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Home My WebLink AboutPermit Mechanical 2005-1-14 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 1330 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1703253208700 PROJECT DESCRIPTION: pellet insert Owner: ANN MARLBOROUGH Address: 1330 OLYMPIC ST SPRINGFIELD OR 97477 .. CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00050 ISSUED: 01/14/2005 APPLIED: 01/14/2005 EXPIRES: 07/14/2005 VALUE: Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential I CONTRACTOR INFORMATION , Contractor Type Mechanical Contractor JAMES ALLEN MCGREW Phone 541-942-2941 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Tvpe of Construction License 11143 Expiration Date 04/19/2006 VN I BUIL~~~~ ~~~~~~~I_ON.lv requires you ~ #f6tlstt/lii4!lS adopted by the oragOI~' 1lt~ljfhl~W. Those rules are Floor: IfMi\Mt lWltO01-o01 0 through OAR t~ Floor: l}OOEl: T~):ll'l91ay obtain copies of the CJ;q ll'sement: Raog~rnpe center. (Note: the tele~arageJCarport EmlUtl'lt!ur the Oregon Utility NOtilSfj1llrother: Sprinkledl!}yillllpIll1-800-33ll.a344).Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: NOTICE: _ _.. "lrvnIDc Inl-t~ WnRK I PUBLIC IMPRQY.EME;:Jis I~~ER lHIS PERMIT IS NOT 'COMMENCED OR ISsid''e~'':JikC''F1~g: FOR ANY 180 DAY PER1CWo'wnspoutsmrains: Total: Handicapped: Compact: I Valuation Descriotion , $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00050 ISSUED: 01/14/2005 APPLIED: 01/1412005 EXPIRES: 07/1412005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fee, Paid' Fee Description -Mechanical Issuance Fe..... + 10% Administrative Fee + 7% State Surcharge Minimum/Adjustment Mechanical Pellet StoveJInsert Amount Paid Date Paid Receipt Number $10.00 $4.50 $3.15 $15.00 $30.00 1114/05 1/14/05 1/14/05 1/14/05 1/14/05 2200500000000000056 2200500000000000056 2200500000000000056 2200500000000000056 2200500000000000056 Total Amount Paid $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 Renuiredln'~ Pellet Insert: After installation 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. r:L~ ??U/1'--PJl~ Owner or C~ntractors Signature /' 1- / ~ - CO' ,.-s- Date Paee 2 of2 22:; Fifth.Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-00050 COM2005-00050 COM2005-00050 COM2005-00050 COM2005-00050 Payments: Type of Payment Check 1/1412005 . RECEIPT #: 81~1. ~ ~,j JiiitY of Springfield Official Receipt .elopment Services Department Public Works Department 2200500000000000056 Date: 01/14/2005 Description + 7% State Surcharge + 10% Administrative Fee Pellet Stovellnsert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Paid By ANN MARLBOROUGH Item Total: Check Number Authorization Received By Batch Number Number How Received djb 2908 In Person Payment Total: Page I of I 10:l3:26AM Amount Due 3,15 4.50 30.00 15.00 10.00 $62.65 Amount Paid $62.65 $62.65 e. \ i , .. " " " ,,' . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Satem OR 97309-5052 Phone: 503-378-4621 Web Address: www.cch.state.or.us Permit#:(O/M z.o'- - 000 $"0 Address: ,;. "30 O/YV'" fl- '-- S}- Issued by: ~ ~ Date: / -/Y - 0 S- 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 appropriate blanks and initial boxes I and 2, and either box 3A or 3B: WI. @" 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 ~ 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. ~m. I-/.t-./- oS- , (Signature ofpe it applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner,doc 06-0t-04 j,. . AdnlID~ ~~ 11 ([))1lliIr ([J)Willl GtelIDteIr~ll (C([))illl1Ir~~~([))Ir? INFORMATION 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. j EmjplHoyen- lRe~jploHll~Ji]}ili~ne~ You will, in most instances, be ruled to be an "employer" and the contractors you contract with wiII 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: i i Oregon's Withholding Tax lLaw: 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 actuaIly withhold the tax from your employees. For more information, caIl the Department of Revenue at 503-378-4988. Unemployment In$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, caIl 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, caIl 503-945-8091 or www.dor.state.or.us/formsoav.htmll for the appropriate forms. Workers' 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 cou\() 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 Rcv~nue Scrvice: As an employer, you must withhold federal income tax from employees' wages. You wiIl be liable for the tax payment even if you didn't actuaIly withhold the tax. For a Federal EIN number, caIl the IRS at 1-800-829-4933 or visit their web site at www.irs,l!ov. Otllnell" JRe!ljploun!lftilJlfiTIfitl:fie!l tillIlllIlll AlI"etill!l olT COIlll~ell"Illl!l 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. lLiahility 2nd J!>roperty Damgge Knsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as faIling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure )tou have sufficient time to supcrvise your employees. EXllertise: Make $ure 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 al'l',vl'.;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 I Box 14140, Salem, OR 97309-5052. Property _ o"ner.doc Q6-0 1-04 , I