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Home My WebLink AboutPermit Mechanical 2003-10-29F FIELD Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2003-01095ISSUED: 1012912003APPLIEDz 1012912003 EXPIRESz 0412912004 VALUE: SITE ADDRESS: 210 S 37TH ST ASSESSOR'S PARCEL NO.: 1702314205400 PROJECT DESCRIPTION: install pellet stove Owner: RANDy KRUSE Address: 210 S 37TH ST SPRINGFIELD OR 97478 Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New PhoneNumber: 541-744-8177 License Expiration Date Phone Residential Contractor Type Mechanical Contractor OWNER # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stq{e{t.NTION:Oregon law S you to adoPted bY the UtititY Type o n Center' Those rul w ater 952ro01-0010 th ou may obtain c opi g the cente r. (Note: lor the Oregon util R-3 VN Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh ofLot Coverage: AUTHORIZED COMMENCED ANY I8O OAY Area: REQUIRED PARIilNG Total: Handicapped: Compact: ffi $ Per Sq Ft or multiplier Square Footage or Bid Amount Total Value of Project Page I of2 Description Type of Construction Value Date Calculated -T UUN I It\r(rt(uArruN I I'UILL'II\ U II\I UIUVIA T TIJT\ I Valuation Description 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: COM2003-01095ISSUED: 1012912003APPLIED: 1012912003 EXPIRESz 0412912004 VALUE: Amount Paid Date Paid Receipt Number 220020000000000170s 220020000000000170s 220020000000000170s 2200200000000001705 2200200000000001705 Fee Description -Mechanical Issuance Fee- + l0o/o Administrative Fee + 1oh State Surcharge Minimum/Adj ustment Mechanical Pellet Stove/Insert Total Amount Paid $10.00 $4.s0 $3.1s $15.00 $30.00 10t29103 10t29t03 10t29t03 10t29t03 10t29t03 $62.6s 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. I Freestanding Pellet Stove: After installation. .eouired Insnections 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 witl 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 70f .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 construction. tE I zq /os Signature Date Paee 2 of 2 rlees rSl(L Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ryfolg]g permit #. COyvt?s>,*-J- OI()?f Ad&ess: Zta S 3-7lL- si^ Issued by:\l(Date: / O Z?,c 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 and2, and either box 3A or 38 *"r.ft,I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. r o /-q /o= of permit applicant)@ate) (ll/hite copy to issuing agency perunitfile, pink copy to applicant.) n 3A. My general contractor is (Name)(ccB #) I will instruct my general contactor that all subcontractors who work on the strrcture must be licensed with the Constnrction Conffactors Board. OR 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 confractor 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 Owners about Construction Responsibilities on the reverse side of this form. Property_owner.doc 03/l l/03 x Acting as Your Own General Contractor? IHFORMATION NOTICE TO PROPERTY OWNERS ABOUT GONSTRUCTION RESPONSIBILITIES ffOfF: This lnfarmatian Nati*e ta Property Owners aboul Conslruction Respansibititie,s was develaped by the Consfruc*bn Contractors Board in accardance with ARS 7A1.A5,5{5J, passed by the 1989 Oregon Legislature. If you are acting as your own contraotor to consFuct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsrbiiities and csncerns. 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 contactors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvernent of a residential $8ugture. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income laxes from employee tryages at the time ernployees are paid. You wiil be liable 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 Information Center at 503-986-2200. IJnemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. Formore information, call the Oregon Employment DepartmantatsA3-947-1488. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your ernployees. If you fail to obtain workers' compensation insurance, you couid be subject to penalties and be liable for all claim costs if one of your empioyees is injured on thejob. For more information, call the Workers' Compensation Divrsion at the Department of Consumer and Business Services at 503-947-78i5. U.S. lntern*l Revenue Service: As an ernployer, you must withhold federal income tax from employees' wages. You wili be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 866-8I6-2065 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 requirements that may be brought to your attention through inspections. Liabitity 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 &om 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 yolr own general conffactor, to coordinate the work of rough-in and finish kades, and to notifu building officials as the appropriate times so they can pe,rform the required inspections. If you have additional questions call the Construction Contractors Board (503-3?8-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 03/1 I 103 225 Fifth Street Springfield, Oregon 97 47 7 541-726-3759 Phone City of Springfield Official Receipt Develop ment Services Department Public Works Department Recetpt #: 2200200000000001705 D*et 1012912003 tt24.2tPl[{ coM2003-01095 coM2003-01095 coM2003-01095 coM2003-0109s coM2003-01095 + 7%o Stale Surcharge + l0Yo Administrative Fee Pellet Stove/Insert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- 3. t5 4.50 30.00 15.00 10.00 Item Total:$62.6s Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Cash RANDY KRUSE djb In Person Payment Total: $62.65 $62.6s ( 225 FIIH STRLET . SPRINGFIELD, OR'97477 o PI-l:(541)726-3753 r FAX: (541)726-3689 City Job Number C5rut Zrsc>) -- () tO7 ( 1 7Job L 3tqZ Lot o rYoo Owner Address City Value of Wood Phone 7 State gK-q-7v 7zip { s B oo (please circle appropriate appliance) ['reliminar-v Inspection is $i45.(]0 Wood Stor,e/Pelletilnsert Permit (prior-ttinsert) 6f}65lincludes Permit, I Surcharge & Admin l:ee.)1c.' SSTTA Controctor I rtform*tt o n Address Construction Contractors Registration $ \5${ot}o \9 \ By signing this permit/application, I agree to call for an inspection(s) as information on this application /permit is correct and that I was infonnation for wood burning appliances and of Environmental Quality or the Federal approval number to the inspector at the time of preliminary inspection, the wall covering may be S I state that all Safety the Oregon Department agree to provide the testing that if I am requesting a Date sO For Office Use t)Date of Application for HistoricalChecked for Delinquencies <>) Checked Shared Drive(T:)/Building Fomrs/Wood Stove Pennill-0l.doc CITY OF &XTEItrIN Assessors zit, dF{crp(sd Orfi !q{ A.g]* 11FT \J r pr{ {, Q (} (1, l-la (-''(F( )-.'{ # $-.( () U)t<Ht-{ () c# U) I5co f .lt Q+-+,, o