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Home My WebLink AboutPermit Building 2005-6-3 (2) Status Issued . CITY OF SPRINGFIELD. . Building/Combination Permit PERMIT NO: COM2005-00664 ISSUED: 06/03/2005 APPLIED: 06/03/2005 EXPIRES: 12/03/2005 VALUE: $ 5,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 922 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264302000 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Repair PROJECT DESCRIPTION: Replace foundation on west side only. Approx 25lfstorm sewer connection Residential . Owner: ;', Address: ERIK BERGLAND 1311 G ST SPRINGFIELD OR 97477 Phone Number: 541-744-1642 I CONTRACTOR INFORMATION. Contractor Type General Plumbing Contractor OWNER OWNER License Expiration Date Phone Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: BUlL~I~GI~F?RMATION . # of Stories: R-3 .. Height of Structure .~j~8g-J Sf J91U9~ Vlhr 1lO!I&O!J!lOWAmnnIW5eJO 9qJ JOj J9qwnu . euoqdeleFaqJ~M: ~elueo 9tn BUll/eo "q salOJ e~.B~6ielOO" . ~~~S6 ~~QBMsJIIgY~'rn~~~~^u~~ ~,~.f.NmlMA1.IfI!ON!~ON . ~'~~;i&ii~~'L?~~...... 0>>01"" IV\uIlbj OJ n seJJnbeJ Me, ~o6aJO :NOI1N311V Overlay Dlst: # Street Trees Rqd: Paved Drive Rqd: % ofL~t Coverage: Lot Size: Sq Ft Ist Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Group: . Primary Construction Type Secondary Construction Type: # of Bedrooms: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: N01~C\E: ORK THIS PERMIT SHALL EXPIRE IF THE W AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Pa2e 1 of3 _6PAINGP'Q!) ~... -... .... i. WJL.. ..~~---. ; ; lilt: ._,.n.,' L ....._ ._..___ __" . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Tvpe of Construction Total Value of Project ~ Fee Description + 10% Administrative Fee + 7% State Surcharge Encroachment Permit Foundation Permit Storm Sewer - 1st 50 Feet Amount Paid Date Paid $11.34 $7.94 $130.00 $68.40 $45.00 6/3/05 6/3/05 6/3/05 6/3/05 6/3/05 Total Amount Paid $262.68 I Plan Reviews I Structural Review 06/03/2005 06/03/2005 APP DJB . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2005-00664 ISSUED: 06/03/2005 APPLIED: 06/03/2005 EXPIRES: 12/03/2005 VALUE: $ 5,000.00 Value Date Calculated Receipt Number 3200500000000000283 3200500000000000283 3200500000000000283 3200500000000000283 3200500000000000283 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Storm Sewer Line: Prior to filling trench. Pal!e 2 of 3 Status Issued . CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2005-00664 ISSUED: 06/03/2005 APPLIED: 06/03/2005 EXPIRES: 12/03/2005 VALUE: $ 5,000.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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. ~~ft~~~~ \. ~-:5 _~r- Owner or Contract~ Signatu~ Date Pae:e 3 of 3 225 Fifth Street ~pringfield, Oregon 97477 541-726-3759 Phone j Job/Journal Number COM2005-00664 COM2005-00664 COM2005-00664 COM2G05-00664 COM2005-00664 Payments: Type of Payment Check I, ~ " .( '.. , '" .. 6/3/2005 RECEIPT #: Description Foundation Permit Storm Sewer - 1st 50 Feet + 7% State Surcharge + 10% Administrative Fee Encroachment Permit Paid By ERIK BERGLAND ~ iiiIt of Springfield Official Receipt ~lopment Services Department Public Works Department 3200500000000000283 Date: 06/03/2005 9:02:13AM Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 68.40 45.00 7.94 11.34 130.00 $262.68 Amount Paid djb 2251 In Person Payment Total: $262.68 $262.68 Page 1 of 1 \ Consttuction 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 #: C.Oj/l-\ "'t..OO "-0 6 b Lf. Address: 0; Z z... Ctvt ~ ill I iA.J ..~~ Issued by: [slvd.. Date: 6 -:s ~O-r 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 be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: td 1. tr2. 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 !In completion. D . 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must he licensed with the Construction Contractors Board. OR M" 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! 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 ofthe 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. ~,-~gJJ . ~-3-6.s. (Sighature ~rmit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01~04 1"""" :) ~ \'t...- Acifng~'~o~I'Own General Lontractor? . ~.. [',: . INfO~MATIb~'NOTICE'TO PROPERTYOWNE'RS '. ABOUl CONSTRUCTION RESPONSIBILITIES. . , .. .. .<-. '. . i.'" '-;:..) c:::- ~I <..-j NOTE: ;~;S~~for~~on Notice to properl;own~rs about ~onstruciion R~sPon~ibifities was deve/~ped by th~1 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 following responsibilities and concerns. Employer Responsibilities You will, il} most instances, be rul.;:d to be an "employer" and the contractors you contract with will be "employees" if you use contracto.rs not licensed with the Construction Contractors Board to do . labor 'in constructing or to assist in the construction or improvement of a res.idential structure. As the employ~r, you must comply with the follo';"'ing: 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 taxpayments 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 Insurance Tax: As an employer, you are required to pay a tax for unemployment ins.urance 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.oLus/formsnav.htmll for the appropriate forms. . .' )''''' Workers', Compensation Insurance: As an employer, you ke subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers'cornpensation insurance, you could b~ ~ubjeci to penalties 'and be liabie for all claim co.sts if one of yoUr employees i~ injured on the job. For more information, call the Workers' CVUlpensation 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.incoine tax'fromemployees' wag~~ 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 1-800-8'29-4933 or visit their web site at'vW'W.irs~.gov~' " Other 'Respo.nsibillties 'and Areas'of Concerlls. '. 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. - . ,~ .. ~ ,.. - . - ..-.' . <I. . . lLialbnRity and P.roperty Damage ][]msurance:. Contact your'insurance agent to see if you llave 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. have sufficient time to supervise your employees: Expertise: Make sure you h~ve the slO11s to ~~t as your own 'general contrac'ror, to cootdinate 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_owner.doc 06-01-04