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Home My WebLink AboutPermit Mechanical 2007-6-20 . . CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-00905 ISSUED: 06/20/2007 APPLIED: 06/20/2007 EXPIRES: 12120/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1006 OLD ORCHARD LN ASSESSOR'S PARCEL NO.: 1703234405500 Springfield TYPE OF WORK: Mechanical Only TYPE OF USE: New Rcsidential PROJECT DESCRIPTION: Extend existing gas service Owner: Address: WAYNE ULMER 1006 OLD ORCHARD LN SPRINGFIELD OR 97477 Phone Numher: 541-741-2015 ~\o _0.'\0..,,\,\'1 ^.t'\\)\\--,,(\ v J \{)'(\.\' \,,1l'CONT-ID\OfOR'INFORMA TION I 0<;00. " ~eg '0'1 '" ~I,}\e'" - ~'!J-~e'=>v, ~n ~~ro~\e~'(\o,=>e ~'(\ 01" '$'oe ~I,) Of'.0 License 7><S ~ \ ~ol,} 0\ e~~' of'. -< ,,^,e' 'I'~ c,"", "'~ .._,,\~ ~~~O~ :~o<;oo. v;$\'\)~;"h"liulm;i]~tG\[j\j~ORMA TION I \ ,,',c," ~v 0" \I 1\ " ~o\\\~ ~ 9~ ~7>'l \e~' \' ~ u"" l.:r # of Units: '1001" '{Ol,} ec,0f'. O~e~~r,'Stories: Primary Occupancy GroJp.:,\)~\)'~\f'.~~O\.:s.0 \'=> \,'OReight of Structure: Secondary Occupancy Group: c,"" :oe~ ~ e!0\e~ Type of Heat: Primary Construction Type ~'V<S' VW Water Type: Secondary Construction Type: Range Type: # of Bedrooms: Energy Path: Sprinkled Building: Contractor Type Mechanical Expiration Date Phone Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: Occupant Loa.d: p.<;J.,"t- I DEVELOPMENT INFORMATION I "\'<>~:~~~" <. ~ ~,,-R.EQUlRED PARKING ~v ~\"" R'I'<' Overlay Dist: x..~ S 'X~ ~~,oral: # Street Trees Rqd: . ~t~:'''\- ~ '\~ ~~~~Handicapped: Paved Drive R9.<Xv~' ~'\ C;; ~~~ 'r-~~ Compact: % of Lot CO\~J'age~x..~ x..~ 'oS ~ ,CO ~. ,\I(<.':v.~~~rx..~ ~("Iy~\:i I PUBLIC IMPROVEME'N:r~i'~~ ~'r-' . ~ '" \ 'r-""'" Sidewalk Type: nla Street Improvements: Storm Sewer Available: Special Instruction: DownspoutsfOrains: Notes: I Valuation Descriotion I I i Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee I of2 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-0090S ISSUED: 06/20/2007 APPLIED: 06/20/2007 EXPIRES: 12/20/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fp.p.sP~ Fee Description -Mechauical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Gas Outlets 1-4 Minimum/Adjustment Mechanical Amount Paid Date Paid Receipt Number $10.00 $4.50 $2.25 $3.60 $4.00 $41.00 6120/07 6/20/07 6/20/07 6/20/07 6/20/07 6/20/07 1200700000000000795 1200700000000000795 1200700000000000795 1200700000000000795 1200700000000000795 1200700000000000795 Total Amount Paid $65.35 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. lJeouiredJrrr\,p.~tWWJ Rough Gas: After liue is installed and required testiug and capped if not attached to an appliance. Final Gas: When all gas work is complete. 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 pertaiuing to the work described hereiu, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Divisiou, 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. ).-t' .J'-.LA i>'Y''' ""LQf)/'YV'V?.r- Owner or Co'uractors Signature G - d- <.J- 07 Date Pa~e 2 of2 (t), , , , ' , , , " '.. .' , , . - ... Construction Contractors Board 700 Suminer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Pennit #: CJ)W\ '.0-0 Q 90 S- /(Jo6 old Orc1M\...J L-A/ ~ Date: iZu~ 7 Address: Issued by: 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 apl"VI,,;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. ~3B. OR I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl 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. lJu~ ~~;/'o- r.:. -::2--0 - 0 f J (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner, doc 06-01-04 I A~trnnni 2l~ 1rtlllllf CQ)wnn Gtennteff21ll CC!trff21~tr<IDffT , . INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES .. NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Constructid.~ Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting ~ 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, JEmlPnilJlY~]]' lR~!illPilJInn!ilnlbnnll~lle!il 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 witb tbe following: i 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. i Unemployment insurance ']fax: 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.usfformsnav.htmll for the , appropriate forms. Wor:{crs' Compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your 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 infohnation, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947:7815, V.S. Hnternal Rcve1lUe 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 1-800-829-49:33 or visit their web site at www.irS,l!OV, i!JJtlbeIr lFtle5IP'illlrm5n~IinfiD:fie5 2Hml1!l AIrlem5 illllf <CilJlrm~leIrnn5 Code Compliance: I, 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, I lLia;,ltity aUlI Il'ro?erty IDamlllge ITnsurancc: 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 havc sufficient time to supervise your employees, IExllutise: 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 appropriate times so they can perform the required inspections, I 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 J:ifth St,reet Springfield, Oregon 97477 541-726-3759 Phone . a Wit. ar of Springfield Official Receipt .velopment Services Department Puhlic Works Department Job/Journal Number COM2007-00905 COM2007-00905 COM2007-00905 COM2007-00905 COM2007-00905 COM2007-00905 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 11 :46:56AM 1200700000000000795 Date: 06/20/2007 Description + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Gas Outlets 1-4 Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Amount Due 2,25 3,60 4,50 4,00 41.00 10,00 $65.35 Paid By WAYNE ULMER Item Total: Check Number Authorization Received By Batch Number Number How Received djb 256488 In Person Payment Total: $65,35 $65.35 Amount Paid Page 1 of 1 6/20/2007