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Home My WebLink AboutPermit Plumbing 2004-5-4 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00516 ISSUED: 05/04/2004 APPLIED: 05/04/2004 EXPIRES: 11/04/2004 VALUE: 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 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Connect to city water Owner: SHYRER ROBBIE L & MATTHEW Address: 4250 CAMELLIA ST SPRINGFIELD OR 97478 Phone Number: 541-344-5786 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor OWNER License Expiration Date Phone BUILDING INFORMATION' # of Units: # of Stories: Primary Occupancy Group: R-3 Height2.frlitructure Secondary Occupancy Group: I~>.~: Primary Construction Type VN x.. \t ~. Secondary Construction Type: \. 't.i.~\~ Vt.~ t~e: # of Bedrooms: -c\tft. ~ ~\\~\J ~ \\\\~ t"\~YPath: \\~, ot.,,\'f\~ C'\ 'U~\)"::. ,\'O~W~" \' \)~" - '1'"'. r.\ \~ ~ ~'U\\\~~~Ct.\) ?t.\\\Gf~VELOPMENT INFORMATION' SETBACKSc,Q~ \ ~~ \)~ . Front yard Setback: ~~" Overlay Dist: I Side 1 Setback: # Street Trees Rqd: Side 2 Setback: Paved Drive Rqd: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: % of Lot~JmlJ&U to egOft laW (8\\""" "'... U"\"l'I ",.iENT\QN: ~._ *' hVtbe ~'e~:.c\:~ ~"" lo\\oW,:"~~~ Not\11catt ~O'\ the fU es \n QARy~~ may ontEUn COP~th~ te\ephOOe OO~~\\ing the center. \N~t\\\\Y Nont\catlOR mb8f tor the or~^^t:l~2,--2344). f\\1 Center \i 1-ouu-v- Sidewalk Type: Downspouts/Drains: Rearyard Setback: Solar Setbacks: Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Pal!e 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00516 ISSUED: 05/04/2004 APPLIED: 05/04/2004 EXPIRES: 11/04/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid-l $5.90 $4.13 $45.00 $14.00 5/4/04 5/4/04 5/4/04 5/4/04 Receipt Number 1200400000000000617 1200400000000000617 1200400000000000617 1200400000000000617 Fee Description + 10% Administrative Fee + 7% State Surcharge Water Line -1st 50 Feet Water Line - Each Addtll00' Amount Paid Date Paid Total Amount Paid $69.03 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 Reouired Insoections I 1 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 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. ~~~ s1410<+ Owner or Contractors Signature Date Paee 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 #: COM ZOL , ' 005'( b Address: LfZS-O CA-vVIe--( {IA- 'S t- Issued by: -=0 (1'" Date:S:;/0' Lf Statement: Inforl11ation 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 be filed with the permit. Fill in the appropriate blanks ~d initial boxes 1 and 2, and either box 3A or 3B: ~1. ~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. 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. 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. ~~ '--fZ ~&~ S/4(ol{ (Signatur~fpermit applt.tant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner. doc 03/1 I/03 Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES ) , NOTE: This Information Notice to Properly 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 fonowing responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with w111 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 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 IDnumber, 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~.s on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488, . \Vorkers' 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. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages, You will 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 re.solving 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 sure you h~ve s,u~ficient tim~ 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 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_o\vner.doc 03/11/03 225 Fifth Street Spr~ngfieltl, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00516 COM2004-00516 COM2004-00516 COM2004-00516 Payments: Type of Payment Check 5/4/2004 RECEIPT #: Description Water Line - 1st 50 Feet Water Line - Each Addtl 100' + 7% State Surcharge + 10% Administrative Fee Paid By ROBBIE SHYRER ."-i~.fiiI Wit ,.....+y of Springfield Official Receipt velopment Services Department Public Works Department 1200400000000000617 Date: 05/04/2004 Item Total: Check Number Authorization Received By Batch Number Number How Received djb 3503 In Person Payment Total: Page 1 of 1 1:16:46PM Amount Due 45.00 14.00 4.13 5.90 $69.03 Amount Paid $69.03 $69.03