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Home My WebLink AboutPermit Plumbing 2007-10-9 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01527 ISSUED: 10/09/2007 APPLIED: 10/09/2007 EXPIRES: 04/09/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 180 S ST ASSESSOR'S PARCEL NO.: 1703262301300 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Repair PROJECT DESCRIPTION: Replace water line and shower valve Owner: KEVIN DERSHON Address: 180 S ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor OWNER License BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: R-3 Height of Structure: Type of Heat: VB Water Type: Range Type: Energy Path: Sprinkled Building: n/a ~fo;~:~~ON I Notification center.1. h...OpSe I'Ih.OAR 952-00'. ,n OAR 952-001-OO~. ."'lst the rulea bf 0()90. You may obti'\..ao I~i:il~~h~'_ ca\l\ng the cent8i1?aven i ~ rwmbef tor the e: Center " t Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Residential Phone Number: 541-953-9013 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: THIS PERMIT SHAll EXP1RE" mE WORK I =IZED UNDER THIS PERMIT 15 NO r Valuation Descr" NeeD OR IS ABANDONED FOR A~~rl4QJ1^~ PERIOD. . Va~e or Bid Amount Notes: Description $ Per Sq Ft or multiplier Type of Construction Pae:e 1 of2 Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01527 ISSUED: 10/09/2007 APPLIED: 10/0912007 EXPIRES: 04/09/2008 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 t Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Fixture Water Line - 1st 50 Feet Amount Paid Date Paid $6.60 $3.30 $5.28 $16.00 $50.00 10/9/07 10/9/07 10/9/07 10/9/07 10/9/07 Receipt Number 1200700000000001284 1200700000000001284 1200700000000001284 1200700000000001284 1200700000000001284 Total Amount Paid $81.18 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 t Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Final Plumbing: When all plumbing work is complete. 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. ~~ b / qh7 / ;- I Date . I Owner or Contractors Signature Page 2 of2 . ConsfructionContractors 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 #: ) C0u.1z.o-o710/ S-2 7 /%0 s\ 5,..f- Address: Is~ued by: '--"""'" ? Date: I~/ y{ 7 . Statement: Information Notice to Propeity Owners About Construction ResponsibUities... . Note: Oregon Law, ORS 701.055(4) requires residential construction pefmit applicants who are not licensed with the Construction Contractors Board to'sign the followingitatement before a b~ilding permit can be issued. This statement is requiredfor residential building! electrical, mechanical and plumbing permits. Licensed architect and engi~eer applicants, exemptfrbm licensing under ., · . 1 , ORS 7~1. 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; ~d eith~r box 3A or 3,B: . y:' ~. I own, reside in, or will reside in the completed structure. . I understand th~t -I must become licensed as a construction contractor it'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 subcontractors who work on the structure must be licensed with the Construction Contractors Board. . /' OR ,,121 3B. I will be my own general contractor, / /, If I hire subcontractors,J will hire only subcontractors licensed withtheConstritction Contractors Board. If! change mymind and hire a general contractor, I will contradtwith a contractor who is . I . licensed with the CCB and will immediately notify the office issuing tIlls building permit of the name of the contractor. ( I hereby certify that the above information is correct and that I have read and do ILnderstand the Information Notice to Property Owners about Construction Responsibilities on tbe reverse sidyfthiS form. . i1C(Signa4iemrit applicant) . 1:/$&7 (White copy to issuing agency permit file, pink copy to appli-:ant.) Property- owner.doc 06-01-04 . " A\(:fi'hgcas~ Yoiit,tOwil . "';' "> 'J. t ')~. . INFORMATION '. . ,0' , ' '. .:,"" -, \...} j ,. ,. \ '. . , . , \ " . , . Information Notice to Property Owners about Construction Contractors Board in accordance with ORS 701,055(5); passed the a 0"; ,'~.-'~. ~ ....: .' on an more . i i 1 .;. J' is a combi1!~s! 503-945-8091 or \\TI,vw.dor.stute.or , .... you are subject to employees. If , . . ~... " fHI c1aim1co'sts Divisimi at Internal Revenue You 'will ......"" 'wages. "" " the '" you are to tricet code . "~,, ~ '\ or '. to your fr " t to or at PO . .' ~ '. ~ . 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: Date: 10/09/2007 1200700000000001284 Job/Journal Number Description COM2007-0 1527 Fixture COM2007-01527 Water Line - 1st 50 Feet COM2007-01527 + 5% Technology Fee COM2007-01527 + 8% State Surcharge COM2007-01527 + 10% Administrative Fee Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Cash KEVIN DERSHON djb In Person Change KEVIN DERSHON djb In Person Payment Total: Job/Journal Number Description COM2007-01527 Fixture COM2007-01527 Water Line - 1st 50 Feet . COM2007-01527 + 5% Technology Fee COM2007-01527 + 8% State Surcharge COM2007-0 1527 + 10% Administrative Fee Item Total: Payments: Check Number Authorization Type of Payment Paid By Received By Batch Number Number How Received Cash KEVIN DERSHON djb In Person Change KEVIN DERSHON djb In Person Payment Total: cReceintl Page I of I 1:21:16PM Amount Due 16.00 50.00 3.30 5.28 6.60 $81.18 Amount Paid $85.00 ($3.82) $81.18 Amount Due 16.00 50.00 3.30 5.28 6.60 $81.18 Amount Paid $85.00 ($3.82) $81.18 10/9/2007