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Home My WebLink AboutPermit Building 2006-7-18 '. . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00903 ISSUED: 07/18/2006 APPLIED: 07/18/2006 EXPIRES: 01118/2007 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1101 DARLENE AVE ASSESSOR'S PARCEL NO.: 1703272204400 Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential PROJECT DESCRIPTION: Install pellet insert Contractor TED L HUFF JR Phone Number: , , '/~ law reqL,ires you to . -.-.~n oy the Ore U " , .; "-.'[;,) Cl-nter Thn~~ _, ." gon tlllly 'II \Jr"l :::~~-U01-()n1fl th~.... _, -.: ~''''' vCllurrn V,JCONl1RAGfOR INFORMJ\ TlON '1)2-001- lCd/ling the center N . :.- -.."'" ules by number for the Ore' g( otue',Eicen'se)hOnExpiration Date on I"...." I'f' Center j, U'M ~M7~~06) Ilcation 05/15/2007 ~- _U-P""tJ. DU'L'"'''.. INFORMATION I 541-687-6695 Owner: Address: ROBIN CALVERT PO BOX 70522 EUGENE OR 97401 Contractor Type Mechanical Phone 541-338-7550 VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft GaragelCarport Sq Ft Other: . Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Fronlyard Sethack: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: Total: # Street Trees Rqd: Handicapped: fli'~ep,Qfjye Rqd: THE WORKCompact: % of,Lot G:overage:\LL EXPIRE IF T ~~I'{~o~RizE'D UNDER T~,I~.~~~~~T[~CNO - . .' .- ~.... .. ..- . ~ nUl ,,~.... ~.. -. I PUBL1(NMPROVEMENTS'11. t\l'lll I v.... ..... Sidewalk Type: Street Improvements: Storm Sewer Available: Special Instruction: DownspoutslDrains: Notes: I Valuation Descriotion I Description Tvpe of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e I of 2 . .CITY VI' ~rluNGFIELD ' Building/Combination Permit PERMIT NO: COM2006-00903 ISSUED: 07/1812006 APPLIED: 07/18/2006 EXPIRES: 01118/2007 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 Fees P,gid I Fee Description -Mechanical Issuance Fee- + 10% Administrative,Fee + 8% State Surcharge MinimumlAdjustment Mechanical Pellet StovelInsert Amount Paid Date Paid $10.00 $4.50 $3.60 $15.00 $30.00 7/18/06 7/18/06 7/18/06 7/18/06 7/18/06 Receipt Number 3200600000000000387 3200600000000000387 3200600000000000387 3200600000000000387 3200600000000000387 Total Amount Paid $63.10 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. ~edionsl 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 aud correct, and I further certify that any and all work performed shall be done in accordauce with the Ordinances of the Cily of Springfield and the Laws of the State of Oregon pertaiuing to the work described herein, and that NO OCCUPANCY will he made of any structure without permission of the Communily Services Division, Building Safety. I further certify that only coutractors 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 properly, and the approved set of plans will remain on the site at all times during construction. ~K' CJ,+ Owner or Contractors Signature }l Irfl /9; - ()6 Dae - d Pal!e 2 of 2 . . Construction Contractors Board ,/' r 700 Sununer St NE Suite 300 _PO Box 14140 , i Salem OR 97309-5052 \ ./ Pbone: 503-378-4621 '", ..,' Web Address: www.ccb.state.or.us Pennit #: COIN, z.oJt- 00 90:J Address: //0 ( Ot1(t{)::-Nl:' A II 01" Date:~~~ 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 be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~J. ~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, ~3A. My general contractor is \ c~ ~fl- 7:5 go ~ (CCB #) L (Name) 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. IfI hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board, IfI 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. HaP. I:LJ- --f,'%~ (Signaturd-o!permit applicant) 0 ate) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner,doc 06-01.04 AdnlIlig':m~ --AlliIt ~wnn- GtennteIr'~nc!n~Ir'~~~llDIr'? \ ' J."IN~6RMATIONNOTICE TO PROPERTY OWNERS '", ' \ \ ABqU~ CONSTRUC;:TION RESPONSIBiliTIES . '\ , NOTE: This Information Notice to Properly 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, Empnoyer :!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 tbe employer, yon must comply with the following: Oregon's WitbhoIding Tax Law: As an employer, you must withhold income taxes from employee wages at tbe 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 Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpos~s"'" 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 nwnber for both Oregon, Withholding ana Unemployment Insurance Tax, To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmlI for the al'l',ul'.~;ate fOfI!1s, --\.: I ,J ( _,' '" 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 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, c'all the Workers' Compensation Division at the Department of Conswner 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 nwnber, call the IRS at 1-800-829-4933 or visit their web site at www,irs:l!ov, Otlllell" lResponsilbRBitnes31lllqj! Areas of COlllcell"lllls 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 general contractor,' t;;'~oordinate 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 (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052, , . Properly_owner.doc 06-01-04 225 Fifth Street SpringfiekI, Oregon 97477 541-7f'~3759 Phone · ~.t'If Caof Springfield Official Receipt _Iopment Services Department Public Works Department Job/Journal Number COM2006-00903 COM2006-00903 COM2006-00903 COM2006-00903 COM2006-00903 Payments: Type of Payment Cash cReceintl RECEIPT #: Date: 07/18/2006 3200600000000000387 Description + 8% State Surcharge + 10% Administrative Fee Pellet Stove/lnsert Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Paid By ROBIN CALVERT Item Total: l.:heck Number AuthorizatIOn Received By Batch Number Number How Received d j b In Person Payment Total: Page I of 1 11:39:42AM Amount Due 3.60 4,50 30,00 15,00 tO,OO $63.10 Amount Paid $63,10 $63.10 7118/2006