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Home My WebLink AboutPermit Plumbing 2005-5-2 . -WiL.~.'P-l...~.I:~.'~..'...'.".. L.'. IO..tii...... > ~.. UIJr" j Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00509 ISSUED: 05/02/2005 APPLIED: 05/02/2005 EXPIRES: 11/02/2005 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1426 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703253308000 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace approx 130lfsanitary sewer Owner: LETHA POOL Address: 1426 CENTENNIAL BLVD SPRINGFIELD OR 97477 Phone Number: 541-746-9403 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor JOHN PHILLIP DECKER '. ',;. Li~~nse 163938 Expiration Date ,03/29/2007 Phone 541726-6124 VN BUlIoDI.N.G INFORMATION' f{ I" . IIL'N' 0 . ~.\110\~ , 'reg MJf;I~f St:9).'ie~ ado t on law re' Lot Size: ' in ,H.~fi!h~<M1$lelUlt~rPd by the oQUlres YQtl.d1t 1st Floor: lJiil1 Qc: rtzer. ~h reg LO , ooQf~Q~qjf~~,-OO' ose rUles on U1FN~2nd Floor: c~W,af%ey Ob 1.0 throUgh are se~ Basement: nU 'Ji{filgfl/fe'Wnt tam COPies ~AR 952.'ffb Garage/Carport ~R~~,Pn:Ur ef. (Note: th~ the rule~ft Other: sprii~,,~ftt~~,~t~li~ ^~f~onto'iupant Load: I DEVELOPMENT INFORMAHtj't'~4. UOIJ REQUIRED PARKING # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: .~ Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: ~~(~HJYIPROVEMENT~ ue H ",-, THIS PERMIT SHALL EXPIRE l~ifH't~orA~e: AUTHORIZED UNDER THIS PEf~Mrtnr8o~tsnrains: COMMENCED OR IS ABANDONED FOR' u. ANY 180 DAY PERIOD. Notes: .....-'\ I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pal!e 1 of 2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00509 ISSUED: 05/02/2005 APPLIED: 05/02/2005 EXPIRES: 11/02/2005 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 I Fee Description + 10% Administrative Fee + 7% State Surcharge Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each Addtl100' Amount Paid Date Paid Receipt Number $5.90 $4.13 $45.00 $14.00 5/2/05 5/2/05 5/2/05 5/2/05 2200500000000000515 2200500000000000515 2200500000000000515 2200500000000000515 Total Amount Paid $69.03 Plan Reviews, 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 Sanitary Sewer 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. It {)~AO_ fY ~ L .0 Owner or Contractors Signature !J /:1/6/;- , Date Paee 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 Perrnit#: C.Ov1llZO,-" r--c> 0 S-07 Address: 1'1"Z b CCVV~'.A- ( Issued by: D G . Date: ~ - z.. -or . Statement: Information Notice to Property Owners AboutConstruction 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 ar(Jhitect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement. will be filed with the permit. Fiii in the appropriate bl~s and initial boxes 1 and 2, and either box 3A or 3B:' ~1. tt.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 subcontr3;ctors who work on the structure must be , licensed with the Construction Contractors Board. . . OR a 3B. I will be my own gene~al.contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. IfIchange 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. , . ;t (}f-j~ (9, ~ 5" /,1. ) (J S . (Signature of pedmt applicant) / (flate) (White copy 'to issui1'!g agency permit file, pink copy to applicant.) Property,...:owner.doc 06-01-04 Acting as )[ our Own General Contractor? ) ,J . . / :-- ~lNFOR'lvIAtibN 'NbTICETO PROPERTY OWNERS , ) ';. A~9VT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.655(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a subst(intial 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~<;ontractors not licensed with the Construction Contractor~ 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 Wlthllll1ding Tax Law: As an employer, you must withhold income taxes from 'Cinployee wages at the time employees are paid. You will b~ liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, can the Department of Revenue at 503-378-4988. Unemployment Insu,nmce Tax: As an employer, you are required'to pay a tax foruncH!pIoymentinsurance purpos~;'-"" on the wages all employees. For more information, call the Oregon Employment Department at 503-947-1488. ....,/ "'- The Oregon Business Identification Number (BIN) is a combineq number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.oLus/formsnav.html1 for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVU1jJensation Law, and must obtain workers' compensation insur,,!-nce for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all chiim 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-:Z- You liable the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call at 1-800-829-4933 or visit their web site at \V\vw.irs.lWv. Other Resp,onsibilities and Areas of Concerns As the permit holder for this project, you are responsible for resolving any failure to IDeet code h.e brought to your ,attention through inspections. Code , namage Insu'fa,nce: Contact your insurance agent to see if you have adequate insurance accidents omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must redone. ,Make sure youhav'e sufficient time to supervise your employees. and sure you hav~ the skills to act as your ovvn to building officials as contractor, to coordinate work rough-in times so can perform required inspections. call the 97309-5052. Board (503-378-4621) or write the at PO 06-01-04 225 Fifth Street .springfield, Oregon 97477 541-726-3759 Phone Wi~ rity of Springfield Official Receipt .welopment Services Department Public Works Department Job/Journal Number COM2005-00509 COM2005-00509 COM2005-00509 COM2005-00509 Payments: Type of Payment Check "J 5/2/2005 RECEIPT #: 2200500000000000515 Date: 05/02/2005 Description Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each Addt1100' + 7% State Surcharge + 10% Administrative Fee Paid By LETHA POOL Item Total: Check Number Authorization Received By Batch Number Number How Received djb 571 In Person Payment Total: Page 1 of 1 9:24:S9AM Amount Due 45.00 14.00 4.13 5.90 $69.03 Amount Paid $69.03 $69.03