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Home My WebLink AboutPermit Mechanical 2005-1-24 . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00096 ISSUED: 01124/2005 APPLIED: 01124/2005 EXPIRES: 07/24/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1146 SEQUOIA AVE ASSESSOR'S PARCEL NO.: 1703273402702 Springfield TYPE OF WORK: Mechanical Only TYPE OF USE: New PROJECT DESCRIPTION: Gas piping - propane for stove and fireplace insert Residential Owner: FRED LITTLEJOHN Address: 1473 DIAMOND ST SPRINGFIELD OR 97477 Phone Number: 541-746-6085 I, CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor SUBURBAN PROPANE LP License 147469 Expiration Date 051l1l2005 Phone 800-526-0620 , BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # of Stories: Lot Size: Height of Structure ua~ Sq Ft 1st Floor: Type of !I~ttt,S- \ S\ la~ 10\ la~Ull\U Sq Ft 2nd Floor: .~~t€r1iYP'(jooaIO all\ ell\ O\l\\\"BO. Sq Ft Basement: Rang'e\l1'ype: \'I) 'la\U00 Ull\O'- 'OliOO~q Ft Garage/Carport \lO\\-eO~~~Sfgy.\l".rt'q U\-e\~O f,-e Zeoli 'c:I-.t0 U q Ft Other: . e~~~~C~~~!~~OI!:~~ U~\'l30~~c:,., ccupant Load: I'DElVllliV~MmW' -m~Mimo;..r.\:",::. .~~ ," · mr ""WI I ~~ \.\\10\ \O~ . OalO 64" '1.Io6e1U .,~~' f.\\\\\l(',~~bi)IiJ,"f"'\ 0\ !)PStreet Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING R-3 Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: Handicapped: Compact: 1 PUBLIC IMPROVEMENTS I Description Tvpe of Construction Side\f~~lfl'type: ...;.\t, \l'l .,,,",, ~t, \r Do.w~spoutslDrains: t,'I-?\ t,"'\'l\\ \ ~ ~ ~\\,,\C\\JI\\ S\\;~~'" \\\\S~~G~t,G rG \\\\S.~~?\1.t,'i) ~ [\\'- \S ~I,)\X I r- 'l,J\\:."- 'I ~v,. I Vahfation,Des"criDtion l\~' . $ Per Sq Ft Square Footage or multiplier or Bid Amount Value Date Calculated Street Improvements: Storm Sewer Available: Special Instruction: Notes: Pa!!e I of2 . . CITY OF SPRIr'itJt< I~L1J . Building/Combination Permit PERMIT NO: COM2005-00096 ISSUED: 01124/2005 APPLIED: 01124/2005 EXPIRES: 07/24/2005 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 Fp.p.~ Paid I Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Cas Fireplace LP Cas Tank & Piping Minimum/Adjustment Mechanical Amount Paid $10.00 $4.50 $3.15 $15.00 $12.00 $18.00 Date Paid 1/24/05 1/24/05 1/24/05 1/24/05 1/24/05 1/24/05 Receipt Number 1200500000000000106 1200500000000000106 1200500000000000106 1200500000000000106 1200500000000000106 1200500000000000106 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. IRp.ou~ Rough Cas: After line is installed and required testing and capped if not attached to an appliance. Final Cas: When all gas work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. By signature, I state and agree, that I have carefully examined tbe 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 Cnmmunity 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 readahle 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. ;/ ~ 0t//()~ Dfe . v Owner or Contrac ors Signature Pae:e 2 of2 225 Fifth Street Spl:jngfieid, Oregon 97477 541-726-3759 Phone . -~-Q"'~ . Wt".~".""'.'..'."".""".. 1 " . 1: ):. \ . . .."Ii: JiJ..ty of Springfield Official Receipt .velopment Services Department Public Works Department Job/Journal Number COM2005-00096 COM2005-00096 COM2005-00096 COM2005-00096 COM2005-00096 COM2005-00096 Payments: Type of Payment Cash Change Job/Journal Number COM2005-00096 COM2005-00096 COM2005-00096 COM2005-00096 COM2005-00096 COM2005-00096 Payments: Type of Payment Cash Change 1/24/2005 RECEIPT #: 1200500000000000106 Date: 01124/2005 Description + 7% State Surcharge + 10% Administrative Fee LP Gas Tank & Piping Gas Fireplace Minimum! Adjustment Mechanical -Mechanical Issuance F ee- Paid By FRED LITTLEJOHN FRED LITTLEJOHN Item Total: Check Number Authorization Received By Batch Number Number How Received djb djb In Person In Person Payment Total: Description + 7% State Surcharge + 10% Administrative Fee LP Gas Tank & Piping Gas Fireplace Minimum! Adjustment Mechanical' -Mechanical Issuance Fee- Paid By FRED LITTLEJOHN FRED LITTLEJOHN Item Total: Check Number AuthoriZation Received By Batcb Number Number How Received djb In Person djb In Person Payment Total: Page I ofl 1:20:47PM Amount Due 3.15 4.50 12.00 15.00 18.00 10.00 $62.65 Amount Paid $63.00 ($0.35) $62.65 Amount Due 3.15 4.50 i2.00 15.00 18.00 10.00 $62.65 Amount Paid $63.00 ($0.35) $62.65 e.! '\ l \; ," o. ..' . - . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ecb.state.or.us . Permit #: (O""'t.=:> _ DC 0 9'(" . Address: /IL/b ~ SC=Q..u...o/t/'. Date: J /z 'f /0-:;- / I 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 Constroction 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 "'t'tUut',:ate blanks and initial boxes I and 2, and either box 3A or 3B: Q-l. 0\' 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 ofthis form. ~\1~=t) //t!.~5 (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 . . ", A.~~nlIDg 1al~ 1( ([J)Ulllf COho/lID GlelIDleIr1alll CC([J)IID~Ir~~~([DIr? INFORMATION NOTiCE TO PROPE~TY 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 eonstruct 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. lEmplloyer Re~ponn~ftlbnlln~ne~ You will, in most in~tances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors hot 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 foUowing: Oregon's Withholrliing 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. Unemployment insurance Tax: As an employer, you are required to pay a tax for lillemployment insurance purposes. 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 number for both Oregon Withholding and Unemployment Insuranee Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.usIformsnav.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 coul~ be subject to penalties and be liable for,all claim costs if one of your employees is injured on the job. For more infonnation, call .the Workers'_Compen~~t!on Division at the Department of Consumer and Business Services at 503-947;7815.' 'i U.S. InternallRevenue Service: As an employer, you must withhold federal income tax from employees' wages;--'" I ., ... 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.nov. O[!hu Re~~orrn~ftbftnft[ftte~ lllmll All"te21~ olT <Corrnl\:tell"rrn~ Code Compliance: As the permit bolder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Licbilily and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidcras and omissions such as falling tools, paint over spray, water damage from pipe plillctures, fire or work that must be redone. Time: Malee sure you have suffieient time to supervise your cmployees. EJr;>e,tis2: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, an,;! to notify building officials as the apf"Vp.;ate times so they can perform the required inspections. , , If you have additinn~l qucstions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, 9R 97309-5052. Property- owner. doc 01$-01-04