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Home My WebLink AboutPermit Mechanical 2004-10-12 . . CITY OF SPRINGFII'..LU . Building/Combination Permit PERMIT NO: COM2004-01260 ISSUED: 1011212004 APPLIED: 10/1212004 EXPIRES: 04/12/2005 VALUE: Status Issued 225 Firth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1307 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1703253210000 Springfield TYPE OF WORK: Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: InstaU LP insert Owner: HELFRICH DEAN TE Address: 2587 N 19TH ST SPRINGFIELD OR 97477 1 CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor SUBURBANPROPANELP License 147469 Expiration Date 05/1112005 Phone 800-526-0620 I. BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: R-3 ~. Height of Structure Secondary Occupancy Group: ~~ ~~ .:'1'Ype of Heat: Primary Construction Type ~~'\. '$ i;;.~';!Y,at'!{ Type: Secondary Construction Type: ~ ~~ ~ ~ .~R~Jige Type: # of Bedrooms: ~~ ()~ f::><I;;~~ ,,!j:rie~gy~ath: ,'?i >$'~ ~'S. O'?! .'-~ Sptink1~d Building: r<::- -~ ;-~ 'f'\ ~~ _,*,:..,'v,'V O<'~~0~ ~O~O.,)'i~DEVEioPMENT INFORMATION I ~. ~O~~. <;)~ ()d.'I!/J' '~~',.j:t. &-0 'Ii ~0 !:>" 'S' ~O ~~'[l.tr Frontyard Setbac~' ~.g.> <Jb ~ ~'Ii ~.~ o~ ~Overlay Dist: Side I Sethack: ~Y_-~~~o~ r?<;) ~o ~0 ~0<$o..<::)<::j # Street Trees Rqd: Side 2 Setback: 't'.~~lP Q)~ # ()0 00 -.!" Paved Drive Rqd: ..... '~'.<:J.. ,:) 0 .;s' '!II Rearyard Setback: ~Ol O~ 4,0 .;s' ~ <it'" % of Lot Coverage: Solar Sethacks: ....~~. ;,:$:'~ '*' ,0 'b~ ~ _<:i ;;:;. ,^v CJ - ~~ I PUBLIC IMPROVEMENTS I Lot Size: Sq Ft 1st Floor; Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla Notes: REQUIRED PARKING Tot~J:. H~~pped: ~~t: ~~ ~ #<.",~~ -<<., .~ .<'. . ~v '{v ~v ~ .p Q'S Sid~~~n:~-t C:f ,<:-,'<J c ~ l.." DpwnspoutSIDeains: 'V. ~ 'V ~ ~ ~()~ ~(.~'SQ.~ _.s:> r_" R' S-lv ~ ~ ~J -:>;-'S dJ <;;j~ ^' ~~ ~~.q,<::; , \..>'" ;,.. I Valuation Descriotion I ~ Street Improvements: Storm Sewer Availahle: Special Instruction: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Pal!elof2 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 Gas Fireplace LP Gas Tank & Piping Minimum/Adjustment Mechanical Total Amount Paid . . CITY OF SPRIr'i\.d<II'..LJJ Building/Combination Permit PERMIT NO: COM2004-01260 ISSUED: 10/12/2004 APPLIED: 10/12/2004 EXPIRES: 04/12/2005 VALUE: Fp.p..P,~ Amount Paid Date Paid 10/12/04 10/12/04 10/12/04 10112/04 10/12/04 10/12104 10112104 Receipt Number 1200400000000001467 1200400000000001467 1200400000000001467 1200400000000001467 1200400000000001467 1200400000000001467 1200400000000001467 SIO.OO S4.50 $3.15 S6.00 S15.00 S12.00 S12.00 S62.65 I Plan Reviews , 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..,jeouir~d Insnp.~tions I Rough Gas: After line Is instaUed and required testing and capped If not attached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When aU gas work Is complete. Final Mechanical: When all mechanical work Is complete. Preliminary Inspection: Prior to the Installation of solid fuel appliance which will be vented through an existing chimney. 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 aU work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of tbe 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 he used on this project. I further agree to ensure that aU 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 ail times during construction. ~1\vA. ~ \t0vk or Contractors Signature L b.-- Vi. ---0 4 Date Paee 2 of2 . . permit#:Co.M-z..o_- OIl-bO Address: /30r 0/'7'''''' f' L. ~1- Issued by: '::t:, (f Date: 10 - / Z. -0 l.( -. , , \., ..J ", ,.' Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ceh.state.or.us Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constrnction 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 al'l"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. OR ~ 3B. I will be my own general contractor. IfI 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. \,~ \~~Of_it 'Pp!;''''') \ 0-- ~;,;-" 4- (White copy to issuing agency permit file, pink copy to applicant.) :'.~t'~.;Lowner.doc 06-01-04 ;'. . A(C~nIl1lg ~~ W ([])Uilll" (Q)WlID G~Il1l~ll"2Jn C([])Il1lttll"~(c~([])ll"? iN~ORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES '. . " 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. , JEmlPlloyer JRe!llPol!1l!lnlbnllnrrne!l 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 tbe following: ,. Oregon's Witbbolding 'fax 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 lln~urance 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 Busipess 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.doLstate.or.us/fonnsnav.htmll for the appropriate forms.: " , Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain ~orkers' 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 information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815, , " U.S. Internal JR~venue 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. Ottllner Re~piOlrrn~Ji!biJillJitt:Jies anull AIrelllS OJ[ CiOlrrniCeIrIIDS Code CompliaD~e: 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, " Llablllty and Property Damage IInsuraDce: Contact your insurance agent to see if you have adequate insurance coverage for acc:dents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must ~.e-redonc, Time: Make sure you have sufficient time to supervise your employees, , JEllpel't:se: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trade$, and to notif'y butlding officials as the aI'I'WI',;ate times so they can perform the rcquircd inspections. If you have add~ional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Sal~m, OR 97309-5052. Property _ owner doc 06-01-04 225 Fifth Street Springfietd, Oregon 97477 541..716-3759 Phone . Job/Journal Number COM2004-0 1260 COM2004-0 1260 COM2004-0 1260 COM2004-0 1260 COM2004-01260 COM2004-0 1260 COM2004-0 1260 Payments: Type of Payment CreditCard 10/1212004 RECEIPT #: 7~. ~ ~ ' 1200400000000001467 Description + 7% State Surcharge + 10% Administrative Fee Appliance Vent LP Gas Tank & Piping Gas Fireplace Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Paid By JAMES DEAN HELFRICH Received By djb Check Number Batcb Number Page I of I Miy of Springfield Official Receipt .velopment Services Department Public Works Department Date: 10/12/2004 Item Total: Authorization Number How Received 012390 In Person Payment Total: 1:36:49PM Amount Due 3.15 4.50 6,00 12,00 15.00 12,00 10.00 $62.65 Amount Paid $62.65 $62.65