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Home My WebLink AboutPermit Mechanical 2004-9-10 .. CITY 01' ~rKll~uN~LD Building/Combination Permit PERMIT NO: COM2004-01127 ISSUED: 09/10/2004 APPLIED: 09/10/2004 EXPIRES: 03/10/2005 VALUE: -. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2788 MANOR DR ASSESSOR'S PARCEL NO.: 1703233302400 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: PROJECT DESCRIPTION: Gas insert, hot water heater and gas line stub out for dryer Total: .' ~JJ;:~ped: ~ ~r;tiI4'iP: IPUBLICIMPRovrtMi~~;~~ . ~~~\l.. ~~~~~~ ~o\\~~~$~df!J!~~ ~O ~.'4oo,)::~O~o~~~ (>09 ~\i(lc.) \O~ ~e \A '\~- . f\o$fI....e~ fP~~ ... Owner: FAIRBOURN CAROLYN J Address: 2812 MANOR DR SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor LiceJlse BISWELL ENTERPRISES INC .. ,e ~'ij) I BUlLDINGf1I~\:..~jATIe~r ""\C~' ~1 ~\..(.l!'{r\\~ ~L~t.\) ~\Jll ~u \'t.?-~\ ~tl'i~~\)C) '~O?-\1.t.\) ~\Q ii1'Sfructure I'-\}'~.~~~C,t.\) l?~'Ifl1'leat: ~\,' \)~ ater Type: ~'( \~\) Range Type: Energy Path: Sprinkled Building: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: I DEVELOPM",,, 1 mrORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: . Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descrintion I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Total Value of Project Paeelof2 Alteration Residential Expiration Date 07112/2006 Phone 541-998-8143 nla Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Otber: Occupant Load: . .,.,...-REQUlRED PARKING Value Date Calculated Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Appliance Vent Fixture Gas Fireplace Gas Outlets 1-4 Minimum/Adjustment Mechanical Minimum/Adjustment Plumhing Total Amount Paid . . CITY VI' ~nuNGFIELD Building/Combination Permit PERMIT NO: COM2004-01127 ISSUED: 09/10/2004 APPLIED: 09/10/2004 EXPIRES: 03/10/2005 VALUE: I Fees P3idJ Amount Paid Date Paid Receipt Number 1200400000000001338 1200400000000001338 1200400000000001338 1200400000000001338 1200400000000001338 1200400000000001338 1200400000000001338 1200400000000001338 1200400000000001338 $10.00 $9.00 $6.30 $6.00 $14.00 $15.00 $4.00 $20.00 $31.00 9/10/04 9/10/04 9/10104 9/10/04 9/10/04 9/10/04 9/10104 9/10/04 9/10104 $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. L.Reouired Tnsnedions I Rough Plumhing: Prior to cover and including required testing. Final Plumhing: When all plumbing work is complete. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. By signature, I state and agree, that I have carefully examined the completed application and do herehy 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 he 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 tall uquired inspections are requested at the proper time, that each address is readable from the street, that the permit ca i located at the front of the property, and the approved set of plans will remain on the site at all 7~ri.' """,,' ". " r9:JA/I"- 7'. /0- do tD J Owner tr C tr~ctors Signature Date Paee 2 on . Pennit #: COllA ~- 01/ z.. ( -' . , \. ./ , " ", ..' Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.cch.state.or.us Address: Issued by: 27 ~ 8' mA-rt'OYL. 'b (5 Date: ~tL Y:/~~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constrnctionpermit 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 I and 2, and either box 3A or 3B: o o 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. K'3A. My general contractor isG 5VJ~{ I I. I own, reside in, or will reside in the completed structure. ElItk-Qr:~Es. L<- (Name) . /1) /71 (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR o 3B. I will be my own general contractor. In 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 b ve information is correct and that I have read and do understand the Information Notice to Property Ow ers bout Cons~uction Responsibilities on the reverse side of this form. a I~~M^," q-In~ ;::;.mJ (Si \l atureofpermit applicant) . '(Date) I (White copy to issuing agency permit file, pink copy to applicant.) Property_owner .doc 06-01-04 . .. . A~~JiIID'g ~~ 1l @1UlIr.'(Q)WIID INFORMATION-NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES . GtelID teIr~nC @ lID ~Ir~~~@ Ir? , 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 improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. JEmpHoyer Responsibilities 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 infonnation, call the Department of Revenue at 503-3784988. 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 infonnation, 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 Inst,mmce Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate forms. \ .} . ,\. ; ", Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Cv"'p,..sation Law, and must obtain workers' compensation inst,mmce for your employees. Tfyou 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 infonnation, 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 EIN number, call the IRS at 1-800-8294933 or visit their web site at www.irs.l!ov. 'Otllnell" RespoBllsibmties SlI1lcl All"eas of Concell"lI1lS 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 must be redone. ~. Time: Make sure you have sufficient time to supervise your employees. " Expertise: Make sure you have the skills to act as your own generalcontra'ctor, to coordinate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) 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 . G!'1'~I!,_Q!,,!l!,I?"_~_j ~ '. -. : .-.-"..,..... ,... ,'. JiiiilY of Springfield Official Receipt "elopment Services Department Public Works Department Job/Journal Number COM2004-01127 COM2004-01127 COM2004-01127 , COM2004-01l27 . ,COM2004-01127 COM2004-01127 COM2004-01127 COM2004-01127 COM2004-01127 RECEIPT #: 1200400000000001338 Date: 09/10/2004 Description Fixture Minimum! Adjustment Plumbing Appliance Vent Gas Outlets 1-4 Gas Fireplace Mini!llum! Adjustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Payments: Type of Paymenl Paid By Check CAROLYN F AIRBOURN Item Total: Check Number Authorization Received By Batch Number Number How Received djb 3423 In Person Payment Total: 9/1 0/2004 Page I of 1 2:01:46PM Amount Due 14.00 3\.00 6.00 4_00 15.00 20.00 10,00 6.30 9.00 $115.30 Amount Paid $115.30 $115.30