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Home My WebLink AboutPermit Miscellaneous 2005-11-2 . . CITY OF SPKll"l~t<lliL1J Building/Combination Permit PERMIT NO: COM2005-01553 ISSUED: 11/02/2005 APPLIED: 11/02/2005 EXPIRES: 05/02/2006 VALUE: Status: Issued 225 Flftb Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line SITE ADDRESS: 1101 DELROSE CT ASSESSOR'S PARCEL NO.: 1703234410300 Springfield TYPE OF Heating System TYPE OF USE: New Residential PROJECT DESCRIPTION: Install gas fireplace Owner: LUVERNE D & AILEEN M RITTER REVOC L Address: 1101 DELROSE CRT SPRINGFIELD OR 97477 Phone Number: 541-747-6268 Contractor Type Mechanical OU\O 'CONTRACTOR INFORMATION I \illeS'j "'\" \a.~' . ~O; 11 \.1\1 \., 4111 Ole90 'o(l.n Contractor :lION', 01 iseAs,~e ~!pirttion.pate LARRY ALLEN CHRISTENsEN~~.,,\es a.dO?51\~jSe IU~ nJl,?lf2'ifja'6Q~ , BUlLDli\fb"U1RgWii;'O\"lIlJ'I~;i~S 0\ \n,e ~~;l1e .' - .", ,"p" - bW.~' c , Ine Ie e--: \\011 ioltP'" (\130':1 0 ~Nole, ~\",.,\\C3o # of -;mri~:{o\l el1lel, \.I\\lil'jEot Size: Helgilt li1.ai\\119 \ne \.e Ole9011 '2>'2>'2..tsci-'Ft'lst Floor: Type of HJ~'bel \01 \ e( is \ .\)()(). Sq Ft 2nd Floor: Water 1)lpe: cel1\ Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Patb: Sq Ft Other: Sprinkled nla Occupant Load: Phone 541-912-1746 # of Units: Primary Occupancy Group: Secondary Occupancy Yrlmary Construction Type Secondary Construction # of Bedrooms: R-3 VN I DEVELOPMENT INFORMATION I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Storm Sewer Available: Special Instruction: IPUBLIC IMPROVEMENTSI SldeWal\\\t~~ .,.o~~ "O't\Cf:. SI-\~~Lls\S ~O 11-\\5 ~t.~~~~ U~Ot.?\ Qt>.~OO~t.O fO~ r>.\.Ii\'lOn D QPo \'5 ~" CQ\JItAt.~COt:~'C p~\OO. :.1\':' "I'Q I Valuation Descrintion I Notes: Description Type of Construction $ PerSq Ft or multiplier Square Footage or Bid Amount Value Date Calculated 1 of 2 . Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspection Line Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Gas Fireplace Gas Outlets 1-4 Minimum/Adjustment Mechanical Total Amount Total Value of Project Fees Paid I Amount Paid Date Paid . CITYOFSPRINGFIELD~ Building/Combination Permit PERMIT NO: COM2005-01553 ISSUED: 11/02/2005 APPLIED: 11/02/2005 EXPIRES: 05/02/2006 VALUE: Receipt Number 1200500000000001665 1200500000000001665 1200500000000001665 1200500000000001665 1200500000000001665 1200500000000001665 ~ $10.00 $4.50 $3.15 $15.00 $4,00 $26,00 11/2/05 11/2/05 11/2/05 1112/05 11/2/05 1112/05 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. $62,65 I Plan Reviews , Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. By signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all Information hereon is true and correct, and 1 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 wiD be made of any structure without permission of the Community Services Division, Building Safety. 1 further certify that only contractors and employees who are in compliance with ORS 701,005 will be used on this project. 1 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 wiD remain on the site at all times during constructiolL ~ (;'\ """'-'!L......... C 1'~''=''--'' )(..,L ~_ Owner or Contractors Signature 2 of 2 Date ///zh 5 if ~ -' , , . , \, / , " '" ,.' . Construction Contractors 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 Address: ~ Permit #: L.oWlZ-O.- 0 I ~--:X-3 b e..( ro- ~'} is /lot .1Cf c..+ Issued by: Date: J / - 0 z.. -oS- 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 al'l'oul'riate blanks and initial boxes I 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, Q(-- 3A. My general contractor is L/t<L.~ clr.':,.+~......EN (Name) /SYb71 (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR D 3B. I will be my own general contractor, If! 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. ~ign~O~~cant) IfO~t~ (White copy to issuing agency permit file, pink copy to applicant.) Property_owner ,doc 06-01-04 AdBITil~ ~~'@1Ul[[, (Q)WIill CG~ffil~ll"mH C'lJ],~[[,21d([T)[['1 !M~iO~iliJA110N NOi/'~CIE TO P~OPIE~TY OWNERS A~iDUT CONSTRUCTION RESPONSIBiliTIES .. NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the II 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 concems, lEmjplllilJiyeIl' lRe!!i]]J:orrn5n~fillii~ne5 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 t~e fo!!owbg: O,egon's WithholcJiing 'lfllX ILIlW: 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, Uneml'~oyme:nt [::lsm'ance 'lfax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages ofall 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.us/fonnsnav.htmll for the ayt'& ....P& ;ate forms. Wor!{ers' Compe:nslltEon [nsurlmce: As an employer, you are subject to thc 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, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815, u.s. J:ntemzllRevenue 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 1-800-829-4933 or visit their web site at www.irS,l!OV, ([j)1L')e;r ~e~jp)ilDII1l9niblnnn~ne~ 2l1IliIll AJl"e21~ I(Jlll CilDITJ::cerrII1l9 Code Comllliance: 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, ;;"ieolr~y 1m:; i'roperty likm:;ge ~nsurance: 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, Tln::e: Make sure you have sufficient time to supervise your employees. Zj{j>e~ise: Make sure you have the skills to act as your own general contractor, to coordinate thc work of rough-in and finish trades, and to nohlY building officials as the appropriate times so they can perform the requircd inspections, If you have addihonal questlOns call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052, PropertLowner.doc 06-01-04 , 225 Fifth Street 'SpriDgfleld, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-0 1553 COM2005-0 1553 COM2005-0 1553 COM2005-0 1553 COM2005-0 1553 COM2005-0 1553 Payments: T~e of Payment CreditCard , '!' :~ , " ':' " . f \ '; ~ . ~ '4~ '1 11/2/2005 . ~,~lI!!!!!".',,""'. _ ____. .'... 1ItL' i { ~~-,. J City of Springfield Official Receipt evelopment Services Department Public Works Department RECEIPT #: 1200500000000001665 Date: 11/02/2005 Description + 7% State Surcharge + 10% Administrative Fee Gas Outlets 1-4 Gas Fireplace Minimum! Adjustment Mechanical -Mechanical Issuance Fee- Paid By LUVERNE RITTER Item Total: LnecK Numoer AuUlonzatlon Received By Batch Number Number How Reeelved djb 020559 In Person Payment Total: 1 of 1 1:05:13PM Amount Due 3,15 4.50 . 4,00 15,00 26,00 10,00 $62.65 ' Amount Paid $62.65 $62,65