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Home My WebLink AboutPermit Plumbing 2003-8-8 ,~. . City of Springfield Plumbing Permit tI-, - .. Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: PLM2003-00042 ISSUED: 8/8/2003 APPLIED: 8/8/2003 EXPIRES: 2/8/2004 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: Springfield TYPE~~ORK: Repair e,s"i ~\~'I. .f\T Replace 50ft sanitary sewer eo.ov\"~~E R~uSE: Residential \'^~ '\ ,(),\6) _~i!fj ~e.~J}O . .o'\el.tiMJBm~~G0'Nt~cioR: ~. :\\O~ ~"" ~ '" ~"" ~'\'- ....0.,0 'a>o.c&'fNEft.<toov~ ~ c\ '\; ~f!;;)'f)'f\ 'j).\\O~ :,,\~\... eS ~0' ~'\;\' <ft,\G ('f)\'0Y' 't\\~ ~ ,\ov'i Ge~ O~~. cov . ~ ~O\... \o\\o.~ fb\\O~?;OO'\' o~\~'t\ ~o\~~~\~ "b~~'" ~O\\\\C ~ OJ(Jj <(\\~~ 1t\\fJj~'~~'{\ r!>'b?':"t \'(\ O~.~ o~ ~C~1#O~,\}b~t::J' EXPIRES O':Jv ~~~ :\~. \S () ('.~ ~~1 \0 _<f'\\.r:o'\ -.\'t' \,J \J..J Amount Paid '\'I.vate Paid 4424 DAISY ST 1702323404420 OWNER/APPLICANT: JONES KENNTH LESTER 4424 DAISY ST SPRINGFIELD OR 97477 Descriotion Receiot Number + 10% Administrative Fee + 7% State Surcharge Sanitary Sewer - 1st 50 Feet 1200200000000001927 1200200000000001927 1200200000000001927. \.to.\\)~~ , \\\~ '4' ~\ ..."Q\~~ ~ "f\\\ \~ ~ ~. ~~\,\.. \or' ~~ y\.~' ~ '{J<.. To Request an inspection call the 24 hour recording at 726-376~, ~lI\~~"~~~~~e(.~l~~~t%\)~~ a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made ~f6'\vi~f'I{l1m ~~ _\ \}'\l\ ..f'\ (\'f\ c\'"' ~\) \ \ ~\)\,.'" 't.\,\\\J~ Reouired Insoections: C\)~~~~ ~~ \> 1 Sanitary Sewer Line: Prior to filling trench and includin~~u1red testing. 4.50 3.15 45.00 08/08/2003 08/08/2003 08/08/2003 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. I further certify that only contractors and employees who are in compliance with ORS 701.055 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, and that the approved set of plans, if applicable, will remain on the site at all times during construction. ?(~ 1- ~ Owner or Contractors Signature (j G;<---g --0 3 Date 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt i Development Services Department ' Public Works Department ~ Date: 08/08/2003 11:50:59AM Amount Paid 4.50 3.15 45.00 $52.65 Receipt #: 1200200000000001927 Job/Journal Number Description + 10% Administrative Fee + 7% State Surcharge Sanitary Sewer - 1st 50 Feet , PLM2003-00042 PLM2003-00042 PLM2003-00042 Item Total: Payments: Type of Payment Check Paid By KENNETH JONES - Received By djb Check Number Batch Number Authorization Number How Received In Person Payment Total: Amount Paid $52.65 $52.65 . . '~ . 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 #: Issued by: yLvVl zA- oooLf Z 4LfZ4 ~~lS.y , ~ CS Date: 'S>\ 08"O~03 '):..... . Address: 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: ;a. 1. -e 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 subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR ~ 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I 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 Owners about Construction Responsibilities on the reverse side of this form. l(~~/~ ~-8-u~~ (Signature of permit appli~:) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property- owner. doc 03/11/03 .' . A~~nll1l~ 2l~ y (Q)llilIr (Q)Wll1l Gcell1lceIr21ll C(Q)ll1l~Ir21~~(Q)Ir1 ~U\lJfOIf2{MA1'~OU\lJ U\lJ01'~tlE 1'0 1f2l1f2{01f2llElf2{1'V OWU\lJlElf2{$ ArBOU1' tOU\lJ$1'If2{Ut1'~OU\lJ If2{lE$1f2l0U\lJ$~I8\~U1'~lE$ .." '... I NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the I Constru~t~on Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. . C...m~.C_=.._.. . _ u,_, u.. ... , ...'~m~~'~m'm~__~m~~~,m- ___m m,~,____=,..m.._..-- ~,-,--,--..~,-,.-_~,~C,u._~.~_. _ '" _ ,.._ ,. U _,,_,_____,,_ ,_____--.-J 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. JElIII1l~ll@y~rr IRS.~~~@ll1l~n1tDnlln~n~~ You will, in most 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 constructing or to assist in the construction or improvement of a residential structure. A~ ttllne emmjplla}Yu~ ymUl mmnnstt cmTI1ljplly wiittlln ttllne l1'olllla}wiiTI1lg: 01l'egmll~s WiittllnllnolldliilIllg Tmx JLmw: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payrrients even if you don't actually withhold the tax from your employees. For a State Business ill number, call the Business Information Center at 503-986-2200. Ull1lemjplloymelIlltt ITll1l~nnll'mlIlliCe Tmx: As an employer, you are required to pay a tax for Unemployment insurance purposes on the wages of all employees.' For more information, call the Oregon Employment Department at 503-947-1488. Worrlkerr~' ComjpelIll~mttiia}ll1l ITlIll~nnn.ll1lCe: As an employer, you are subject to ~he 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 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. ITlIllttulIllmll lRevemne Serrviice: As an employer, you must withhold federal income 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 866-816-2065 or fax them at 801-620-7115. ([J)~Jhl~Jr IRS.~~~@lID~nlbnfi:ll~n~~ ~IIDml All"~~~ @jf CC@ll1l~tell"lJll~ Cadle ComjpllfiatlIlliCe: 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. JLiim1biillfiry atlIlldl JPrrojpury ]])mmatge ITll1lSnnrrmlIllce: Contact your insurance agent to see if you have 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. 1rimme: Make sure you have sufficient time to supervise your employees. IEx]!)ertii~e: 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 03/11/03