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Home My WebLink AboutPermit Mechanical 2003-4-28 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF ~rKll~uJ11J!.LU Building/Combination Permit PERMIT NO: COM2003-00307 ISSUED: 04/28/2003 APPLIED: 04/28/2003 EXPIRES: 10/28/2003 VALUE: * SITE ADDRESS: 6815 MAIN ST ASSESSOR'S PARCEL NO.: 1702344400501 Springfield TYPE OF WORK: Mechanical Only PROJECT DESCRIPTION: InstaU gas piping TYPE OF USE: Owner: JOSHUA MOORE Address: 6815 MAIN ST SPRINGFIELD OR 97478 Contractor Type Mechanical Owner I CONTRACTOR INFORMATION I License Contractor JOSHUA MOORE JOSHUA MOORE # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description ,0 .....~ .~...\ BUILDING.INFORMAlJION I "' .\ ~0(..,~0'/>- 0 "'- ~- '0'> jj'ofStoric. s: 7fi. C?J'5 '0'<> :\S~ ,,!-'- ,a~ Q- ,>' 0 R-3 d'0 lleiglit of.Stru~fure ~ ^~ ^ O~",Y) :!.." ~e.' "'~ '(\'- ~v .0" ~. ~,0'!..~~:o~U~at:o' ~0~ '(j~ VN,O ,,00 ,,~Water~'fy. .P.€I" ",0 ,0 ^~~ _" ~v ~'" .'0' ,\~ '(\' ~v --<.0- ,s.0 (j0~ J~..an~~'r:~p.~1' .&~ ~"v ~ .. >t\ ~ , o~ Rl' Energy~alh;)~ [l,":J '~~,,(j~ C?J~'1PA\0-~ u...~'0':0Q,0~,,_~~'I; _"-".t'1. . ,..- rv 1"'\'- _C'\'-' ~~O~~I~ii0.VELopiVIENT INFORMATION I I:)C:S '/Yo. 0" ~'- (j r$''<:J (j0 ~-S Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: New Residential Phone Number: 541-914-8102 Expiration Date Phone 541-914-8102 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING Total: R:l~andicapped: ~ ~ ~~pact: ~'\~~~~ .-l.'Q~\~~~'V <..\S I PUBLIC IMPROVEMENTS t~~~ ,\~~~'V\),. ,,\~~~$ ~ ~~'V~~!k Type: ~~ ~ 'V.~ ~\,~ x.'V 'V~~spoutsmrains: '\~ ~~\S ~~~ ~ ~ ';:)~~,'Q~ 'V ~~~ % of Lot Coverage: I Valuation Descriotion I Type of Construction Square Footage $ Per Sq Ft Page 1 of2 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 Furnace - up to 100,000 btu Gas Outlets 1-4 Minimum/Adjustment Mechanical Total Amount Paid . . CITY OF ~rKll~ut<lJ!.LD Building/Combination Permit PERMIT NO: COM2003-00307 ISSUED: 04/28/2003 APPLIED: 04/28/2003 EXPIRES: 10/28/2003 VALUE: Total Value of Project ~ Amount Paid Date Pai Receipt Number 1200200000000001080 1200200000000001080 1200200000000001080 1200200000000001080 1200200000000001080 1200200000000001080 1200200000000001080 $10.00 $4.50 $3.15 $12.00 $12.00 $4.00 $17.00 4/28/03 4/28/03 4/28/03 4/28/03 4/28/03 4/28/03 4/28/03 $62.65 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. I Reunired Insnedion" I Rough Mechanical: Prior to Cover 2 Final Mechanical: When all mechanical work is complete. 3 Gas Service: After line is instaUed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. 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 wbo 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. owner~:to~= Lj~ Z;3 -0 :;5 Date Pal!e 2 of2 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone _~..F1.IU.D......,... Wit. , , I ~cC _~_. . : City of Springfield Development Services Department Public Works Department Official Receipt Receipt #: 1200200000000001080 Date: 04/28/2003 Job/Journal Number Description Furnace - up to 100,000 btu Appliance Vent Gas Outlets 1-4 Minimum! Adjustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Amount Paid COM2003-00307 COM2003-00307 COM2003-00307 COM2003-00307 COM2003-00307 COM2003-00307 COM2003-00307 12,00 12,00 4,00 17,00 10,00 3,15 4,50 $62.65 . Item Total: Payments: Type of Payment Paid By Received By Check Number Confirm No How Received Cash JOSHUA MOORE djb In Person Change JOSHUA MOORE djb In Person Payment Total: Job/Journal Number Uescription COM2003-00307 Furnace - up to 100,000 btu COM2003-00307 Appliance Vent COM2003-00307 Gas Outlets 1-4 COM2003-00307 Minimum! Adjustment Mechanical COM2003-00307 -Mechanical Issuance Fce- COM2003-00307 + 7% State Surcharge COM2003-00307 + 10% Administrative Fee Item Total: Payments: Type of Payment Paid By Received By Check Number Conl1rm No How Received Cash JOSHUA MOORE djb In Person Change JOSHUA MOORE djb 10 Person Payment Total: Amount Paid 80,00 (17.35) $62.65 Amount Paid 12.00 12.00 4.00 17.00 10.00 3,15 4,50 . $62.65 Amount Paid 80.00 (17.35) $62.65 4/28/2003 1:16:l5PM Page 1 of! cReceipt.rpl - C~nstruction Contractts 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 e. , . . . , . . . " . " ...- Permit #: CO"", z.~ 3.0 7 Address: b'if/)" m#IN SJ Issued by: oCS Date: i2-~~( 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 be filed with the permit, Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: '1. I 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. D 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 f 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. ClML~1Z- (~;~~ of permit applicant) y- 2/1-0 3 (Date) (White copy to issuing agency permit file, pink copy to applicant.) prop-own. doc 05/22/00 . . A~G:llilll~ ~~ Y C\l1lIY' r[JJWD CG~llile:r~[ C([D1'}11:r~c;~:0;;'T 'Mc::nF:>1iJ"""r'''.1 M"''7I'''''' "","'l< ~",~,"q{,:'.'"", """,","'.'''''' iI\:~ vloil...~'~. ~~;;I\l r\;~.. 1Wt:~ _ ,oJ .. ~'\U. ._.\\ j b' ''''I..\,'..\.:c.''~ A~~;:j"~ ::;O~~~t::'{JC~.:O~ ~1~:~:5)O:~S:~]t .:~:'~CS } ,_.'_.~...-<o _.__~,,____._ ___________ __ ___ ~ _ _ _ _. _..__... _ ___._ __ _._._ __"'.- _, I, NOTE: This Information Notice to Properly Owners about Construction Responsibilmes WES developed by tlu' : Construction Coptractors Board in accordance I'lith ORS 701.055(5), passed by the 1989 Oregon Legislature. J . ~---"~. -'-., -'-.- -'--'" ----_..... -... -..-...-- ._.<.-- '. rfyou au acting as your own cflnVactcr to construct a new home or make a substantial improve:nent to an existif\;< "tructure, you can prevent many problems by being aware ofth~ following responsibilit:c\ and c~ncerns. ZI::QILDj4)Ver lRZe~;lJJ~~S)ffu:nllEt=(2z) ~ ~ .. You will, in most instances, be mled to be an "employer" and the contractors your contTact with will be "employ~es" if you use contra.;to:s not licensed with the Construction Contractors Board to do labor in constructing or to a~sl~t i,., the construction or improvement of a residential structure, fi:..~ ~::2 2~)!oye\.. you m.!<.1 ru;np'y "';,,a ,::c r~:::l",. :'if:: C:-egO:1's Wftt2C:diilg ':'ur ::"!:~7: As an employer, you must withhold income taxes from employee wages at thL l!me employees ar~ paid, You will b" habIt for the tax payments eYen i, yOU don't actually \\1thhold the lu,; f(Om }ou. employees. For:: State 3usiness ill nurr,!1er, cal1 the Business Information Ccnter at 503-986-2222. '~:ilo;:~:?:oy:ne:1f ::TI5l::n:cce ']['clr: As an .:nploycr. you ar~ required to pay a t1X for unemploym~nt insurr.llce PT""~' on the wages of al1 employees. For more infonn;.1tion, call the Oregon Employment Department ht 503-37\1-35:"". \.;~,'c::<e:.s' r::n:..:;zn~a~:o:n =c&:::~f'-,--:C2: /\5 an employer, you are subject to th..: O:egon \Vor!(c_.~' Comp.:nsation J ,,'1\\'. and must obtalTl workers' compensation in;urancc for your er"jJ;oyees, If you faillo obtain workers' eomper,,"iI011 insurance, you could b~ subject to penaJ'l~s and be Ija~le for all claim costs if one of your employees is injured on thl job. "For more infonnutlon, cull the ',Vorkt.:rs' Cpmpensail11n Divisio:l at the Departnh.nt of Consuri~lr n::d Bus\ '\.:"', SerVlCI'S at 503-947-7810, :".s. =::~2:r:-:n! ~~e\~i::C~ 52T".:t'~: i\...');P ~mploy~r. you must \'.ithhold fecicr~l incom..: tax from err:p:uy;:t.s' \"\ ;;r\.'~. Yo" wi!: be 1i;;I-1e fQT th~ tax ;,ayn:ent c,en ifynu d:c.n't actually \\1thhold the tax, ell;. J Fcde-~l 'eL" nu!"",ber, C the IRS l': RI0-620-7115 or write to th~m at IRS, Mail Slup 6271, PO Dox 9941, Ogden. liT 8.'409. "-",A"",,~_ T1),.....~.--._-...,..~~~'1\.~-~.A_~_, ---:,,>,-r, A. "3r' "'"' r.J;' ~"""''--'A~'''''-''''B. \_'-.-...::~ 'S"'\~;;;,)j ..I\IJ;'.,.:s....JI......""..l\;;5 f?:. _:...1 . j .....c!-& 01',. \.L, ...,.........,:;.. __..... Cn;:C2 c::::::- .;;~~ "2: .~,s the pewit holdcr [or thIS project, you are responsible fo, resolvmg any fnil<.:re I,) rr..~t cl'd~ req-.J~rements that may he brOl.,lgh1 to your 3ttentlUn through mspt:ctions.. :':1:j)::!~' z~:c: '?ro~(,7ty I;2lT:-f-ge =t:E:~:rar:ce: Contact your insuranc..: agt'11t to see if )'ou ha \'l,,; G(lequate insuranct. co\'~ragc [or accidcJts rr:d OtTIll-oSWnS ~u,:h as fal!1'1g tco:s. paint o\'er spray~ wat...! d~m~~:.c froro "'1.~;: pl'~ctu'-..:s. tlrL' or work that must be r~-done. A~ any empl"yt.T, you nlay be responsible for injuries su~tai;-;l'd by yO;ir emplo)'l.:l's. ":'i~2: :\lake sure you heW sufficient time to supcn1se your ~mpJoyces. ZJ::>~~tjS2: Make ,urc you have the skills to act as your o"n general contractor, to coordina:e the work of rou~h-1O anL tin ish tTudc'. and to notify bLildmg officials as the appropriate times so they can perform the required irsiJectiom. If you have atldllional questions call thc Construction Contractors Board (503-378-4621 ext. 4900) or writc the agency at PO Box 14140. Salem, OR 97309-5052, PIOP-O\\ n.doc 05"2200