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Home My WebLink AboutPermit Mechanical 2007-8-7 ~4 ~4 ~ fo~4 I!'~ '~ ~ r"~~ ..:---14 ~\ ~~ ~J4 .<: ~~ ~4 .~ ""~4 ~~ ~ ~ {Q\~ .,--- ~ OO} ~4 t~l~ ~ ~ rfl4J ~4 ~. _y-~4 ~ ~ I ~> '~ ! ~) . 1.-..... : ,~ !~ ~ . (Q) I' (Q) I.~' , ~ 'r I~ I I "'-. '~ '),,? "'..., ~ ""-w."~"~"~' ~-;,>\; '{; cji,,,~~>>'t~1'~~~Y7-'---'o/~~f ,"';',\ ,,-""',"'''4 >-' ~ if CITY'mlfSl>ItIN6FIEED OREGON "-. ,~~" :?\-'~, 0" _~ "'~~ 1k:~ ~,~"~ ~.,;~~:~ _ ~~~' ^ ::"'''i ' ~ >=M= ~ ~ ~,,_ "~" '-"~ ~~ ~~~ 225 TIrrn STREET. SPRINGTIEW, OR 97477. PH:(541)7Z6-3753 . FAX: (541)726-3689 City Job Number LOtIV' 'Z..C> 0 7- ~ II b J Job Location: S~3s-b~~({ ~t- a.,\)QLQ. \D\ Assessor's Map:. 170 Z. 3'3 C> 0 Tax Lot: 0(300 Owner: M o...r\<.. +- (' ~~\~k"O-. (5' f"-<-.JL("\ Address: .s~ s,s- ~t"A " ~\. 1 .s-t c:::;,C?a.. CJL \ \) I City: c.... \" \ ~C\QQ \d State: t""\K ~ ~ - Phone: SLJ r - S 4S'- ^ I J ! Zip: c., l LIt ~ Preliminary Inspection for wood burning inserts is $61.50 (prior to insert). Wood Stove/Pellet/Insert Permit is $71.50 (includes applicable fees and surcharges). . 4'0 Contractor InformatIo~ ~~ . -1o~~ ,o^ ~ (lUL ~a ,~ . -11}t-''71,;,: ~~ ~one: . State: ~_~A<$). &'-4 Zip: V ...~. (I; :1tA <?~,t <:> a ~&~.~s: ,o~ ~{r J? .l~ ~~ )~ ij~ I'~ . . h' . / I' . II f . . (~) ~~~~~~ ) By sIgmng t I~ permIt .app IcatI?n, I a~ree. to ca o~ ~n mspectIon s as r ~:~~. -3~69. I state that all mformatIon on thIS applIcatIon/permIt IS correct and that I w *OXIth the Wood Stove Safety information for wood burning A iances and prelimina~iW~~ standards as set by the Oregon Department of Envi~~e I Quality or the Fedetfl . V;- Environmental Protection Agency and I agree t~~'@j ting approval number to the inspector at the time of inspection. I also unde~~ffa requesting a preliminary inspection, the wall covering may be requir~~~ ~~~.,~ Q.& . ~~Q ~ ~ ~ ~ 'q,.l:CP~~ 90~ ~o~ . ~-6~~ ~ "b~ Q'<s. i~ Ci~ ~~qp~l.l\qs~ ~~~Q.~~ ~ , -.d;, \ ~~ JD;;: q!~ ,~i,,~i~~cp ~/ ~/() 7 / 6' - .I: ~ r~'6 ~. ~ CP", ~.1{p / ,- ---- FORoma USE ~ol?~:to'~~~:'~~~1> -"J ---- ---- --~~ ~ ~~"76)--O~"'?-6 ~-- ---- /. / ~-~o~.~~~, 'OO~ ~ 7jzc>o'7 ~ %..P~.o1S'~2 I ' ~6! ~ Checked for Historical Statu~ Contractor: -.J::::) l A') '\\ ~ \" Address: City: Construction Contractor's Registration #: Signature: Date of Application: Checked for Delinquencies: I./' Shared Drive(T:)lBuilding Fonns/Wood Stove Pennit 7-07.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-01l65 ISSUED: 08/07/2007 APPLIED: 08/07/2007 EXPIRES: 02/07/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 5335 Daisy St 101 ASSESSOR'S PARCEL NO.: 1702330001300 Springfield TYPE OF WORK: Wood Stove TYPE OF USE: New Residential PROJECT DESCRIPTION: Wood stove Owner: MARK GREEN Address: 5335 DAISY ST #101 SPRINGFIELD OR 97478 Phone Number: 541-345-0717 I~NTRACTOR INFORMATION I Contractor Type Mechanical Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VB # 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 Garage/Carport Sq Ft Other: Occupant Load: R-3 n/a Notes: I DEVELOPMENT INFORMATION I \f ,\\\: \NO"'" Front yard Setback: \to,.\CE~ \\~l\.. f.YS)\~~~6~~~Ol Side 1 Setback: \.1\S PER,,^\' $ MDER 1\\\$ ~n~\lt ~s Rqd: Side 2 Setback: 1 p OR\lED U\'I ~'Of\~i~~&'brive Rqd: Rearyard Setback: ~U1\-\l\ftE~CEU OR \$ 0 % of Lot Coverage: Solar Setbacks: COW\\'I\ {\ nf\'l pER\O · hH'i '\~\.1 v . I PUBLIC IMPROVEMENTS' AI I l:afWoi<J!lbWff6i. faw requires you to follow mS.~SDlrbtflAhe Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone '......L... I",. 1I.g ~"'::I~U" ulImy '-'UlIIIQBUOn I Valuation DescriPtion' Center Is 1-800-332-2344). REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2007-01165 ISSUED: 08/07/2007 APPLIED: 08/07/2007 EXPIRES: 02/07/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid' Fee Description ~Mechanical Issuance Fee~ + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Minimum/Adjustment Mechanical Wood Stove/Insert Amount Paid Date Paid Receipt Number $20.00 $5.00 $2.50 $4.00 $17.00 $33.00 8/7/07 8/7/07 8/7/07 8/7/07 8/7/07 8/7/07 2200700000000001262 2200700000000001262 2200700000000001262 2200700000000001262 2200700000000001262 2200700000000001262 Total Amount Paid $81.50 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspections 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. ReQuired InsDections I Wood Stove: 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. ~~~~ Owner or contractor~re ~/7 II) 7 ;' .. Date Pa2e 2 of2 I I' ' ' , . ! i Construction Contractors Bo~rd ; 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Permit #: L 0'>/1'/\ Z-O 07- 0 II b. S- Address: 5.33 S- "b Al ~ V '\..If? ' Issued by: ~ 'jJ Date: s.~- 10 I ?/7/0t I I Statement: Information Notice-to Property Owners About Construction Responsibilities' Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare not licensed With the Construction - Contra~tors 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, and either box 3A or 3B: .er- 1. I own, reside in, or will reside in the completed structure. ~ 2. I understap.d that I must become licensed as a construction.contractorifthe 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 ~. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! 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. ~-5~ --- 8"/7/07 (Sign~permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 ,~, - Acting').a's Y,o:ur'-Own' GeneraIContr~~tor?, . " ( , -. ' -'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 contr~ctor to construct a new home or make a subs~ntial iU1~novement to'an existing structure, you can prevent many problems by beIng aware of the following resp'onsibilities'and concerns. ' Employer Responsibilities You will,. in most.instances, be ruled to be an "employer" and the c,ontractors you contract with will be "employees" if you use contractors not licenst?d with the Construction Contractors Boatd to 40 labor in constructing or to assist in the construction or iHlj!lovement of a ~esid~ntial s~ct~e. . As the emp~oye'(, you must comply :w~~h the fo~lowing:. .. . . -...., . -' . .. 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 f~r the tax payments even if you don't actually witJiliold the tax from your employees. For more information, call the Department of Reveriue at 503~378-4988.- - . :. . .. . Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes-~ on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. " . I .~. ..... r ..-.~. ". 1._ "" The Oregon Business Identification Number (BIN) is a combined. nwnber for, both, Oregqn. Withholding and "- Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.doLstate.or.us/formsnav.htmll for the appropriate forms, .".:... .".. .- . Workers' Comp~nsation I~s~ll"ance: As an employer, y~u are subject to. the> Oregon Workers' Compensation Law, and must obtain. workers' compensation insurance for your. employees. If you fail to obtain workers' compensatiqn insurance, yoU: could be subject to peria1ti~s arid be liable for all claifn costs.jlfone of-your efupioyee;s is injured on the job. For more information, call the Workers' Compensation Division.'at the Departrllerit of Consumer 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 number, call the IRS at 1-800-829-4933 or visittheirweb site at "\V\-V\v.irs,gQ.'{. :.. ,. . Other 1RespoIDlsibiUti,esa~~ AJreas of C(fJ)lI1C~Jr~s Code Compliance: As the permit holder for this project, you are responsible for resolving. any failure to meet code require~ents that T?ay be broug~t t~ your attention throu~h inspections. , . , Liability and Property Damage Insurante:'. Contac(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 redol1e, ('". ."\ ~. -,. '-., '....; ~ " . .." \ ..._ < ,~ - . - ..... ... '1)~~,,:; '\ .....- '\'" \. '.... -.- .':":';.. ", ~...5' ........ ''--, Time: Make sure you have sufficient time to supervise your employees. .' Expertise: Make sure you. ha~e the" skills to act as y~ur o\~"gen'eral cbritra~tor, to cooicii~ate 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. PropertLowner.doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-0I165 COM2007-0I165 COM2007-01165 COM2007-01165 COM2007-01165 COM2007-01165 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000001262 Date: 08/07/2007 Description Wood Stove/Insert Minimum/Adjustment Mechanical ~Mechanicallssuance Fee~ + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By MARK GREEN Item Total: Check Number Authorization Received By Batch Number Number How Received djb 589 In Person Payment Total: Page I of I 2:29:48PM Amount Due 33,00 17,00 20.00 2,50 4,00 5.00 $81.50 Amount Paid $81.50 $81.50 8/7/2007