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Home My WebLink AboutPermit Mechanical 2005-2-8 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00152 ISSUED: 02/08/2005 APPLIED: 02/08[2005 EXPIRES: :e 08/08/2005 VALUE: " 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2440 J ST ASSESSOR'S PARCEL NO.: 1703254306104 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New ~ "'}" Residential PROJECT DESCRIPTION: Install tankless water heater Owner: ELLEN PETERS Address: 2440 J ST SPRINGFIELD OR 97477 Phone Number: 541-744-0070 I CONTRACTOR INFORMATION. Contractor Type Mechanical Plumbing Contractor OWNER OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: ' R-3 Height of Structure ' ,', Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Vlhr Water Type: Sq Ft Basement: Rang~ Type:AIII:NTION: Oregon ~ti~&1f8ort , Ene.rgy Path:~I.low rules adC)J>ted by~69dBrm jJJllity Sprinkled B~tfon CenfiJP. ThosllfbY8IikietYorth I DEVELOPMENT ~':'T0:-:;1,,~~Vmf\unU tnro~gh OAR 852'()()1- ~n coPlesoftlmrwfm~)\'PARKING calling the center; (Note: the telepnone- Overlay Dist:nutnber for the Oregon Utility No\Y~~n # Street Trees Rqd: Center is 1..eo0-332.~andicapped: Paved Drive Rqd: ' ,~ '!"C!~mpact: % of Lot Coverage: Front yard Setback: , Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: - '.: ~~: I PUBLIC IMPROVEMENTS. Street Improvements: Sidewalk Type: Downspouts/Drains: . , ' Storm Sewer Available: ", Special Instruction: Notes: NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Pae:e 1 of 3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description $ Per Sq Ft or multiplier Tvpe of Construction Square Footage or Bid Amount Total Value of Project ~ Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Appliance Vent Fixture Gas Outlets 1-4 Minimum/Adjustment Mechanical Minimum/Adjustment Plumbing Amount Paid $10.00 $9.00 $6.30 $6.00 $14.00 $,4.00 $35.00 $31.00 Total Amount Paid $115.30 Plan Reviews ,I Date Paid 2/8/05 2/8/05 2/8/05 2/8/05 2/8/05 , 2/8/05 2/8/05 2/8/05 CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2005-00152 ISSUED: 02/08/2005 APPLIED: 02/08/2005 EXPIRES: 08/08/2005 VALUE: Value Date Calculated Receipt Number 1200500000000000167 1200500000000000167 1200500000000000167 1200500000000000167 1200500000000000167 1200500000000000167 1200500000000000167 1200500000000000167 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. ' ' ' Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Pa2e 2 of 3 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2005-00152 ISSUED: 02/08/2005 APPLIED: 02/08/2005 EXPIRES: 08/08/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. - /Ltb/J--1/1 - /7 dUA Owner or Contrac~~nature ;;2 - d Vr- Date Paee 3 of 3 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 #: Co jIV\ 7-00 .J - 0 D ( )' Z --:r Sr- Date:' Z- / 8' /0 'J I t- Issued by: ZL(l.{O '"bQ: 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 1 and 2; an~ either box 3A or 3B: ~ 1. ~~. 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. If I 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 Responsibilitie~ on the reverse side of this form. . ~/bA4L?;?"~ :;2-J-CJS- (Signature~fpermit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 AC,ting"ss:Iour Own 'General~Contractor? INfoRMAt16N 'NOT!CETO PROPERTY O""NERS ABQ_UT 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. Employer Responsibili~ie~ ", You will, in most instances.. be ruled to be an '~employ~r" and the ~ontractors\you c~ntractwith wiilbe "employees" if you use contractor~, not licenseq with the Construction Contractors Board to do labor in constructing or to assist in the construction pr improvement of a residential, s~cture.. As th,e employer, you must comply with the fo~owing: . . . . ' ' - ~".'" - ., ,..., 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.' ";,':; -' r.,' .. . Unemployment Insurance Tax: As an employer, you'are requited to pay a tax for unemployment insurance purPoses on the wages of all employees. For more information, can the Oregon Employment Department at 503-947-1488. , ' " . The Oregon Business Identification Number (BIN) is a combitl~d number for bo~h 9regon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/fonnsnav.htmll for the app. upriate 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 could be subject to penalties and be liable' fdr ~lr claim costs if one of your einpioyees is injured on ,the job. For more information, call the Workers' Compensation Dlvisiohat the Department of Consumer'alid Business SeI:Vices at 503-947-7815. " ' U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' 'wage~:' 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.20v. ' Other Responsibiliti~s and Alreasof Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any fai'Irire to meet code requirements that may be brought to your attention through inspections. Liability and Property D~~age InSUllr~][lCe: Contact yobr insurance agent to s~e 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. e , , 'lrime: Make sure you have sufficient time to supervise your employees. j'.' .'. ....~,..~_. .~.; " 1- ,f' ...,~. Expertise: Make sure you have the skills to act as your own geheriH contractor, to coordin'ate the work of rough-in and finish trades, and to notify building officials as the appropriate ti~es 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. . ~, .. }.' , Property- owner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone <;J,ry of Springfield Official Receipt 'f~welopment Services Department Public Works Department Job/Journal Number COM2005-00152 COM2005-00 152 COM2005-00152 COM2005-00152 COM2005-00152 COM2005-00 152 COM2005-00 152 COM2005-00 152 Payments: Type of Payment Cash Change Job/Journal Number COM2005-00 152 COM2005-00152 COM2005-00152 COM2005-00152 COM2005-00152 COM2005-00 152 COM2005-00 152 COM2005-00 152 Payments: Type of Payment Cash Change I . . 2/8/2005 RECEIPT #: 1200500000000000167 Date: 02/08/2005 Description Fixture Minimum/Adjustment Plumbing Gas Outlets 1-4 Appliance Vent Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Paid By ELLEN PETERS ELLEN PETERS Item Total: Check Number Authorization Received By Batch Number Number How Received djb djb In Person In Person Payment Total: Description Fixture Minimum/Adjustment Plumbing Gas Outlets 1-4 Appliance Vent Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Paid By ELLEN PETERS ELLEN PETERS Item Total: Check Number Authorization Received By Batch Number Number How Received djb In Person djb In Person Payment Total: Page I of 1 8:38:21AM Amount Due 14.00 31.00 4.00 6.00 35.00 10.00 6.30 9.00 $115.30 Amount Paid $120.00 ($4.70) $115.30 Amount Due 14.00 31.00 4.00 6.00 35.00 10.00 6.30 9.00 $115.30 Amount Paid $120.00 ($4.70) $115.30