The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 2005-10-27 $.'..p., .R.'...''''.. G..F.'.a;&..lO.... ..fij......... "'. .. ......... ,,-~,. .,.-..... ~ - .- ..,.~. ,--..*,', Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4250 CAMELLIA ST ASSESSOR'S PARCEL NO.: 1702323300800 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01526 ISSUED: 10/27/2005, APPLIED: 10/27/2005 EXPIRES: 04/27/2006 VALUE: Springfield TYPE OF Plumbing Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Install approx 50lfwater line Owner: ROBBIE SHYRER Address: 4250 CAMELLIA ST SPRINGFIELD OR 97478 Contractor Type Plumbing Contractor OWNER # of Units: Primary Occupancy Group: R-3 Secondary Occupancy Yrimary Construction Type VN Secondary Construction # of Bedrooms: Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: Description Type of Construction Phone Number: 541-344-5786 I CONTRACTOR INFORMATION. Lifcen~~quirci~pirtaion Date Phone /lTTI=NTION: Orego,~ a~h'" nreOOn Utility. I BUIL'~JN@ INFo~~.fFiGNI~ rules are s~~~~~~~ NofltlcallUl1 ~ ,,- 0 through OAR 9 ~\qf~tPrre~i2-001-0~t~in copies of thEJJJJ~srz~~ ~~JtJofou ,maY 0 (Note: the tel(sq~rr~ Floor: TYP~af~at:e center'e on Util'lty NO'Sqr-Ftl~n(l Floor: Walffir1;'MB~:lor the, Or g 00_332-2344$q Ft Basement: Range Type:;;enter IS 1-8 Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled n/a Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: IPUBLIC IMPROVE~ E~P\RE \f 1\-\E 'NOR~ \\-\\5 PERM\l ~~ei>ERM\1 \5 NO ~U1\10R\1.EO#e,,~~~~sEO fOR COMM~ONCO~'t p~R\OO. ' AN't 1u__ I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated 1 of 2 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01526 ISSUED: 10/27/2005 APPLIED: 10/27/2005 EXPIRES: 04/27/2006 VALUE: Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Water Line - Ist 50 Feet Amount Paid Date Paid Receipt Number $4.50 $3.15 $45.00 10/27/05 10/27/05 10/27/05 1200500000000001624 1200500000000001624 1200500000000001624 Total Amount $52.65 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. Water Line: Prior to filling trench and including required testing. 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 wiD 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 wiD remain on the site ,at all ti s during construction. 2l~~----- ICfd1-!6~ Owner ~actors Signatu~e.. "') Date 2 of 2 ,. .. . . 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 #: CouvtZ-OO__ -0 I .) z- G LfZ,~O UtW\E/ZA , ,~t;f Address: Issued by: Date: /0-2- 7~0r Statement: Information Notice to Property Owners . About Construction .~esponsibilities Note: Oregon Law, 'ORS 701.055(4) requires residential con~truction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building perm..ft cmi be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under pRS 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: ~1. Qt-2. I own, reside in,.orwill reside in the completed structure. I understand that I must become licensed as a construction contractor ifthe structure is sold or offered for sale before or on completion. D 3A. My general contrac~or 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 % 3B. I will be my own general contractor. If! hire subcontractors,! will hire only subcontractors licensed with the Construction Contractors Board. If! change my mind and hire a generai 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. (' ~_ r, ~.." ~ ""~1D~~ . . U ~---- ID\&-TrOS' ,"-.J "') tsl~ature"ofpe it a~an9 (Date) (White. copy to issuing agency permit file, pink copytd applicant.) PropertLowner.doc 06-01-04 :\ ,-- ---- ,._,~ ': - ,-,.,~. -:-"~. ' Acting its-'lL our 'eWn -Genera] Contractor? - ',,\' ~ ('I:~FdRM'~Tldr~lNOTICETO PROPERTY OWNERS' ; , ' ~) -',' ,>' ;~J\ ABOJ:fr~CONSTRUCTI9NRESPONSIBIUTIES - -' " '" 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 ovvn contractor to construct anew home or make a substantial iU!plovement 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 c~ntract ,,,-ith wilfb~ "eIl!ployees" if you use ,contractors not,license<:i with the ConstrucjiQn Contractors B,?ard to do labqr in constructing or to assist in the construction or irrlprovementof a residential structur~. As ,theempioye:r, you:must complyyvith 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 more information, call the Department of Revenue at 503-378-4988. '. , Unemployment Insurance Tax: As an employer, you are required to pay a tax 'fofunemploymentinsurance purposeS'- on the wages of employees. for more information, can Oregon Employment Department at 503-947-1488. , , 4_ ~,~ ~ Oregon Business Identification Number (BIN) is a combined number for both. Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, can 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the -, appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' comp(;nsation 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 au11e Department of Consumer and Business Services at 503-947-7815. ., U.S. Internal Service: As an employer, you must withhold federalin:come -tax from -employees' wages~ You will 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 W\VW,irS.IWV. .:.. .' ".... -:: Other Responsibilities -Are,as of Concerns > Code requirements, that ,. , As the permit holder for this project, be brollght to your attention through , are -resppnsible for resolving any failure' to meet code , .', ,/ ..- Damage Insurance: . Contact coverage for accidents omissions such as falling work that must be redone. , 1 ; ) I \ ./ I '\. I..... ' --_._.~ ~-,.- ..1 - -- to see if you have adequate insurance over spray, water damage from pipe punctures, fire or ..... i- ~ '.... ) \ .~ "j ') "- -- /' .1 , sure you 'have sufficient time to your -...".. sure you have. the ;kius act as to notify buih}ing officials as , , to coordinate the work of rough-in so they can perform the required inspections. j{ and (503-378-4621) or write the agency at PO call the Construction 97309-5052. 06-01-04 ~..~, _' i ...., -'''-....; 225 Fift,h Street . 0 , Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2005-0 1526 COM2005-0 1526 COM2005-01526 Payments: Type of Payment CreditCard - " -- I', ,. .j" 10/27/2005 RECEIPT #: Description + 7% State Surcharge + 10% Administrative Fee Water Line - 1st 50 Feet Paid By ROBBIE SHYRER City of Springfield Official Receipt velopment Services Department Public Works Department 1200500000000001624 Date: 10/27/2005 Item Total: Check Number Auttlorization Received By Batch Number Number How Received djb 048903 In Person Payment Total: 1 of 1 1:29:32PM Amount Due 3.15 4.50 45.00 $52.65 Amount Paid $52.65 $52.65