HomeMy WebLinkAboutPermit Plumbing 2008-1-15
CITY OF ~rKl1~GFIELD
Building/Combination Permit
PERMIT NO. COM2008-00059
ISSUED. 01/15/2008
APPLIED' 01/15/2008
EXPIRES. 07/15/2008
VALUE:
Status
Issued
225 F,fth Street, Sprmgfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 InspectIOn Lme
SITE ADDRESS 3770 VIRGINIA AVE
ASSESSOR'S PARCEL NO 1702314302000
Spnngfield TYPE OF WORK Plumhmg Only
PROJECT DESCRIPTION Repldce 50 If water hne
TYPE OF USE Repall
Resldenllal
Owner WILLIAM KEMPER
Address 3770 VIRGINIA ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMA nON I
Contractor Type
Plumbmg
Contractor
OWNER
License
BUILDING INFORMA nON,
# of UUltS
Pnmary Occupdncy Group
Secondary Occupancy Group
Pnmary ConstructIOn Type
Secondary ConstructIOn Type
# of Bedrooms
Fronlyal d Setback
S,de I Setback
S,de 2 Setback
Reary.lrd Setback
Solar Setbacks
# of Stones
HeIght of Structure
Type of Heat
Water Type
Range Type
Ener~(Jd~
..ffl:'" nrA!lon.I~~.~~~~~~~mg nla
~~~~ rules adopte;\H4\tBteyPJni~l~ORMA nON I
NotIficatIOn ~~~~10 \lIlOU9rr ~: the rules 6~
In OAR 952 obtain CoP\e~~~Br-e
0090. '(o~:eaJenter. lNot~t,~~\l~~~\lqd
call1ngr tor the Ole9o~-33:!,~\)nve Rqd
l\umbe center \8 1-80 % of Lot Coverage
R-3
VB
I PUBLIC IMPROVEMENTS I
Street Improvements
Storm Sewer AvaIlable
Spec131 InstructIOn
ExpiratIOn Date Phone
Lot S,ze
Sq Ft 1st Floor
Sq Ft 2nd Floor
Sq Ft Basement
Sq Ft Gal age/Cdrport
Sq Ft Other
Occupdnt Load
REQUIRED PARKING
Total
Handlcdpped
Compact
SIdewalk Type
DownspoutslDl ams
\fiHE \NOt\.\{
tt01\Ct~ it SHt>.\.\. ~l'\t\.E E\'.t.J\\1 \S ~Oi
1HIS :;~~~O \l~OE\'. ~~~~~O~EO fOR
,.,,11 ,. EO \)t\ fu "
I ValuatIOn DescrlDtlO~t~i~~A.,{ PERIOO.
$ Per Sq Ft Square Footage
or mnlllpher or BId Amount
Notes
DeSCriptIOn
Type of ConstructIOn
Pa2e I of2
Value
Date Calculated
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2008-00059
ISSUED. 01/15/2008
APPLIED. 01/15/2008
EXPIRES 07/15/2008
VALUE:
225 FIfth Street, Sprmgfield, OR
541-726-3753 Phone
541,726-3676 Fax
541-726-3769 InspectIOn Lme
Total Valne of Project
Fees Paul I
Fee Description
+ 10% Admmlstrallve Fee
+ 12% State Snrcharge
+ 5% Technology Fee
Water Lme - 1st 50 Feet
Amount PaId
Date PaId
Receipt Number
$500
$600
$250
$50 00
III 5/08
III 5/08
III 5/08
III 5/08
2200800000000000047
2200800000000000047
2200800000000000047
2200800000000000047
Total Amonnt PaId
$63 50
I Plan Reviews I
To Request an inspection call the 24 hour recordmg at 726-3769 All inspectIOns requested before 7'00
a m. will be made the same working day, inspections requested after 7.00 a.m will be made the followmg
work day.
I Reolllrerl I"s"echo"s I
Water Lme PrIor to fillmg trench and mcludmg required testmg
By SIgnature, I state and agree, th.t I have carefully exammed the completed apphcatlOn and do hereby certIfy that all
mformdtlOn hereon IS true and correct, and I further certify that any and all work performed shall be done In accordance With
the Ordmances of the CIty of Sprmgfield and the Laws of the State of Oregon pertammg to the work descrIbed herem, and
tbat NO OCCUPANCY WIll be made of .ny sllucture WIthout permISSIOn of the CommuDlty ServIces DIVISIon, BUlldmg Safety
I further cel tlly that only conll actors and employees who are m comphance WIth ORS 701 005 WIll be used on thIS project
I further agree to ensure that all required mspectlOns are requested .t the proper lime, that each address IS readable from the
, street, th.t the permIt card IS locyed at the front of the pI operty, and the approved set of plans will remam on lhe sIte at all
;;z;~o~~~ __ I /S cJ~
Owner or Contractors i.;natu?e 0 Date
Paee 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
Pemnt #
com 2:-000- .:;J 0 OS-'7
3770 \J /1L'71V\/'A
D 6 Date 1;1 T/O %
I
I
Address
Issued by
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note Oregon Law, ORS 701 055(4) requires resldentwl constructIOn permit applzcants 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. electrzcal, mechanical and
plumbing permits Licensed architect and engineer applzcants. exempt from lzcenslng under
ORS 701010(7). need not submit thiS statement This statement will befiled With the permit
Fill III the appropnate blanks and Imtial boxes 1 and 2, and either box 3A or 3B
~1
I own, reSide m, or will reSide III the completed struct!ire
----
..EJ 2
o 3A
I understand that I must become licensed as a constructIon contractor If the struct!ire IS sold or
offered for sale before or o:1~~on /
Mygeneralcontracto~~~C;, ,
:/ (N~ (CCB #)
I will Illstruct my general contractor that all subcontractors who work on the struct!ire must be
licensed With the ConstructIOn Contractors Board
./' OR
j2i' 3B I will be my own general contractor
If! lure subcontractors, I will hire only subcontractors licensed With the ConstructIOn Contractors
Board If I change my mllld and lure a general contractor, I Will contract With a contractor who IS
licensed With the CCB and will Immediately notIfY the office ISSUlllg thIS bUlldlllg 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
c----....
d/'~~ /- /S-"-/J~
(Signature of~ermlt IIcant) (Date)
(White copy to ISSUing agency permit file. pink copy to applzcant)
Property- owner doc 06-01-04
\ . ( .' -.,/. ~
A-~tlung ~~ r our Own General C.ontra~tor?
J '
, 'I '~INFORMATION NOTICE TO PROPERTY OWNERS
ABOWT CONSTRUCTION RESPONSIBILITIES
.
NOTE This Information Notice to Property Owners about Construction Responslblldles was developed by the
Construction Contractors Board In accordance wdh ORS 701 055(5). passed by the 1989 Oregon Legislature
If you are actmg as your own contractor to construct a new home or make a substannal Improvement to an eXlstmg
structure, you can prevent many problems by bemg aware of the followmg responslb1l1l1es and concerns
Employer Responsibilities
\ .
You will, m most mstances, be ruled to be an "employer:' and the contractors you contract With will be "employees" If
you use contractors not hcensed With the Construcnon Contractors Board to do labor m constructmg or to asSiSt III the
constructIOn or Improvement of a resldenl1al structure As, the employer, you mnst comply with the following:
Oregon's Withholding Tax Law' As an employer, you must Withhold mcome taxes from employee wages at the time
employees are paid You Will be hable for the tax payments even If you don't actually Withhold the tax from your
employees For more mformanon, call the Department'ofRevenue at 503-378-4988 .
, '
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 mformanon, call the Oregon Employment Department at 503-947-1488
'r~ ~
The Oregon Busmess Idenl1fication Number (BIN) IS a combmed~mun,ber for both Oregon Wlthholdmg and
Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or ''Www dor state or us/formsoav htmll for the
appropnateforms _ _'_ .' _'" .'" _ .', '. .
Workers; 'Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtam workers' compensatIOn msurance for your employees If you fall to obtam workers' compensatIOn
msurance, you could be subject to pehall1es ani! be liable for all claim costs If one ofyoqr employees IS mjured on the
job For more mformatlOn, call the Workers' Compensation DIVISion at the Department of Consumer and Busmess
Servtces at 503-947-7815
US Internal Revenue Service' As an employer, you must Withhold federal mcome tax from employees' wages....,
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 1-800-829-4933 or VIsit thelI web site at WW\" liS <,OV
, Other RespmnsU;inWes,allll.dl Areas of Concerns
Code Compliance As the permit holder for tillS project, you are responSible for resolVIng any failure to meet code
reqUirements that may be brought to your attentIOn through mspecl10ns
Liability and Property Damage Insurance: Contact your msurance agent to see If you bave' adequate msurance
coverage for aCCidents and onusslons such as fallmg tools, pamt over spray, water damage from pipe punctures, flIe or
work that must be redone -
'--
~ "
,., -~....'..
Time Make sure you have suffiCient tIme to supervise your employees
,
Expertise. Make sure you have the slalls to act as your own general contractor, to coordmate the work of rough-m
and fimsh trades, and to notIfy bUlldmg offiCials as the appropnate tImes so they can perform the reqUIred mspectIons
If you have addlnonal questJOns call the ConstructIon Contractors Board (503-378-4621) or wnte the agency at PO
Box 14140, Salem, OR 97309,5052
Property_owner doc 06-01-04
225 Fifth Strect
Sprmgfic)d, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2008-00059
COM2008-00059
COM2008,00059
COM2008-00059
Payments
Type of Payment
Check
cRecemtl
RECEIPT #:
DescnptlOn
Water Lme - 1st 50 Feet
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdminIstratIve Fee
PaId By
WILLIAM KEMPeR
~~,
~
City of Spnngfield Official Receipt
Development Scrvlces Department
Public Works Department
2200800000000000047
Date. 01/15/2008
Item Total
Chec..k Number AuthorizatIOn
Received By Batch Number Number How Received
dJb
1974
In Person
Payment Total
Page I of 1
I 07 JOPM
Amount Due
5000
250
600
500
$63 50
Amount Paid
$63 50
$63 50
I II 5/2008