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Home My WebLink AboutPermit Building 2004-7-29 . Status Issued ~ 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 775 S 57TH ST ASSESSOR'S PARCEL NO.: 1802041105100 PROJECT DESCRIPTION: Interior remodel . Ll1 i' OF ~rKlNGFIELD Building/<;::ombination Permit PERMIT NO: COM2004-00941 ISSUED: 07/29/2004 APPLIED: 07/29/2004 EXPIRES: 0112912005 VALUE: $ 15,000.00 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Residential Alteration Owner: HORTON DONALD M & LAUREN E Address: 775 S 57TH ST SPRINGFIELD OR 97478 ... Contractor Type General Electrical Mechanical Plumbing Contractor OWNER OWNER OWNER OWNER # of Units: Primary Occupancy Group: R-3 Secondary Occupancy Group: Primary Construction Type VN Secondary Construction Type: # of Bedrooms: .. Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: - I CONTRACTOR INFORMATION I . o~~l:ttion Date Phone. ~~bY~Oregonse\tort\\ to\\CJllIculBS ~ ~~::962.()()1. ~,.oo1.cD10~ Qi9\e rules bY ...nAR952 ,......lnCO~ ,........na I, Bu~~1M:I~;t'l;:..;;"l*~~; ~;flC8t\Ol\ ~U...' ttl3OTtl"(,I~ 1.23'\4\. #~-:':la1-8~ Lot Size: Hci;ht of ~re Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: nla Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: nil . ~ ~O"" d\"f \~ '\~ ,{: t-Io1 I PUBLIC IMPROVEME~~''''. ~ S",t-.\.\. 't~,~V~\\~~ fO\\ ',,,,,S ~~~~~~r.l/l~~\)O~~ , t-.lji"'~~",~~\~rains: CO\>tl ~O \)t-.'1 r-.~'1 '\ Page I of3 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00941 ISSUED: 07/29/2004 APPLIED: 07/29/2004 EXPIRES: 0112912005 VALUE: $ 15,000.00 Status Issued 225 Fifth Street, Springfield, OR 541.726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion I Bid Amount Use Bid Amount $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 15,000.00 Value Date Calculated Description Tvpe of Construction Total Value of Project $15,000.00 $15,000.00 07/29/2004 ~ F pp~ PIiIIJ Fee Description -Mechanical Issuance Fee- + 100/0 Administrative Fee + 7% State Surcharge Building Permit Fixture Minimum/Adjustment Mechanical Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Amount Paid Date Paid Receipt Numher $10.00 $59.34 $41.54 $146.40 $182.00 $45.00 $106.00 $1l4.00 7/29/04 7/29/04 7/29/04 7/29/04 7/29/04 7/29/04 7/29/04 7/29/04 1200400000000001154 1200400000000001154 1200400000000001154 1200400000000001154 1200400000000001154 1200400000000001154 1200400000000001154 1200400000000001154 Total Amount Paid $704.28 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 ~~ ' ~",J1II~I~til~ Framing Inspection: Prior to cover and after all rough in inspections have heen approved. Wall Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Electric Service: Approval required prior to utility company energizing service. Paee 2 of3 / .-it.....~~~ ~ -~~ ~ . 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: COM2004-00941 ISSUED: 07/29/2004 APPLIED: 07/29/2004 EXPIRES: 0112912005 VALUE: $ 15,000.00 By signature, 1 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 Ordinanees 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. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. 1 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. ''D~ ~ ~\, ~ Owner or C'<nrr.:actors Signature Paee 3 of3 1/<7'/ /';4 I I Date -. \ i ", " " " . . . 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 #: COVVl A'i _0091{ I 77) S 5y1-l-.. ~~ ~+- C' Address: Issued by: , Date: ~/Z- VOL( 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: kL ~ 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. 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 ,;:ff 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 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. -- \ ')~ Y\oo\,.,. C-----" (Signature of permit applicant) \\ \- 7/2-,-'1 /('J Lf I (D'ate)' (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06.01-04 A. ~.' ..,. '0 r; II C. f4. t ? CllJllillg 2S X OUrt" WIDJ. 'U'~neraJl. mlll!.rac or 0 INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property OWllers about Construction Responsibilities was developed by the Construction Contractors Board in accordallce with ORS 701.055(5), passed by the 1989 Oregoll Legis/ature. 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 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 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 employecs 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 for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488, The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appj.Vt'l~ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' CVWI'''usation 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 1-800-829-4933 or visit their web site at www.irs.Qov. Othell" Responsibilities ami Area~ 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 coveragc for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone, , '\),.., . ..,\i" ... , -\ " Time: Make sure you h'ave sufficient time 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 al'l"VI',;ate 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 _ owner.doc 06-01.04 22.5.Fifth Street \"Springfield, Oregon 97477 541-726-3759 Phone . ~l a.v of Springfield Official Receipt _elopment Services Department Public Works Department Job/Journal Number COM2004-0094I COM2004-0094! COM2004-0094I COM2004-0094I COM2004-0094I COM2004-0094I COM2004-0094I COM2004-0094I Payments: Type or Payment ~ Check k !; 7/29/2004 RECEIPT #: 1200400000000001154 Date: 07/29/2004 Description Fixture Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Building Permit + 7% State Surcharge + 10% Administrative Fee Paid By DON HORTON Item Total: Check Number Authorization Received By Batch Number Number How Received djb 283 In Person Payment Total: Page I oft 8:28:42AM Amount Due 182.00 45,00 10.00 106.00 114.00 146.40 41.54 59.34 $704.28 Amount Paid $704,28 $704.28