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Home My WebLink AboutPermit Mechanical 2005-11-10Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-01597ISSUED: llll0l2005APPLIED: 11/1012005EXPIRES: 05/1012006 YALUE: SITE ADDRESS: 198 S 38TH ST ASSESSOR'S PARCEL NO.: 1702314207100 PROJECT DESCRIPTION: Installing Wood Stove. Springfield TYPE OF WORK: Wood Stove TYPE OF USE: New Residential Owner: Address: Contractor Type Mechanical Contractor OWNER ADAM BIEGHLER 198 S 38TH ST SPRINGFIELD OR 97478 PhoneNumber: 541-915-4180 License Expiration Date Phone )R INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: i Height of Structure , Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Yo of Lot rs 1_g Sq Ft Garage/Carport Sq Ft Other: nla Occupant Load: ru REQUIRED PARKING Total: Handicapped: Compact: NOT the cer ror the enter /es by R-3 oregon U VN Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: $ Per Sq Ft or multiplier IEO OAY Square Footage or Bid Amount Af'Jy DEVELOPMENT INFORMATION Description Type of Construction Pase I of2 Value Date Calculated EE \ gh oAB rh 952_00 set for UNOER THIS PERM'I ,S FOB Valuation Description I Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone " 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-01597ISSUED: llll0l2005APPLIED: llll0l2005EXPIRES: 05/1012006 VALUE: Total Value of Project Date PaidFee Description -Mechanical Issuance Fee- + l0o/o Administrative Fee + 7Yo State Surcharge Minimum/Adj ustment Mechanical Wood Stove/Insert Total Amount Paid Amount Paid $10.00 $4.50 $3.15 $15.00 $30.00 $62.6s tut0t05 11/10/05 1Ul0/05 11/r0/0s 11/10/05 Receipt Number 2200s00000000001s69 2200s00000000001s69 2200500000000001569 2200s00000000001s69 2200s00000000001s69 Plan Reviews To Request an inspection call the24 hour recording at 726-3769. AII 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. Wood Stove: After Installation. Reouired Insoections 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 Springlield 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 tr lpl oS\ lt0wner or Signature Pase2 of2 Date _loFrgo rees raro I Construction Contractors Board 700 Summer St IrlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us perrnit *: Cltt't@ - -- O I S7 -7 Address: Issued by:Date: lf-tO'Of kr h- 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 1. 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 or on completion. tr 3A. My general contractor is (Name)(ccB #) I will instrrct my general contractor that all subcontractors who work on the strucfure must be licensed with the Construction Contractors Board. \- OR )-./[4 38. I will be my own general confractor. 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 noti$/ 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 about Construction Responsibilities on the reverse side of this form. 0 ofpermit applicant) (White copy to issuing agency permitfile, pink copy to applicant.) @ate) Property_owner.doc 06-0 I -04 I Acting as \ our own General contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT GONSTRUCTION RE$PONSIBILITIE$ NOfg: This lnfarmation Noti*a ta Praperty Owners about Construction Responsibilitr'es was developed by the Constructian Contractors Eaard in accordance with ORS 701.A55f5J, passed by the 1989 Oregon Legislature- If you are acting as your own contractor to construct a naw home or make a stibstantial improvernent to an existing skuctur:e, you san prevent fiiany probl*ms by being awar* *f the following responsil'rilities Employer Responsibilities You wlf, iprrpsn insiances, be ruled to be an "employer" and the contactors you.conkact with will be "employees" if you.u$9 c.on*aqfors not lisensed with the Construction Coatractors Board to do labor in coqstructing o: tg apsis! in the corstruction or improvement of a residgntial structure. As the employer, you must.comply with the following: Oregon's Witnnotding Tax Law: As an employer, you must withhoid income taxes from employbe wages at the time empioyees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Departmant of Revenue at 503-378-4988. Unemployment Insurance Tax: As an emplcyer,.you arerequired to pay a tzfi far unanploynrent insurance purpose&: on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. \ The Oregon Business Identification Number (BII.{) is a combined number for bo& , Oregon Withholding and Unemployrnent lnsurance Tax. To file for a BIN, call 503-945-8091 or wwrv.dor"state."or.us/&rmspay.htrrll for the appropriate forms. W'orkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensalion insurance for your employees. If you fail to obtain workers' cornpensation insurance, you could be subject to pehalties and be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-78 I 5. U.S. Internal Revenue Service: As an employer, you must withhold fedeml irrcome tax-tom emplo3rees'*ug"N You will be liable for lhe tax payrnent even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at l-800-8294933 or visit their web site at qw!{.i!:s.sov" , Other Responsibilities and Areas of Concerrs 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 attenfion through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insuranee coyerage for accidents and omissions such as falling tools, paint over spray, rvater damage from pipe punctures, fire or work that must be redone" Time: Make sure you have sufficient time to supcrvise your employees. Expertise: Make sure you have ih.'skilh to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building offrcials as the appropriate times so they can perform the required inspections. If you have additional questions call the Constmction Contractors Board (503-3784621) or write the ageney at PO Box 14140, Salem, OR 97309-5052. : ,, ,) .i Property_owner. doc 06-0 l'04 2?5 Fiftl Street Springfield, Oregon 97 47 7 541-726-3759 Phone City of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT #: 2200500000000001569 Date: llll0l2005 2:52:53PM Job/Journal Number coM2005-01s97 coM2005-01597 coM2005-01597 coM2005-01597 coM200s-01597 Description + 7%o State Surcharge + l0o/o Administrative Fee Wood Stove/Insert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Item Total:$62.65 Amount Due 3.15 4.50 30.00 15.00 10.00 Payments: Type ofPayment Received By Check Number Batch Number Number How Received Amount PaidPaid By ADAM BIEGHLER djb 145715 In Person Payment Total: $62.6s $62.6s l( .1.' I 1/10/200s Page I of I *pi$raFl*t-}