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Home My WebLink AboutPermit Plumbing 2008-2-11 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00207 ISSUED: 02/11/2008 APPLIED: 02/11/2008 EXPIRES: 08/11/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 875 S 43RD ST ASSESSOR'S PARCEL NO.: JANICE JACKSON PAR SPRINGFIETYPE OF WORK: Plumbing Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Sewer line Owner: JANICE JACKSON Address: 875 S 43RD SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor OWNER License Expiration Date Phone BUILDING INFORMATION' # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a I DEVELOPMENT INFORMA nON I Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Oy.erlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: . I PUBLIC IMP~~~~~-009-l S! JeJueO j n u06aJO elU JOl Jeqwnu tI 0 aa/a} a41 ;a10N~i<WWallO Aq salnJ a41 JO sardoo u1elqo Ae _(}UJ!,e:J .lOO-Z96 8\>'0 46nOJ4R1l.l)B~f8~~flW\li6lfl.OO lUloJ las ale salnl . ~S6l::fVO UI AlI/Im u06al0 a4~~~~~J~~~:O UO!leoJl!JON Notes: Ol noA sal!nbaJ Mel uo6alQ 'N~,nJ MOrrOj I\lnTlCE: .. . , c n: THE WORK . I1N311V THIS PERMII bMI<CC (hrIPpERMIT 1StU I AUTHORIZED UNDER THIS OONEO FO Valuation Description' COMMENCEO OR IS ABAN DesAf\i~t~o OAY'f\lii~onstruction Street Improvements: Storm Sewer Available: Special Instruction: $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of 2 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00207 ISSUED: 02/11/2008 APPLIED: 02/11/2008 EXPIRES: 08/11/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paidvt Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Storm Sewer - 1st 50 Feet Amount Paid Date Paid Receipt Number $5.00 $6.00 $2.50 $50.00 2/11108 2/11108 2/11108 2/11108 2200800000000000183 2200800000000000183 2200800000000000183 2200800000000000183 Total Amount Paid $63.50 I Plan Reviews I To Request an inspection call the 24 hour recording 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 following work day. I ReQuired 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 m 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. ~/;{Jt1-d.A//1, ;;2. -//-011 O;lner or Contractor~gnature 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 , Penmt #V)1I1 ?/rlJ g-- , 00 dO 7 ~es~ l?7S)L.j3 ,w 5; bw~~~ IX, Date:;)/;;/OA>' , } I I / {J Statement: Information Notice to Property Owners About Construction Responsibilities Note. Oregon Law, ORS 701.055(4) requzres residentzal construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a budding permit can be issued. Thzs statement is required for residential buildzng, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licenszng under ORS 701.010(7), need not submit thzs statement. This statement will be filed with the permit. Fill in the appJ.vpriate blanks and initial boxes 1 and 2, and either box 3A or 3B: ~ 1. I own, reside in, or will reside in the completed structure. . 0 2. 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 . 03B. I will be my own general contractor. (PW/hblA?J) 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 wlllnnmediately 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. ~ynt!!ul/~ h~//-cJ? V (SigTI~ure ofn it applicant) (Date) (Whzt copy to zssuzng agency permit file, pznk copy to applicant.) Property_owner. doc 06-01-04 as General Contractor? INFORMATION TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBiLITIES , , NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701055(5), passed by the 1989 Oregon Legislature. If you are actmg as your 0"'11 contractor to construct a new home or a substantIal Improvement to an existing structure, you can prevent many problems by bemg aware of the fonowmg responslbilItles and concerns. Employer You m most mstances, be ~led to be an "employer" and contractors you contract 'wIth be "employees" If you use cont,factors not Hcef!sed with the ConstructIOn Contractors to do labor m constructing or to aSSIst m the constructIOn or Improvement a residentIal structure. you must comply the following: , " . Oregon's Tax Law: As an employer, you must mcome taxes from employee wages at the tIme employees are paId. You w1l1 be lIable for the tax payments even If you don't actually the tax from your employees. For more mfonnatIOn, call the of Revenue at 503-378-4988. II nempioyment on wages of Tax: As an employer, are employees. For more mformabon, call to pay a tax for unemployment msurance purposes - Employment Department at 503-947-1488. The Oregon IdentIficatiQn Number (BIN) Unemployment Insurance Tax. To file for a BIN, approprIate forms. is a number for both Qregon Withholding and 503-945-8091 or \'.'Ww.dor state.or us/formsnav.htmU for the Insurance: As an employer, you are to the Oregon Workers' CompensatIOn Law, and must obtam compensatIOn in~~ance for your you fad to workers' compensabon msurance, you could subject to penaltIeS and"be lIable for costs If one ofyo'ur employees ls"injured on the Job. For more mformatIon, can the Workers' CompensatlOn D1Vl1non at the Department of Consumer Busmess SerVIces at 503-947-7815. U.S. Revenue Service: As an empleyer, you\must You be tax payment even if you IRS at 1-'800-8294933 or visIt theIr web SIte at \'v,\lil\V","lfS.gQY. federal mcome tax from employees' wages. . tax. For a number, call the Concerns Code As the holder for proJect, you are that may be b!oug?t to your attentlOTI through resolVIng any to meet code your msunmce agent to see If you have adequate msurancc over water damage pipe punctures, fire or " ,. \ Time: sure you ha'Ve tIme to supervIse your sure you have the shEs to act as to notIfy bmlding officials as own contractor, to coordmate the work of rough-m nmes so can perfonn the reqmred mspections. If you addItIonal questwns call the ConstructIon Box 14140, Salem, OR 97309-5052. or vmte the agency at PO Property_owner doc 06-01-04 225 Fifth Street S}?ringfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2008-00207 COM2008-00207 COM2008-00207 COM2008-00207 Payments: Type of Payment Check cRecemtl RECEIPT #: DescrIption Storm Sewer - 1st 50 Feet + 5% Technology Fee + 12% State Surcharge + 10% AdminIstratIve Fee Paid By HARRIS E JACKSON City of Springfield Official Receipt Development Services Department Public Works Department 2200800000000000183 Date: 02/11/2008 Item Total: Check Number AuthOrIzatIOn Received By Batch Number Number How Received nJm 3663 In Person Payment Total: Page 1 of I 2:37:17PM Amount Due 5000 250 600 500 $63.50 Amount Paid $63 50 $63,50 2/11/2008