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Home My WebLink AboutPermit Mechanical 2005-4-20 ~. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line i. . CITY OF Sl"K1~(jFIELD Building/Combination Permit PERMIT NO: COM2005-00452 ISSUED: 04/20/2005 APPLIED: 04/20/2005 EXPIRES: 10/20/2005 VALUE: SITE ADDRESS: 1841 MARKET ST ASSESSOR'S PARCEL NO.: 1703253213300 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Repair , PROJECT DESCRIPTION: Add gas service replace interior waste and water Owner: MICHAEL GROFF Address: 1841 MARKET ST SPRINGFIELD OR 97477 Contractor Type Mechanical Plumbing Contractor OWNER OWNER , # 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: Residential Phone Number: 541-915-6652 I CONTRACTOR INFORMATION I License Expiration Date Phone I BUILDING INFORMATION I R-3 # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: ATTEJmt1M~Mgon law requIres you to Sq Ft 2nd Floor: ~li~E'led by the Oregon UtilitySq Ft Basement: Notific t,7r Pi ;. Those rules are set fort~q Ft Garage/Carport In OAR '1}* a :1111hrough OAR Q52-D0 .q Ft Other: 0090 >p rii't{ e 11lIm~:. of thn/li I b ccupant Load: . ou may 0 n CODles e ru es V I DEv\Ef'XI)~MEl\'-'1u~~~~+rON<tlhone ""I,~,.!f !~rl ~ . r ~t!!f ~"J.t~ IllJicatlon Center 181-800-332-2344). Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: VN REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Sidewalk Type: Downspouts/Drains: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Paee I of 3 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00452 ISSUED: 04/20/2005 APPLIED: 04/20/2005 EXPIRES: 10/20/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project J{ pp~ tIiILI Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Gas Outlets 1-4 Minimum/Adjustment Mechanical Miscellaneous Plumbing Amount Paid Date Paid Receipt Number $10.00 $9.00 $6.30 $4.00 $41.00 $45.00 4/20/05 4/20/05 4/20/05 4/20/05 4/20/05 4/20/05 1200500000000000478 1200500000000000478 1200500000000000478 1200500000000000478 1200500000000000478 1200500000000000478 Total Amount Paid $115.30 I Plan Reviews I 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. ~ RIi=llrlll;rprlIWII~i'''tilnll'LI Rougb Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Paee 2 00 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00452 ISSUED: 04/20/2005 APPLIED: 04/20/2005 EXPIRES: 10/20/2005 VALUE: Status Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. Ill;' itA (/ ~~ fA J!&;fj 1/- ';) ("J - O~ Owner or Contractors Signature Date Pa~e 3 of3 _! \" ..f '" ..' . . 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 Penmt#: COvVI'l.O_- bOLl)' z... '" An "'" Address: I 0 l( I IU" lc..l'-<::T ~ Issued by: ~ a Date: 'f - Z 0 -C r Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the app<vp<;ate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~1. ~2. 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. o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR -!K[ 3B. I will be my own general contractor. If! 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 notify 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. ~::g;.,.,1;'Pli!!'7f/ Ii - ..?~~n <;' (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 06-01-04 . . . _ Adnrnlg ~~TI ([])1UlJr (()wnn <GennteJ!"~ll CC([])nnt1:J!"~(Ct1:([])J!"? - j' ..I. .l' INFORII/lATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBiliTIES __ f. ,. . 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 acting as your own contractor to construct a new home or make a substantial improvemen(to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer lRe~JIlOJ]~ill>ilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees 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 Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposeS'. on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined number for both. Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appt.upl.;ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' C~u.y~..sation Law, and must obtain workers' compensation insurance for yo;rr employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties 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 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold. federal income tax from employees' wages>- You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EINnumber, call the IRS at 1-800-829-4933 or visit their web site at www.irs.l!Ov. OtRneJl" Respollllsilbnllntnes amll Areas olf COIlJl\l.~eIl"lI1S 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. Liability and Property Damage Insurance: 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 from pipe punctures, fire or work that mus(~t; redont;.: .' \. . .. \ \ {~,#~~".. '-~' ~ - \" ..,' "'\_.~.?;.,\""-:.' Time: Make sure you have sufficient time to supervise your employees. , Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the ayy.vp.;ate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owner.doc 06-01-04 225 Fifth Street , Springfield, Oregon 97477 541-726-3759 Phone . "'~lNQ"'II.D' . Wir.'.. ,.,"..-..,'.'.,.,....'... ~" '. t -.-. ; ~, ,,: r ' . ~ ' --' ~ty of Springfield Official Receipt .velopment Services Department Public Works Department Job/Journal Number COM2005-00452 COM2005-00452 . COM2005-00452 COM2005-00452 COM2005-00452 COM2005-00452 L.Payments: Type of Payment Check 'I 1".. .j A" ., 4/20/2005 RECEIPT #: 1200500000000000478 Date: 04/20/2005 Description Miscellaneous Plumbing Gas Outlets 1-4 -Mechanical Issuance Fee- Minimum/Adjustment Mechanical + 7% State Surcharge + 10% Administrative Fee Paid By MICHAEL GROFF lIem Total: Check Number Authorization Received By Batch Numher Numher How Received djb 4416 In Person Payment Total: Page 1 of 1 1I:07:35AM Amount Due 45.00 4.00 10.00 41.00 6.30 9.00 $115.30 Amount Paid $115.30 $1I5.3U