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Home My WebLink AboutPermit Mechanical 2006-8-31 .CITY OF SPRI~l..J< Ir,LD . Building/Combination Permit PERMIT NO: COM2006-01I34 ISS UED: 08/3112006 APPLIED: 08/31/2006 EXPIRES: 02/28/2007 VALUE: . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1400 RAINBOW DR ASSESSOR'S PARCEL NO.: 1703273400400 Springfield TYPE OF WORK: Pellet Stove PROJECT DESCRIPTION: Pellet stove - freestanding TYPE OF USE: New Residential Total: Handicapped: '!"lCl'il-'fCompact: \r'V>'\: ,'0 ~\:o,\ , ~i.'i"~~~'il-~~ (.(\'il- I PUBLIC IJ.I)I.I\~UVEMENifs:,~'il- \'0~~\)Cl\'<"-v' ,. ~v." \J" "- \>:'0 "v>,S "n\1.~v I"\'il- '''' \~idewalk Type: , \ ;\v>\J" x.\l v \C\\.\' \>.\J ~~,\:~c, \>.'{ 'i''C.~ DownspoulslDrains: c,Cl "\ 'Q\l \l \>.~'{ Owner: MICHAEL HAMPSHIRE Address: 1400 RAINBOW DR SPRINGFIELD OR 97477 Contractor Type Mechanical I CONTRACTOR INFORMATION I au \0 le"\J11es'/ License la\N '"' Ol\ V" . . OWNER ~,I' ()le~ol\. .. .\Oe Qle9 _ opl \olln 1\\'1'2-1 'u' ;-!cBUmOING:INFORMATION ","J'o':' \'.-,I.!{ , 10 'v " . Ii eel "... 0 \"IOv,," 1 ."e 1U1vo { ~,,\\o . n("\-\ , so\. n6 '\o\\..~~ ,,"_00 #ofStories:l\e \e1e""0 \"'- X\ c~'" '....'~\\\...-. __hP: t' . '(\ 1..~~3P; 0 u f{\a'!ieit:~t o,~~J~"clur~o\\\lca\\O 0090, ~o \"e (!\yp~~~~~~.f:)\\I\\'! AA). vN~a\l\l\9 101 WaterT1;e~.33'2.-'2.3 (\uf{\'oe1 Ce\~~nife Type: Energy Path: Sprinkled Building: Contractor # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Constrnction Type Secondary Construction Type: # of Bedrooms: I DEVELOPMENT INFORMATION I Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation Descriotion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Paee I of2 Phone Number: 541-556-8500 Expiration Date Phone nla Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Value Date Calculated . . CITY OF ~rKll~GFIELD Building/Combination Permit PERMIT NO: COM2006-01134 ISSUED: 08/31/2006 APPLIED: 08/31/2006 EXPIRES: 02128/2007 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 Fees Paid I Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge MinimumlAdjustment Mechanical Pellet Stove/l nsert Amount Paid Date Paid $10,00 $4,50 $2.25 $3,60 $15,00 $30,00 8/31/06 8/31/06 8/31/06 8/31/06 8/31/06 8/31/06 Receipt Number 1200600000000001361 1200600000000001361 1200600000000001361 1200600000000001361 1200600000000001361 1200600000000001361 Total Amount Paid $65,35 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. I Renu~ Freestanding Pellet 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 011 the site at all times during construction. /~.:;-:'~~ '{'.I', Owner or Contractors Signature . ... --"'" ---- ~ /S ( &/7 Date { I Paee 2 of2 ~ . Construction Contractors Board 700 Summer St NE Suite 300 PO BOI 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Pennit#: COVl1z.oat OtlJc..{ Address: /400 KftWldn.Af e, . . \, .I ". ,,' " ..' Issued by: ~~ -ptL o/:r~;:, Date: 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 befiled with the permit, Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~I. kl--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, o 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontraclors who work on the structure must be licensed with the Construction Contractors Board, OR l2r 3B. I will be my own general contractor. In hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board, Ifl 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 informatioo is correet and that I have read and do understand the Information Notice to Property Owners about Coostmetion Respoosiblllties on the reverse side of this form. ~Z-z~ 'f /51 Jo~ (Signature of permit applicant) , tDate) (White copy to issuing agency permit file, pink copy to applicant.) --------- Property_owner.doc 06-01-04 Adnll1l~ tal~ l11mf OWll1l Gtell1lteJrtalll cC!~Jrtal<\::~(QJr? 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 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, lEmJPlnoyer JRe~JPlorrn~nbnmne~ You will, in most ins\ances, be ruled to be an "employer" and the contractors you contract with wiII be "employees" if you use contractors not 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 foUowiog: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid, You wiII 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, Uoemploymeot Insuraoce 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, , 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/formsnav.htmll for the appropriate forms, Workers' Compensation Insuraoce: 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 He 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. IoterRal JReveoue Service: As an employer, you must withhold federal income tax from employees' wages, You wiII 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,!!ov, <DltllneIr ~e!lIPoll1l!lfilb>finfi1l:fies 2111la:ll AIre2!lo!f COll1ltCeI1'II1l!l I Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may 1;>e brought to your attention through inspections. Liability and Property Damagc Insurance: Contact your insurance agent to see if you have adequate insurance coveragc for accidents and omissions such as faIling tools, paint ovcr spray, water damage from pipe punctures, fire or work that must be redone, 'Time: Make sure you have sufficient time to supervise your employees, Expertise: Make 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 a",,'Ut,,;ate 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 06-01-04 225 Fifth Street Sprir,gfield, Oregon 97477 541-726-3759 Phone . J:~A~ Mi!... . C..of Springfield Official Rcceipt _Iopment Services Department Public Works Department Job/Journal Number COM2006-0 1134 COM2006-0 1134 COM2006-0 1134 COM2006-0 1134 COM2006-0 1134 COM2006-0 1134 Payments: Type of Payment CreditCard cRcceiotl RECEIPT #: 1200600000000001361 Date: 08/31/2006 Description + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Pellet Stovellnsert Minirnum/Adjustment Mechanical -Mechanical Issuance Fee- Paid By MICHAEL HAMPSHIRE Item Total: (;heck Number Authorization Received By Batch Number Number How Received djb 134458 In Person Payment Total: Page I of I 2:45:46PM Amount Due 2.25 3.60 4.50 30.00 15,00 10.00 $65,35 Amount Paid $65.35 $65,35 8/3 1/2006