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Home My WebLink AboutPermit Plumbing 2006-5-1 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00509 ISSUED: 05/01/2006 APPLIED: 05/01/2006 EXPIRES: 11/01/2006 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1030 CENTENNIAL BLVD ASSESSOR'S PARCEL NO.: 1703264410200 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace approx 80lfsanitary sewer line Owner: Address: GWEN POLK 1030 CENTENNIAL BLVD SPRINGFIELD OR 97477 Phone Number: 541-736-0191 ,..., , ;-,:;r' I .~:"':'~ '/nll +...... Contractor Type Plumbing ,I CONTRACT,ORIN~0R~i':r~lQ~f:'(., , , ',,' .0'", -,.n ,,- , .' , , 'u ~'~, :tClIr',l C r, ;:i CfC;? (;01 Contractor'"" - -, "'~. ,-,~, c'.C!';,~;i,l co,::;';s ol't,1}ceris-eb - Expiration Date Phone C~'I' " , ,,-- /,<.. rUinS y OWNER l",'l:' ,,'" r'~ -',- ('", " . ...... -. ''- '-'"-',1.:'1. ~''-O~3: T;i~ +-:):c',-..:-,......_~ . .....'.1'11.....0. It 1/ ," ';-'..... lr'~ - . I . 1 rBUILD.IN,G ~fNFeRM!A'TI:Or.tltion .~ ~vv vu~-'::::044). # of Stories: R-3 ' Height of Structure Type of Heat: VN Water Type: Range Type: Energy Path: Sprinkled Building: n/a Lot Size: Sq Ft 1st 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: I DEVELOPMENT INFORMATION I . .. REQUIRED PARKING Total: Handicapped: Compact: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: ~T\r..%.Of Lot Coverage: c IC THE \NORK l{U, \:t. LL EXPIRl. r , 01 Tlllc DI=RMll SH/\ -n TI~c DI=RM\I IS N I~ - 5\liWPtB~'%iiwtM~ONED fUt\ cEt~~~~ ptRIOO. Sidewalk Type: /\N'< ~ 8 n Downspouts/Drains: Street Improvements: Storm Sewer Available: Special Instruction: It ~ Notes: I Valuation Description I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00509 ISSUED: 05/01/2006 APPLIED: 05/01/2006 EXPIRES: 11/01/2006 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 + 8% State Surcharge Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each Addtll00' Amount Paid Date Paid Receipt Number $5.90 5/1/06 1200600000000000577 $4.72 5/1/06 1200600000000000577 $45.00 5/1/06 1200600000000000577 $14.00 5/1/06 1200600000000000577 Total Amount Paid $69.62 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 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 tirnz=hO 4-:~ 1)!1 ! CXo Owner or Contracto~ture' ,/ Date Pa2e 2 of2 . 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 #: C OV\I\ z:..o l;.. ~ -- 00 s-o 7 Address: '/O:I 0 c..e~ .fc'YLV\ IA- ( 35:1" d ;~~ Date: Sit lOb ~' I / Issued by: Stater11en~: 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: t. 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 )g:f. 3B. I will be my own general contraqtor. 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 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 Ow about Construction Responsibilities on the reverse side of this. form. t)) 100 " (bate) (White copy to issuing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 ~.) , :. -A~tilig'~'ils"I -bu'r ,O,wn General Contractor? I ~ ~,) ,oJ. ,i iNF-ORMA liON NOTICE -TO 'PROPERTY OWNERS ' ; ABOVI.CONSTRUCTION RESPONSIBILITIES c. A ' ,\"\'~ \0:.. . NOTE: Th;s InformaUon NoUce to Property Owners about ConstrucUon Respons;bmties was developed by the ConstrucUon Contractors Board;n accordance with ORS 701.055(5), passed by the 1989 Oregon Leg;s/ature. ... . .... ',', If you are acting as your own contractor to construct ~ new home or make a substantial il~lplovement to an existing structUre, you can prevent m.any problems by being aware of the following responsibilities and concerns, Employer Responsibilities ~\ You will, in mo~t instances, be ruled to be an "emplqyer", and the contractors you contract with will be "employees" if YOU'llse contractors not lic,ensed with the Construction Co~tractors Board to do labor in constructing or to assist in the construction or impro~ement of a residential structure. As the employer, y~u must comply ~ith the following: , . ... . , 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 tax payments even if you don't actually withhold the tax from your employees. For more information, call the Depa.1L~,ent of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to paya 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/fonnsnav.htmll for the app, V.I:-" ;ate forms. - - Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers,' compensation insurance for your employees. If you fail to obtain workers'compensation insurance, you'could be subject to penalties' and be liable for all claim cos,ts if one ofyotir'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 iilcome 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.lwv. ' , ~ Other Responsibilities and Areas o(Concerns , . Code Compliance: As the permit holder for this project, you are responsible for resolving any failure'to meet code requirements that :;n.ay be brought to your attention through inspections. Liability and Property Damage Insurance: 'Contact your insUrance agent to see if you have adequate insurance coverage for accjdents 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 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 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 06-01-04 225 Fifth Street Springflelcl, Oregon 97477 541-726-3759 Phone 0...., of Springfield Official Receipt l Jopment Services Department Public Works Department Job/Journal Number COM2006-00509 COM2006-00509 COM2006-00509 COM2006-00509 Payments: Type of Payment CreditCard cReceintl RECEIPT #: 1200600000000000577 Date: 05/0112006 Description Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each Addtl 100' + 8% State Surcharge + 10% Administrative Fee Paid By GWEN FRASERPOLK Item Total: Check Number Authorization Received By Batch Number Number How Received djb 09851 B In Person Payment Total: Page I of I 1 :43:59PM Amount Due 45,00 14,00 4,72 5,90 $69,62 Amount Paid $69,62 $69.62 5/1/2006