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Home My WebLink AboutPermit Mechanical 2004-11-3 . . ,CITY OF SPRIr~ul'lJ!.L1J Building/Combination Permit PERMIT NO: COM2004-01365 ISSUED: 11/03/2004 APPLIED: 11/03/2004 EXPIRES: 05/03/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1619 W QUINALT ST ASSESSOR'S PARCEL NO.: 1703273200131 Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential PROJECT DESCRIPTION: Pellet stove Owner: JAMES GLAVIN Address: 1619 W QUINALT AVE SPRINGFIELD OR 97477 "QTlrt._~ ,r ,.u~ INUKl\. r'CONTRAIilT0RUNFORMAT10N'1 NO\ 1r..., , ! UNOEK \111;) , -"" . Contractor I\.~:~OI~;~CE~O OR IS I\.Bf\NOili~~~s~Qf\ Expiration Date JACC ENTERPR[SI5StUf,!!~." nCQ\nO. 157125 09/24/2005 j\~1 "-BUiLDIN'G INFORMATION I Phone Number: 541-726-7434 Contractor Type Mechanical Phone 541-747-8600 VN # 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: # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 nla I DEVELOPMENT INFORMATION I Frontyard Setback: SIde 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEl\1,Ii:NiliStregOn laW requIreS VuUtui\':. , . t;1hV the Oregon ". follow rules adopte t1jj)tlllB/~\~<<1l!m set forth Notification Center, hOSUSl@'il~~~"()()1. in OAR 952-001-001 ~~oPies of the lUreS bV 0090. '(ou may obtalO(Note: the telephone calling the center. Utility Notification number for the. O~e~~~_ ~~?2344). . ."',\.0'-' - I Valuation DescriDti;~' . Notes: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page 1 of2 . . CITY OF 1)rKlj~lit<l~LD Building/Combination Permit PERMIT NO: COM2004-01365 ISSUED: 11103/2004 APPLIED: 11103/2004 EXPIRES: 05/03/2005 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspection Line I Fp.p.sP",W Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Minimum/Adjustment Mechanical Pellet StovelInsert Amount Paid Date Paid Receipt Number $10.00 $4.50 $3.15 $15.00 $30.00 1113/04 1113/04 1113/04 1113/04 1113104 1200400000000001559 1200400000000001559 1200400000000001559 1200400000000001559 1200400000000001559 Total Amount Paid $62.65 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. I Rp.llu\r~1 \lw'ections I Pellet Insert: 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. ~~J~ Owner orllontractors Signature 11- a -t:? tJ Date Pa2e 2 of2 225 Fifth Street Sp'ringfield, Oregon 97477 541-726-3759 Phone . .r~IIIN,Q,'''',~.__._--- ;' WiL' - ",,- I ... i "<- -..-.- lIIIIiity of Springfield Official Receipt .velopment Services Department Public Works Department RECEIPT #: 1200400000000001559 Date: 11/03/2004 11 :49:04AM Job/Journal Number COM2004-01365 COM2004-0 1365 COM2004-01365 COM2004-0 1365 COM2004-0 1365 Description + 7% State Surcharge + 10% Administrative Fee Pellet StovelInsert Minimum! Adjustment Mechanical -Mechanical Issuance Fee- Payments: Type of Payment Paid By CreditCard JAMES GLAVIN Item Total: Check Number Authorization Received By Batch Number Number How ReceIved djb 644758 [n Person Payment Total: Amount Due 3.15 4.50 30.00 15.00 10.00 $62.65 Amount PaId $62.65 $62.65 [ [/312004 Page 1 of I e. . , \ ,.: ", .,' '. ,.' . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us Address: . Permit #: c..OIM"l.-O"_ - C) / '3 IS } Q,^,,^ Al f- Date: ((-0;'-0'1 /6( '1 vJ b~ Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential constrnction 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 ,"""."".:ate blanks and initial boxes I and 2, and either box 3A or 3B: f(rI. W2. 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 ~ 38. I will be my own general contractor. In 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 of this form. ~~ hf 1/&,__, -. 11- 3 -o~ (} (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) r,_,,'''J_owner,doc 06-01-04 , .. . A~~nlJllg ~~ 1l @1illIr ([J)wnn GenneIr21U CC@nn~Ir2J~~@Ir? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors BoarrJ in accorrJance 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 Re!lpmnsnbnlftties " You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors no't licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improv;ement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid, ~ou 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 unernployment insurance purposes on the wages of all e~ployees. 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/formsoav.htmll for the appropriate forms. Wor/{ers' 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 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. InternallRevenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable fQr 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.QOv. Ottll1l<<~ll" Re!i~ollD!iftbmn:fte!i allllDidl AJrean!i 011' <COIlD~UIlDS ". Code Compliancc: As the permit holder for this project, you arc responsible for resolving any failure to meet code requirements that llJ!lY be brought to your attention through inspections. Liability and !Property Damage linsurance: ,Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as,Jalling'lools, paint over spray, water damage from pipe punctures, fire or work that must be redone. ... Time: Make sure you have sufficient time to'supervise your employees. JElrpertlse: Makc 'sure you have the skills to act as your own general contractor, to coordinate 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. Property _ owner.doc 06-0 I -04 ,