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Home My WebLink AboutPermit Mechanical 2007-8-15 Status Issued CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-01202 ISSUED: 08/15/2007 APPLIED: 08/15/2007 EXPIRES: 02/15/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 814 W FAIRVIEW DR ASSESSOR'S PARCEL NO.: 1703274200605 Springfield TYPE OF WORK: Mechanical Only TYPE OF USE: Addition PROJECT DESCRIPTION: Gas line and service with three appliance connections Residential Owner: PETER JENSEN Address: 814 WEST FAIRVIEW DRIVE SPRINGFIELD OR 97477 Phone Number: 602-510-6151 I CONTRACTOR 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: # 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: n/a I DEVELOPMENT INFORMATION I REQUIRED PARKING Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handica pped: Compact: -L" ..... reqUite" .:' ~ ON' ore~ ,&VI Oreg~~ IMPROVEMENTS I ~:t1tN11 . ted bV the e $8\ ,,"ll\. Street 1m .<<~~ adOI' '{hose (Utes ar 952..001- Sidewalk Type: --.:~....th\\,\ (".enter. ugh otu' bY NOTICE- Storm Se"wuawa~2!601..oo10\hrO 1 s otthe (Utes THIS. Downspouts/Drains: Special 1~<<i\~~U mav obtain COPe~ \he \e\ephO~e n PERMfT SHAll EXPfRF IF THF WORK OO~,\\~: \he center. ~ ui\\\\V NOut\ca\\o ~UTHOR'ZED UNDER THIS PERMIT IS NOT Notes: C8 rnbef tor th' ~~0()432.2344). OMMENCED OR IS ABANDONED FOR t\U 'UAnter " ANY 1 SUl nAV ~:fl$E. I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pae:e 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-01202 ISSUED: 08/15/2007 APPLIED: 08/15/2007 EXPIRES: 02/15/2008 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 I Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Minimum/Adjustment Mechanical Amount Paid Date Paid Receipt Number $20.00 $5.00 $2.50 $4.00 $50.00 8/15/07 8/15/07 8/15/07 8/15/07 8/15/07 1200700000000001041 1200700000000001041 1200700000000001041 1200700000000001041 1200700000000001041 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. L' Reauired Insoections I Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Final Gas: When all gas work is complete. 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. 11d/ -~ Ownerfor C~actor~ature ' -- CfJ(rs/o7 Date Pal!e 2 of 2 215 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01202 COM2007-01202 COM2007-01202 COM2007-01202 COM2007-01202 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 1200700000000001041 Date: 08/15/2007 Description Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By PETER JENSEN Item Total: Check Number Authorization Received By Batch Number Number How Received IIh 025198 In Person Payment Total: Page I of I 9:23:56AM Amount Due 50,00 20,00 2.50 4,00 5.00 $81.50 Amount Paid $81.50 $81.50 8/15/2007 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 - ( ~ I .r '0 / , '. penmt#'-<r5 '7 ~ lot .~. - \\ / Address: () lL\ vO ~ ~ V( ISSUedbyG~{). ) Da~6!t(o/rf} Statement: Inform~tion Notice to Property Owner~ About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants whoare 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, and either box 3A or 3B: " r6) 1. 1[J'2. I own, reside in, or will reside in the completed. structure. I understand that I must become licensed asa construction contractor if the structure is sold or ' offered for sale before or on completion. f 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 Me~~_ B. I will be my own..&i_~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. J "- " r)i /1.// /.- eo/ISlen (Si#atUre of pefiTIit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 ~ , /' \ <~" 4 . ._.." . . .... Alc~iri~ J~~e-YO/~t'~~wn General <;ontractor? ': /- " _ ,', ' INFOR~AtION NOTICE TO PROPERTY OWNERS \ '" \ . \ -~', "'} \'\,j\ '), \ \ " 'f;; AB9U~ ~cq~SJ~UCTION RESPONSIBILITIES, I, :' i... " 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 contractqr t~ construct ~ new home o~ make a substanti~l impr9~ement to an existing structure, you can prevent many problems,by being aware 'of the followihg I'esponsibili~ies and concerns. Employer Responsibilities , ' You will, in most instances, be:ruled to be an "employer" ~nd the contractors you contract with v:rm be "employees" if you use ~ontractQrs not licensed with the Construction Contractors B.oard to do labor in constructing or to assist in the construction or impf5JVement ofaresidentialstructure'- As,the employer, you must c,omply with the following: Oregon's Withholding 'Tax Law: As an employe~, you must ~ithhoid income taxes from employ~e wages at the time employees are paid. You will be,liable fqr the tax payments evenif 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 purposes " on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. '\ .. .' ~ t, The Oregon Business Identification Number (BIN) is a combined number for :,l?o,th Oregon., Wit~oldiQ.g and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.oLus/formsnav.htmll for the appropriate forms. ' " , Workers' Compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtaiJ} workers' cUU!pensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject' to p~rialties and be liabie for ~lr claim costs'If one of your employees is injured on the job. For more information, call the Workers' Compensation DiviSIon at -the Department ~of Consumeiand Business Services at 503-947-7815. I -~ ,." ,1; \ 10\ ~ I ~ ;',: " I 1 J J ,/ j I .., I . U.S. Internal Revenue Service: As an employer, you must withhold federal iri~, 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 ~':'800-8294933,orvisit their web site at\\I\V\v.irs,gQY., . , " OtheIrRe~lPoll1J.~ibnlitnes anull Areas oly COIDl~erims ' Co(]lc Compliance: As the permit holder for this project, you are responsible for resolvhig any failureto'meet code requirements that may b~ brought to your attention through inspections. , ~ ..... . . ~..... . . ! :,': ':. .'_' ., .'),'.:' ,i U~bmty and Property D~mage' Insurance: Contact yo'~r''insuta~ce :ageni to 'see if you' haveadequate"msurance coverage for accidents and omissions such as falling tools, paint over spray? water damage from pipe punctures, fire or Ii work that must be redQn~. ,--. ,\ ': -____ 'J ',' '" ~,h . ' , , - Time: Make sure you have sufficient time to supervise your employees. }" Expertise: Make sUr~ y~u hav; the skills to act as yo~r o~'geri~ial contractbr~ to' coordinate the wo~k of rough-in \ and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections. I 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