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Home My WebLink AboutPermit Mechanical 2004-3-22 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2004-00313 ISSUED: 03/22/2004 APPLIED: 03/22/2004 EXPIRES: 09/22/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 316 BLACKSTONE ST ASSESSOR'S PARCEL NO.: 1703233404500 Springfield TYPE OF WORK: Pellet Stove TYPE OF USE: New Residential PROJECT DESCRIPTION: Install pellet insert ~,~ Owner: PHILIP ZAKLAN Address: 316 BLACKSTONE ST SPRINGFIELD OR 97477 Phone Number: 541-726-694 I CONTRACTOR INFORMATION I Contractor Type Mechanical Contractor TED L HUFF JR License 73806 BUILDING INFORMATION I Expiration Date 05/15/2005 Phone 541-338-7550 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: R-3 ~ SETBACKS I DEVELOPMENT INFORMATION. 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: "~t ;.-:-;:-;-; ~-;-I\-!i..-,_ .Irt:lgon law requires you t I PUBLIC 1l\WR:QY.EMlCN,!S I 0 ':'. .1..1 '.' f:!i~' . l. pted by the Oregon Utility 'Jotrflcatlon Center. TSi.d.glYltU<lif~Pj;~e set tort' :n OAR 952-001-001 On+hrnl,nh Ot ,A.Q C\t::~ 00' , .' own~po'UslVl'ams-:;- 0090. You may obtain 'Coples of the rules t ...calling the center. (Note: the telephone Notes: E . number for the Oregon Utility Notification NOTIC: _ _ .1 'J-..,U1 ""'-~+"~;~ 1-ROO-332-2344) I HI~ t'tt"'J111 \)HAt~ E}(Plnt: Ir TUE .. 9P.~ . AUTHORIZED UNDER lHIS~PERMtTV~Nmon Descriotion I COMMENCED OR lS A6ANDONt F\,I\ D . ..A.1U'Y 180.+'lAV D.C.Olnn t. $ Per Sq Ft Square Footage escnpll\W ~e tlll.(!:UlilWPuc Ion It. I' B.d A ' or mu lp ler or I mount Street Improvements: Storm Sewer Available: Special Instruction: Value Date Calculated Total Value of Project Pal!:e 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2004-00313 ISSUED: 03/22/2004 APPLIED: 03/22/2004 EXPIRES: 09/22/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ,:r, '. I Fees Paid. Fee Description -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Minimum/Adjustment Mechanical Pellet Stove/Insert Amount Paid Date Paid Receipt Number $10.00 $4.50 $3.15 $15.00 $30.00 3/22/04 3/22/04 3/22/04 3/22/04 3/22/04 2200400000000000274 2200400000000000274 2200400000000000274 2200400000000000274 2200400000000000274 Total Amount Paid $62.65 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. Reouired Insoections , 1 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. ~ Q, Q ~ 1 t D20A~ Own~;or cor!t;actJis ggna~ure 'g- :2..2.-0'1 Date Pae:e 2 of2 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 Permit#: COVVlZOG . - OOS/] Address: ""3/ b 73/ A-cl.c- ~ ~.....e Issued by: ~g <::.1- ~/2-z.~ l..f , f 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 I and 2, and either box 3A or 3B: ;Rr 1. ..Er.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. ~3A.My general contractor is 'Tt:-,\ L. 1+1..1\ PP (Name) TfL /A~c.. I 7380b (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR D 3B. I will be my own general contractor. If! 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 ofthe 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. 1id7dJ~itapPlicant) L;~ .2;Z~e)O<l (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 03/11103 , . " Acting a,s Your Own General Contractor? . ", J " 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 O\\-'ll 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 Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will 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 ofa 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. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For a State Business ID number, call the Business Information Center at 503-986-2200. >, Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpos~. . on the wages of all employees: For more information, call the Oregon Employment Department at 503-947-1488. Workers' Co~pensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obta{n work~rs' compensation insurance for your employees~ If\you fail to obtain workers' compensat16Il- insurance, you could be subject to penalties and be liable for an 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. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You wiH be liable for the tax payment even if you didn't actually withhold the tax., For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns Code Compliance: . As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage Insurance: Contact 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 redone. Time: Make sur~ you have sufficient time to supervise your employees. Expertise: Make sure you have the .skil1s' 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 can the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner. doc 03/11/03 225 Fifth Street - Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00313 COM2004-00313 COM2004-00313 COM2004-00313 COM2004-00313 Payments: Type of Payment CreditCard Receipt #: 2200400000000000274 Description + 7% State Surcharge + 10% Administrative Fee Pellet StovelInsert Minimum! Adjustment Mechanical -Mechanical Issuance Fee- Received By djb Check Number Batch Number Authorization Number Paid By PHILIP ZAKLAN 000330 323483 .,. City of Springfield Official Receipt _Y Development Services Department Public Works Department ~ Date: 03/22/2004 10:27:00AM Amount Paid Item Total: 3.15 4.50 30.00 15.00 10.00 $62.65 How Received In Person Payment Total: Amount Paid $62.65 $62.65 o o o~ ~ \- cj' U .~- ~--t ~_. ~ ~' ~ o . ~. ~, ~, (,); n, I' .'. ," r.(l ~ ~ cu; r.IJ o ~ ~. (J) > o ~. rd-' Q- 0' ~ , . ZZ5 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 . [OvYl ?r"v-...u _ 00""3 i 'J CIty Job Number ~I Job Location 3/ b 'J5IAc \.L S'TO/v- E '1703Z3sL{ ~ sl SPRWW<t1(Ch\FtElLE:* Assessors Ma~' Tax Lot o L{ S-(:) 0 Owner --=Pit, l'f b4-~LA-tI j 3/ b 'ZIAc:..~ ~--oNe- 5> '? (~ W State elL Address Phone Cit~' Value of Wood Stove/Pellet Stove/Insert: ----- (please circle appropriate appliance) 7zb ~ b6 7 f{ 77Y 77 Zip Preliminary Inspection is $45.00 (prior to insert) Wood Stove/Pellet/Insert Permit is $62.65 (includes Permit, Issuance Fee, State Surcharge & Admin Fee.) Contractor A [S. c. I lEG Zb-S3 7 Phone Address :PC) .;5.oK City erA. G- f::.7\{ ~ Statp 6 (L 73. yo 6 Fxpires Zip Construction Contractors Registration # 33 g --7 .5~(J 9 7f.{() l o s;/J:~S- By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I state that all information on this application /pennit is correct and that I was provided with the Wood Stove Safety information for wood burning appliances and preliminary inspection standards as set by the Oregon Department of Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing approval number to the inspector at the time of inspection. I also understand that if I am requesting a preliminary inspection, the wall covering may be required to be removed. Signaturf' liJU - I 11~ fJL U/ . For Office Use Date of Application 3hz. /0 '-i / I Checked for Delinquencies ~ rhecked for Historical Statm Oat< :p~~ ~ Shared Drive(T:l/Building Fanus/Wood Stove Pemlitl.03.doc