{elk* sxr*.v** hav* t}:* slejlls l{',icl itrs yr}rrr r)\\fi g*xer*} rs:rffiar:t*r" t* c**rdi*ate lllq.: r,q*rk *:{'r*ugh*in and {inish traelq:s. xr:ri tru **i.i}y bxi1dilrg *t&ci*ls xs th* *ppr*pri*t* li*:*s s* th*y **n p*r1*rr* the requir**3 innp**ti*ns. Xf y*u hav* ndditi*::al qer**{i**s *al} lfu* C*nstru*ti*x C*ntract*rs }3*ard {5*3-3?$4$}.1} *r rxril* *:e *g*ncy al}'f ) Box l4l4f)" S*1cm, (]R tj7tfi9-5{i52. Properny,_c*'ner.dq:c S&-* 1 -L!{ 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone city of Springfield Official Receipt rvelopment Services Department Public Works Department RECEIPT #: 2200500000000001201 Date: 0910112005 10:52:52AM Job/Journal Number coM2005-01I l7 coM2005-01I l7 coM2005-01I l7 coM2005-01117 Description + 7Yo State Surcharge + 1006 Administrative Fee Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Due 3.22 4.60 43.00 3.00 ltem Total:$s3.82 Payments: Type of Payment Paid By checkNumber Autnorization Received By Batch Number Number How Received Amount Paid Check DOUG MASON djb 4013 In Person $53.82 Payment Totat: -SSET 91U2005 Page I of I atalliE raLD :(