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Home My WebLink AboutPermit Mechanical 2008-8-21 CITY OF SPRIN\JJ:<lJ',LD Building/Combination Permit PERMIT NO' COM2008-01264 ISSUED, 08121/2008 APPLIED. 08/21/2008 EXPIRES: 02/21/2009 VALUE' Status Issued 225 Fifth Street, SprlDgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme SITE ADDRESS 1373 33RD ST ASSESSOR'S PARCEL NO 1702303407201 Spnngfield TYPE OF WORK Wood Stove TYPE OF USE PROJECT DESCRIPTION Woodstove Owner RONDA JACKSON Address 1373 33RD ST SPRINGFIELD OR 97478 Contractor Type Mechamcal I CONTRACTOR INFORMA~~N I o.\l\~"~ , \}\\\\l1 \9.'" Ie OtagO\} y~~~ L" o~e901\ b'l \"a s e.ta~ .00" ~\ ,::~O"".J.-~\a~"J,.,~~'\l~J ,f'" r;>,~2 0_ ...." ~\O'" to\flt~~lDIpP((;'lNf<:{\JltM1ne~~e \0 ~\C~~~,,~lJ" il\b~V \"alJ,~\ e.\\ol\ R~~~~ ~o;r2~\~~i!~~~;~~0~:\C ce\\\1\9 : \if~~ ~"'il~(). VB t\u(t\~e ~~ ype Range Type Energy Path Spnnkled Bmldmg Contractor OWNER # of Umts Pnmary Occupancy Group Secondary Occupancy Group Pnmal y ConstructIOn Type Secondary ConstructIOn Type # of Bedrooms I DEVELOPMENT INFORMATION I Frontyard Setback SIde I Setback Side 2 Setback Rearyard Setback Solar Setbacks New ReSldenhal Phone Number 541-556-2612 ExpIratIOn Date Phone nla Lot S,ze Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft GaragelCarport Sq Ft Other Occupant Load REQUIRED PARKING Overlay Dlst Total # Street Trees Rqd lk4t&capped Paved Dnve Rqd \\'t. ~~ct % of Lot Coverage 1?-'t. \~ ~ 11.~ \CO ~\,'\ o't.'?-'''' 'f.'i;)y. . . _ i 1 \ (Ie.., J.$.\\ I PUBLIC IMPRQ-'<I\M-E~~~~~~"-'?- ~~\lo.~'i) ,- ~ 1-' ,,-\\ $ :ffi I" \\\\~\\()'?-~c,"-~ ~~~~Ik Type \lo.\J ~~~ ~~ mownspouts/DralDs c,~~"l \'O~ Street Improvements Storm Sewer AvaIlable Spec..llnstructlOn Notes I ValuatIOn DescrlDtlOn , Description $ Per Sq Ft or mulhpher Square Footage or Bid Amount Type of ConstructIOn Pa2e I of 2 Value Date Calculated ~~ Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO, COM2008-01264 ISSUED 08/21/2008 APPLIED 08/21/2008 EXPIRES 02121/2009 VALUE' 225 Fifth Street, Spnngtield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn LlDe Total Value of ProJect Fee~ PaId I Fee DescnptIon ~MechaDlcal Issuance Fee- + 10% AdmmlStratlve Fee + 12% State SUI charge + 5% Technology Fee MlmmumlAdJustment Mechamcal Wood Stovellnsert Amount PaId Date PaId Receipt Number $2100 $520 $624 $260 $1900 $33 00 8/21/08 8/21/08 8/21/08 8/21/08 8/21/08 8/21/08 2200800000000001275 2200800000000001275 2200800000000001275 2200800000000001275 2200800000000001275 2200800000000001275 Total Amount Paid $87 04 I Plan RevIews I To Request an Inspection call the 24 hour recording at 726-3769, All inspections 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, Reolllred I nsnectlOns I Wood Stove After InstallatIOn By SIgnature, I state and agree, that I have carefully examlDed the completed apphcatlOn and do hereby cerhfy that all mformahon hereon IS true and correct, and I further certJfy that any and all work performed shall be done ID accordance with the Ordmances of the CIty of Spnngfield and the Laws of the State of Oregon pertalDlDg to the work descnbed herelD, and that NO OCCUPANCY Will be made of any structure without permISsIOn of the Commumty Services DIVIsIOn, BUlldmg Safety I further certify that only contractors and employees who are 10 comphauce wIth ORS 701 005 will be used on thiS proJect I fUI ther agree to ensure that all reqUIred mspechons 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 remam on the site at all times durmg constructIOn '" i f\___ k / /) M./~ Owner or co-ntractor~ature g _ ;2./-00 Date Pa2e 20f2 Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone, 503-378-4621 Web Address: www ccb state or us PermIt # C0w1Z-0cs-t~ OIZ-bL{ I s73 :J :> a-cL \, (5 Date n/z(/;;;y / Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) reqUIres resldentzal constructIOn permit applzcants who are not lzcensed with the ConstructIOn Contractors Board to sign the following statement before a bUilding permit can be Issued This statement IS reqUIred for resldentzal buzldlng, electrzcal, mechanzcal and plumbing permits Licensed architect and engineer applzcants, exempt from licensing under ORS 701 010(7), need not submit thiS statement This statement will be filed with the permit FIll In the appropnate blanks and lllitlal boxes 1 and 2, and either box 3A or 3B jqI ~2 I own, reside m, or wIll reside III the completed structure I understand that I must become lIcensed as a constructIOn contractor Ifthe structure IS sold or offered for sale before or on completion o 3A My general contractor IS (Name) (CCB #) I will mstruct my general contractor that all subcontractors who work on the structure must be lIcensed With the ConstructIOn Contractors Board OR ~ 3B I wIll be my own general contractor IfI hire subcontractors, I will hire only subcontractors lIcensed With the Construction Contractors Board IfI change my mInd and hire a general contractor, I will contract With a contractor who IS lIcensed With the CCB and wlllllnmedlately notify the office ISSUIng thiS bUIldIng permit ofthe name of the contractor I hereby certIfy that the above mformatlon is correct and that I haye read and do understand the InformatIOn Notice to Property Owners about ConstructIOn ResponSibIlities on the reyerse SIde of thiS form, ~ dvvl ~ _ LA Q - .2/ - 0 r -- (Sl~uieohermlt applIcant) - (Date) V (WhIte copy to ISSUing agency permit file, pink copy to applzcant) Property_owner doc 06-01-04 ") - \ Att~\:D'g-as 'Yout ,Own General Contractor? ,,- , INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ~, - \ s \,\ , , - - NOTE This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board In accordance with ORS 701 055(5), passed by the 1989 Oregon Legislature . If you are actmg as your own contractor to construct a -new home or make a substanl1al Improvement to an eXlstmg structure, you can prevent many problems by bemg aware of the followmg responslblll hes and concerns Employer Responsibilities , You ,:WIll, m most mstanc,"s, be ruled t~ be an "employer" and the contractors you contra\=t WIth WIll be' "employees" If you use contractors not hcensed w1th the ConstructlOn Contractors Board to do labor m constructmg or to asSIst In the construcl1on or Improvement o~ a resldenl1al structure As the employer, you must comply with the following: . ' J. _ . Oregon's Witbb~lding Tax Law: P:s an employer, you must wIthhold mcome taxes from employee wages at the lime employees are paId You WIll be liable for the tax payments eyen If you don't actually wIthhold the tax from your employees For more mfonnatlOn, call'the Dep'arhnent of Revenue at 503-378-4988 : Unemployment Insurance Tax: As an employer, you arc reqUIred to pay a tax for unemployment msurance purposes!... on the wages of all employees For more mformal1on, call the Oregon Employment Deparhnent at 503-947-1488 ' , --!:.. The Oregon Busmes~ Idenl1fical1on Number (BIN) IS a combmed number for both Oregon Wltljho)dmg and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or www dor state OJ us/formsnav htmll for the appropriate forms , " Workers' CompensatIOn In~urance: As an employer, you are subject to the Oregon Workers' Compensal1on La...., and must obtam workers' compensatlOn msurance for your employees If you fall to obtam workers' compensal1on I' Tt msurance, you could be suliJect to penaltIes and be hable for all claIm costs If one of your elflployees IS Injured on the ,. Job For more mformatlon, call the Workers' CompensatlOn DIVIsIon at the Department of Consumer and Busmess ServIces at 503-947-7815 U.S. Internal Revenue Scrvice: As an employer, you must WIthhold federal mcome tax from employees' wages::-<. You WI]] be hable for the tax payment even If you didn't actually Withhold the tax For a Federal ElN number, call tIle IRS at ] -800-829-4933 or V1Slt theIr web sIte at www II S QO~ ~ -, r > , Other Responsibilities amI! Areas of Concerns Code Comphance: As the penrut holder for thIS project, you are responsible for resolV1ng afty faIlure to meet codc reqUIrements that may be brought to your attenhon tlrrough mspectlons ~ ' -: t LiabIlity and I'ropcrty Damage Insurance. Contact your Insurance agent to see If you Rave adequate msurance coverage for a~cldcnt, and omlSSlOns such as fallmg tools, pamt over spray, water damage from pipe punctures, fire or work that must be redone , , .- TIme Make sure youJtave suffiCient l1me to supervIse your employees Expertise: Make sure you have the ,kIlls to act as your own general contractor, to coordmate the work ofrough-m and fimsh trades, and to nol1fy bUlldmg offiCials as the appropnate times so they can perform the reqUIred mspecl10ns If you have additIOnal que"bons call the ConstructlOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 ,: Property_owner doc 06-01-04 225 FIfth, Street Sp"rmgfield, Oregon 97477 541-726-3759 Phone ~114 CIty of Sprmgfield OfficIal ReceIpt Development ServIces Department PublIc Works Department Job/Journal Number COM2008-0 1264 COM2008-0 1264 COM2008-0] 264 COM2008-0] 264 COM2008-0 1264 COM2008-0 1264 Payments Type of Payment Cash Change Job/Journal Number COM2008-0 1264 COM2008-0 1264 COM2008-0 1264 COM2008-0 1264 COM2008-0 1264 COM2008-0 1264 Payments I ype of Payment Cash Change cRecelOtl RECEIPT #. 2200800000000001275 Date: 08/21/2008 Description Wood Stove/lnsert MmlmumlAdJuslment Mechamcal + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee -Mechamcallssuance Fee- Item Total Check Number AuthOrization Received By Batch Number Number How Received PaId By RONDA JACKSON RONDA JACKSON Descnptlon Wood Stove/lnsert Ml1l1mum/AdJustment Mechamcal + 5% Technology Fee + ]2% State Surcharge + 10% AdminIstrative Fee -Mechamcall>suance Fee- dJb dJb In Person ]n Person Payment Total Item Total t:heck Number AuthOrization Received By Batch Number Number How Received PaId By RONDA JACKSON RONDA JACKSON Page 1 of 1 dJb dJb ]n Person In Person Payment Total I 21 25PM Amount Due 3300 1900 260 624 520 2] 00 $87 04 Amount Paid $10010 ($1306) $87 04 Amount Due 3300 1900 260 624 520 2100 $87 04 Amount Paid $]00 ]0 ($]306) $87 04 8/21/2008