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Home My WebLink AboutPermit Mechanical 2007-8-23 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-01252 ISSUED: 08/23/2007 APPLIED: 08/23/2007 EXPIRES: 02/23/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1460 S BROOKLYN ST ASSESSOR'S PARCEL NO.: 1703344300400 Eugene TYPE OF WORK: Mechanical Only PROJECT DESCRIPTION: Gas service and extend existing gas line TYPE OF USE: New Residential Owner: JOSHUA BRYANT Address: 1460 S BROOKLYN ST EUGENE OR 97403 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor OWNER License BUILDING INFORMATION' # of Units: # of Stories: Primary Occupancy Group: R-3 Height of Structure: Secondary Occupancy Group: Type of Heat: Primary Construction Type VB Water Type: Secondary Construction Type: Range Type: # of Bedrooms: ATTENTION: Oregon 'diitle~\1lfbYOUwto~ f II w rules adopted b\8~~gOiJJ n/a o 0 _ . 1'-8&8 r"l~~ AfA !let 0 ~0~~~a~~2.o01t~~ _ATION I 0090. You may obtain C . the tel;phone calling the center. (N~~mtV \lHltification number for the Orego...ll &fl_~A.\"s Rqd' Center is 1-80\:l'V'~~ . Paved Drive Rqd: % of Lot Coverage: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Phone Number: 54]-554-2487 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: NOTICE: EXP\RE IF THE WORK TH\S PERM~ ~~~i~ THIS PERMIT \S NOT ~~;~~~,\~~r' (\Q ,~ ABANDONED FOR I Valuation DescriPtionl\tY 180 DAY PERIOD. Notes: Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pa2e 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2007-01252 ISSUED: 08/23/2007 APPLIED: 08/23/2007 EXPIRES: 02/23/2008 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 Gas Outlets 1-4 Minimum/Adjustment Mechanical Amount Paid Date Paid $20.00 $5.00 $2.50 $4.00 $5.00 $45.00 8/23/07 8/23/07 8/23/07 8/23/07 8/23/07 8/23/07 Receipt Number 2200700000000001340 2200700000000001340 2200700000000001340 2200700000000001340 2200700000000001340 220070000000000]340 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. I Reouired Insoections , Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Final Gas: When all gas work is complete. 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. 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. \ yJ'L5 lO?- t ; Ow~r Contractors Signa~ Date Pa2e 2 of2 , ' .' . . . . . . . . , O. .0 0.. ..' 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 Pennit #: COlM 'E.-C-O 7- 01 z-'Sz. /1/60 S 7Sro6IcJ_/VI <\ I- '':Af5 Date: i/Z~/o7 I I . Address: . Issued by: Statement: Infolll.ation 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 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: ~ ~. I own, "teside in, or will reside in the completed structure. . I understand that 1 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 %313. I will be my own general contractor. If I 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 toPropert~ Owners about Construction Responsibilities on the reverse side of this form. o 7 /'-v-.d - 3'/2-3/ol)c ~gnature of permit a~licant) (Date) - (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 . .,~ . '\. ,. "\~ . j \.~ , ' . . .. ,-: - \ , t--- - ..... ~Ac'ting-as.JYou!r "Own Gene.ral Contractor? ". -,"", ~ .., \ \ - .. . -"INFORMATION' NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ~-1 . ~ , . I, NOTE: ~hiS Information Notice to Property Owners about Constt'Jction Responsibilities was developed by th',~ Construction Contractors Board in accordance with ORS 701.05!:.(5), passed by the 1989 Oregon Legislature. " _._e.. .-..- ,.- ....,..-....-.....- . , If you are acting as your own contr,actor to construct a new home or m*e a substantial iH~p,ovement to an existing structure, you can prevent many problems by being aware of the followling responsibilities and .concems. Emp~oyer Responsib iUt~es You will, in most instances, be ruled to be an "employer" and the contI actors you contract with will be "employees" if you use .contractors not license~ \yith the Construction Contractors. Bm rd to do. labor in constructing or to ~ssist in the construction or iHilli ovement o~ a resi~ential s1fUcture. A~ the emplOYI :1', .Y~U must~o~Pl:v ~itl1lt.he !oUo..ving: . ' . . - . ..... ... '. - - . 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 for the tax.payment~ even if you don't actually ,withhold the tax from your employees, For more information; call the Department of Revenue at 5 )3-3784988. .. ". '. . Unemployment Insurance Tax: As an employer; you are. required to t a'y' a tax forunemploymcht instirance purposes on the wages of all employees. For more information, call the Oregon Lmployment Department at 503-947-1488. . '. . . .,,: ,. . ''-.... The .oregon Business Identification Number (BIN) is a combined number for .both; Oregon~ Witl1holding. ~nd Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 .,)r \v\vw.dor.state.or.us/formsnav.htmll for the appropriate forms. WorkeH's' 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 co'uld be'subject to 'penalties and be liable for ail claim co.~is if oneofyour'emp10yees is injured on the job. For more information, call the Workers' Compensation Division attheDepartment of Consumer and Business Services at 503-947-7815. ". U.S. Internal Revenue SeH'vice: As an employer, you must withhold federal income tax frori1:employees'wages~< You will be liable for the tax payment even if you didn't actually withh(lld the tax. For a Federal EIN number, call the IRS at r..800-829:..4933"or visit their web site atwwwoirs.l.!ov. .' ,-'j ;. OtIhler RespoID!~ibnRtie~ 2ndlAJre,31s .of Concerns. : Code Compliance: As the permit holder for this project, you are responsible for re~olving'any faiIureto meet code requirements th~t may be brought to you~ ~ttention thnmgh inspections. j' Liability and Property Damage IJrnsunahce: Contact yo~r insurance agent' to see if 'you haveadequaie insurance coverage for accidents and omissions such as falling tools, paint over sp'ay, 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 y~u have the skills to act as your oWIl general (ontrador, to ~6ordinate the work ofrough..in and finish trades, and to notify building officials as the appropriate timeE 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. Propcrty_owner.doc 06-01-04 225 Fifth Street . . . Sprmgfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-01252 COM2007-01252 COM2007 -0 I 252 COM2007-01252 COM2007-01252 COM2007-0 1252 Payments: Type of Payment Check cReceintl RECEIPT #: 2200700000000001340 Date: 08/23/2007 Description Gas Outlets 1-4 Minimum! Adjustment Mechanical -Mechanical Issuance Fee- + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Paid By JOSHUA BRYANT Item Total: Check Number Authorization Received By Batch Number Number How Received djb 8025 In Person Payment Total: Page I of I 9:57:55AM Amount Due 5.00 45.00 20.00 2.50 4.00 5.00 $81.50 Amount Paid $81.50 $81.50 8/23/2007