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Home My WebLink AboutPermit Plumbing 2007-4-23 -~~ Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO' COM2007-00587 ISSUED. 04/23/2007 APPLIED. 04/23/2007 EXPIRES. 10/23/2007 VALUE: 225 Flftb Street, Spnngfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 InspectIon Lme SITE ADDRESS 2500 CENTENNIAL BLVD ASSESSOR'S PARCEL NO 1703254400103 Sprmgfield TYPE OF WORK Plumbmg Only TYPE OF USE Repair ReSIdentIal PROJECT DESCRIPTION Replace water beater Owner CARL JAMISON Address 2500 CENTENNIAL BLVD SPRINGFIELD OR 97477 Pbone Number 541- I CONT~fQ.R INFORMATION' ~\J- \;\.- ~\:\, o-'S 0<;\ :<..\0 Contractor ~'Il ~e o~eg '0",'0 '0'\)\' ,\v '0 '().~ b'l: ",\ OWNER ""o<;<o..,,"S' ,\'0'" o.g ,,,,,,,,,, "O~ ~;oR\e~~1l-=B'illf\,Dik'INF,g~1. <\. T10N . ~~, '-' \. , ,in" "r \ ,~n\ . <(;.\~ ec' '3' "/.,'0\ '\) ~ ,. ,'0'" '0 \'0'. ~\c;;o." # of Umts ~'\ ~ \0" !0 CP'\,'\)'\)\ ,<;\ (jol\9j\'Srot,lA~ Pnmary Occupancy Gril,\l~O c,'().~0 b'l:If)3.-\ 0'0\'0' ~'1'il\!.ll'tl)'m,~ucture Secondary Occupancy ql(6'ti8~0 g 0(:':0: '0<;\\'0\ e~cfxJ!J!>7n'Heat Pnmary ConstructIon Typ;e f0 'to ~-@ (J ~e O\_'OW'dter Type Secondary ConstructIon T~~ ~\<;<o~ ~ \0\ "/.,'0\ \'" Range Type # of Bedrooms C, ~'Oe (je<;<O Energy Patb <;\u Sprmkled BUlldmg Contractor Type Plumbmg License ExpIratIon Date Phone Lot S,ze Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft Garage/Carport Sq Ft Otber Occupant Load n/a Frontyard Setback Side 1 Setback S,de 2 SetbdCk Rearyard Setback Solar Setbdcks I DEVELOPMENT INFORMATION' ~~~ Overlay Dlst 1\:, ~ i\ # Street Trees R~dlS \Y\ i\ ,'0 ~~ Paved Dnx-",,~qIa ''<;,~~' ~~ ~: % 0~\Cti\~~ ~'<;,~" ~~\\~<:~~,\_\~\)(i" ~'r-~\)\:j \"\lp,tm~:lc'JN~RQ~ENTS I \\~r~ Ilfr I 'r-\.> ~\'\"v ~ yv ,,'iJ~ ~\) \)\" ~~--{ \ REQUIRED PARKING Total HandIcapped Compact Street Improvements Storm Sewer AvaIlable Speclallnstructwn S,dewalk Type DownspoutsfDrams Notes I ValuatIOn DescriDtIon I DescnptlOn Tvpe of Construction $ Per Sq Ft or multlpher Square Footage or Bid Amount Value Date Calculated Paee I on Status Issued CITY OF SPRIN\.Jl'lELD Building/Combination Permit PERMIT NO' COM2007-00587 ISSUED. 04/23/2007 APPLIED. 04/23/2007 EXPIRES: 10/23/2007 VALUE: 225 Flftb Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 InspectIOn Lme Total Value of Project I, Fees PaId I Fee DescriptIOn + 10% Admmlstrahve Fee + 5% Tecbnology Fee + 8% State Surcbarge Fixture Mmlmum/AdJustment Plumbmg Amount PaId Date Paid Receipt Number $450 $225 $360 $1400 $3100 4/23/07 4/23/07 4/23/07 4/23/07 4/23/07 2200700000000000565 2200700000000000565 2200700000000000565 2200700000000000565 220~700000000000565 Total Amount PaId $55 35 I Plan Reviews I To Request an mspectlOn call the 24 hour recordmg at 726-3769. AllmspectlOns requested before 7:00 a.m Will be made the same working day, mspectlOns requested after 7:00 a.m. WIll be made the followmg work day I Re/llllred T nsnechons I Rougb Plumbmg PrIOr to cnver and mcludmg reqUIred testmg Fmal Plumbmg Wben all plumbmg work IS complete By signature, I state and agree, tbat I bave carefully exammed tbe completed applIcatIOn and do bereby cerhfy tbat dll mformatlOn bereon IS true and correct, and I furtber cerhfy tbat any and all work performed sball be done m accordance wltb tlIe Ordmances of tbe City of Spl mgfield and tbe Laws of tbe State of Oregon pertammg to tbe work described herem, and tbat NO OCCUPANCY will be made of any structure wltbout permIssIOn of tbe CommuDlty ServIces DIVISIOn, BUlldmg Sdfety I fnrtber certIfy tbat only contractors and employees wbo are m complIance wltb ORS 701 005 will be used on thIS prOject I furtber agree to ensure tbat all reqUIred IIIspechons are requested at tbe proper !lme, tbat eacb address IS readable from tbe street, tbat tbe permIt card IS located at tbe front of tbe property, and tbe approved set of plans Will remam on tbe SIte at all times dUring constructIOn t>; . <I/'t5)D7 =----- Owner or Contractors Signature Date Pd2e 2 of2 . Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb state or us Pernut # Co"",- 'Z.O Issued by z s,-O ~ ~ 7- OcS-f>7 Co-- -h",-~ ,.,L ( OJ/V J Date Lj /Z~ /07 '( / Address Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) reqUires resldentzal constructIOn permit applzcants who are not hcensed with the ConstructIOn Contractors Board to sign the follOWing statement before a bUilding permit can be Issued This statement IS reqUired for resldentzal bUilding, electrlcal, mechanical and plumbing permits Licensed architect and engineer applzcants, exempt from hcenslng under ORS 701 010(7), need not submit thiS statement This statement Will be filed with the permit Fill m the appropnate blanks and Imtlal boxes 1 and 2, and either box 3A or 3B 4-1 B-2 I own, reside m, or Will reside m 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 mstruct my general contractor that all subcontractors who work on the structure must be licensed With the ConstructIOn Contractors Board ~3B OR I Will be my own general contractor If! hire subcontractors, I will lure only subcontractors licensed With the ConstructIOn Contractors Board Ifl change my mmd and lure a general contractor, I Will contract With a contractor who IS licensed With the CCB and willllnmedIately notify the office Issumg thIs bmldmg permit of the name of the contractor I hereby certIfy that the above mformatlOn is correct and that I have read and do understand the InformatIon NotIce to Property Owners about ConstructIon ResponslbIllttes on the reverse side of thIS form. [If"') rJ " 1-k~/()/ (Signature OfpenTI1~lcant) (Date) (WhIte copy to ISSUing agency permit file, pink copy to applzcant) Property_owner doc 06-01-04 tJ't Arctftng 'as'; .lL our Own General Contractor? ) --' ~ J "INFORMATlci~ t,lOTICE TO PROPERTY OWNERS '. ,,\ , '. \. ~ ABOUT &ONSTRUCTION'RESPONSIBILlTIES '\ \ ' " ,- NOTE This InformatIOn Notice to Properly Owners about Construction ResponslbilJtles was developed by the Construction Contractors Board In accordance with ORS 701 055(5). passed by the 1989 Oregon Legls/ature If you are actmg as your own contractor to construct a new home or make a substantial Improvement to an eXIstmg structure, you can prevent many problems by bemg aware of the' followmg resjJOnsIblhlJes and concerns Employer Responsibilities . You wIll, m mflst 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 constructmg or to assIst m the cons~ctlo~ 0;' Improvement of l! resldentlal!tructure ~ the ~mployer, you must comply with the followmg: Oregon's Withholding Tax Law' AB an employer, you must WIthhold rncome 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 mformatIOn, can the Department of Revenue at 503'-3784988 . , ., - Unemployment Insurance Tax: As an employer, you are reqUIred to pay a tax for unemployment msurance purposeS"> , on the wages of all employees For more mformatlon, call the Oregon Employment Department at 503-947-1488 r r J . I '1'",l:., ~ . --~ lhe Oregon Busmess IdentIfication Number (BIN) IS a combmed number for both ,Oregon, Wllhh~ldmg and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or www dor state or usfformsoav htmll for the appropnate forms , ' . , ~ . , (' Workers' Compensation Insurance' As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtam workers' cOl:npensatIOn msurance for your employees If you fall to obtam workers' compensatIOn msurance, you could be'subJect to penalties and be lIabl~ for all claim costs If one of your employees IS Injured on the Job For more mformatlOn, can the Workers' Compensatlon Dlv1slon'at the Department of Consumer and Busmess ServIces at 503-947-7815 U S Internal Revenue Service, As an employer, you must WIthhold federal mcome-tax from employees' wag~ You Will be hable for the tax payment even If you dIdn't actually WIthhold the tax For a Federal EIN number, call the IRS at 1-800-8294933 or VISIt thelf web Site at www 11 s nav . . ...Other Responsibilities,and Areas of.Collleen.s " Code ComplIance' As the permIt holder for thIS project, you are responsIble for resoI'vmg any faIlure to meet code reqUIrements that may be brought to your attentIOn thlOugh mspectlons ,'- " LiabIlity and Property Damage Insurance' Contact your msurance agent to see If you nave adequate msurance coverage for acc1dcnts and omISSIOns such as fallmg tools, pamt over spray, water damage from pIpC punctures, fire or work that must be redone TIme' Make sure YOII have SUffiCIent lime to supervise your employees ,,-. .. ExpertIse' Make sure you have the skIlls to act as your own general contractor, 'to coordmate the work of rough-m and fimsh trades, and to notIfY bUlldmg offiCials as the appropndte tImes so they can perform the requIred mspectlOns If you have addlllonal quesl10ns call the ConstructIOn Contractors Board (503-3784621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052 Property_owner doc 06-01-04 225 FIfth Street Spnngfield, Oregon 97477 541-726-3759 Phone GPAINQFlEl-D ~ ~ b 'V -.:.. Otv of Sprmgfield Official ReceIpt I lopment ServIces Department Pubhc Works Department Job/Journal Number COM2007-00587 COM2007-00587 COM2007-00587 COM2007-00587 COM2007-00587 Payments Type of Payment Check LRecemll RECEIPT #: 2200700000000000565 Date: 04/23/2007 DescriptIOn + 5% Technology Fee + 8% State Surcharge + 10% Admmlstral1ve Fee FIxture MlDlmumlAdJustment Plumbmg PaId By JANICE JAMISON Item Total Check Number Authorization Received By Batch Number Number How Received dJb 1403 In Person Payment Total Page I of I 9 07 26AM Amount Due 225 360 450 1400 31 00 $55 35 Amount Paid $5535 $55 35 4/23/2007