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Home My WebLink AboutPermit Plumbing 1994-8-31 ~j ~0.~ ....... ~ /' ,.~ "BACKFLOW PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 ---------------------------------------------------------~---------------------- JOB LOCATION: ~\.o\) ~~~O i \.)~\\)L .~ . ASSESSORS MAP #:. \f6Da l!~v.\I0-. - TAX LOT #: O\DkCU OWNER: ~X\\lr\ ~C\ \ IT j ADDRESS: -6\O\Y ~l\ Q-. PHONE #: fI? 10' \o~ .::) CITY:~~\~OW STATE: ~ ~ ZIP: qrW'B BACKFLOWPERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 CONTRACTOR:_~or ) ADDRESS: PHONE #: CITY: STATE: ZIP: CONSTRUCTION CONTRACTORS REGISTRATION #: EXPIRES: BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOW PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. 0 '.. \~ 0..... -- ......... -- ~ S NATURE 1}'3,\,'I DATE . , \ FOR OFFICE USE ::::~::.-:~::::::~~~:-~~0r~~-::~-~\;~~-~--:::-:~---q4\34i) TOTAL AMOUNT COLLEC~ \0 . 'l[ ') . , -------------------------------------------------------------------------------- Permit #: ~4\34() - ..~ ~_~o\t \j>i\10j C\\:'tJ} J Date: f4.(~. q4- ." Address: Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon .Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registere4 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 registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. 'I the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. . . ILJ. 2. I understand that I must register as a construction con!Tactor if the structure is sold or offered for sale I before or upon completion. ~ 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR \~ 3B. I will be my own If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board.: If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. ----- (Signature of permit applicant) (White copy to issuing agency permit file, pink copy to applicant) . . . ( -- ,.-. -Information Notice to Property Owners About Constructiol1. ,R~~ponsibmties Note: ThisJnformation Notice to Property qwne,:s ab<?ut Construction Responsibilities l-va,\' deveioped by the Constructiini 'Contractors'Board in accordance with ORS 701.055(5).. 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 areas of concem. . ~ - I -'. . '. ... .... =. ~ ,. EMPLOYER RESPONSIBILITIES: '- If you hire persons _ ~ot r~gistered with t:Qe Construction Con~r~ctors Board to dq labor in, constructin? or assisting in the construction or improyem,ent of a residential structure, YQU will,iI! most instances, pe ruled to l;>e ap..employer and the people you hire will be empJoyees. ,1s th~ employet;, you mu~t compfy with theJollowing: - . . . . -, Oregon's withholding tax hiw: - 'As ~e~ployer, y'ou 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 Oregon Dep1. of R:evenue at 945-8091. 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 Division ilt the Department of Human Resources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers: c~mpensation insurance for your employees. If you (ail to obtain wor~ers' compensation insqrance, you may be subject to penalties and will 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 945-7888. . 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 th~ tax. For more information, call the Internal Revenue Service at 1-800-829-1040. . , , OTHER RESPONSIBILITIES AND AREAS OF CONCERN: 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. .J Liability and property damage insurance: Contact.your insurance agent tos,ee if you have adequate insuraQ-ce coverage for accidents and o~issions such as falling tools, -paint overspray, water damage from pipe punctures, fIre, or work that must be re-done.. Time to supervise employees: Make sure you have suffIcient time to supervise your employees. . - . Expertise: Make 's~re you have the expertiseto act as your own- genetai contractor, to coordinate the w~rk of rough-in and finish trades, and to notify building officials at the appropriate times so' they can perform-the required insPections. ' ' If you have additional questions, write or call the Construction Contractors,Board (PO Box,! 4140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer S1. NE Suite 300; in Salem. prop-own.pin4 1/94 . -,.