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Home My WebLink AboutPermit Building 2003-11-18 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-01154 ISSUED: 11/18/2003 APPLIED: 11/18/2003 EXPIRES: 05/18/2004 VALUE: $ 5,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4795 FRANKLIN BLVD SPACE 6 Eugene TYPE OF WORK: Manufactured Home in ASSESSOR'S PARCEL NO.: 1803022002900 Park TYPE OF USE: New Residential PROJECT DESCRIPTION: MH in park - setup and plumbing connection only. NO OCCUPANCY UNTIL ELECTRICAL PERMIT IS OBTAINED. Owner: CESAR LOPEZ Address: 4795 FRANKLIN BLVD EUGENE OR 97403 I CONTRACTOR INFORMATION' Contractor Type Manuf Home Inst Plumbing Contractor OWNER OWNER License Expiration Date Phone BUILDING INFORMATION. # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: LotSi"e: Sq Ft 1st Floor: Sq Ft :!nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impenious Surface Area: R-3 SETBACKS , DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: Handicapped: Compact: IPUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Notes: NOTICE: THIS PERMIT SHAll EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED fOR ANY 180 DAY PERIOD. Sidewalk Type: Downspoutsffirains: ATTENTION:Oregon law reqUireS you. ~o follow rules adopted by the Oregon Utility \Iotification Center. ThoSE' ru~e~:~e9~ei~; In OAR 952-001-0010 throug 0090. You may obtain copies of the rules I calling the center, (NotI3: the tele,~ho~e number for the Oregon Utility Notification \.p"tpr is 1_800-~;32-2344). Pa2e 1 of3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-01154 ISSUED: 11/18/2003 APPLIED: 11/18/2003 EXPIRES: 05/18/2004 VALUE: $ 5,000.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $1.00 Square Footage or Bid Amount 5,000.00 Manuf Home Tvpe of Construction Manufactured Home Fee Description + 10% Administrative Fee + 7% State Surcharge Manuf Home State Issuance Manufactured Home Connection Manufactured Home Placement Total Amount Paid Value Date Calculated Total Value of Project $5,000.00 $5,000.UU 1lI18/2003 F pp< tiliILI Amount Paid Date Paid Receipt Number $20.50 $14.35 $30.00 $45.00 $16U.UU 1lI18/03 1lI18/03 1lI18/03 11/18/03 11118/03 12~0200000000002485 12~0200000000002485 1200200000000002485 1200200000000002485 12UU200000000002485 $269.85 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. IRp~ 1 ManufHome Set Up: When installation of all piers or stands is complete. 2 Final ManufHome Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. 3 Manuf Home Plumbing: After home has been connected to water and sewer. Paee 2 of 3 . . CITY OF SrKlj~uNJ<.LD Building/Combination Permit PERMIT NO: COM2003-01154 ISSUED: 11118/2003 APPLIED: 11/18/2003 EXPIRES: 05/18/2004 VALUE: $ 5,000.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line 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 Shllll be done in accordance with the Ordinances of the City of Springfield and the Laws ofthe State of Oregon pertaining to the Vlork 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 times during construction. AMV- ~{J(Q..'L --?? , Owner or Contractors Signature //-I~- O~\ Date Paee 3 of3 -' , ' , , , , " " , , , . 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 #: <"0","" z..O . 6 J I SL./ Address: 47'7S- ~~I,,,,,, :# 60 Issued by, ^ t3 Date, I~;; ~ 'J Statement: Information Notice to Property Owners About Construction ResponsibilitiEIS 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 l.fcensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the app.vp.:ate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. ff 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, 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 ~ 3B, I will be my own general contractor. 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 undel'Stand the Information Notice to Property Owners about Construction Responsibilities on the reverse side oftbis form. ~far- ~~e_ P /1-/8'-03 (SignatuTe of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner,doc 03/11103 . . Actl:nnng 2l~ 1l ({))1illIr Ownn GenneIr21ll C({))nntl:Ir21c[({))Ir'l INFORMATION NOTICE 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 701,055(5), passed by the 1989 Oregon Legislature. 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, IEmpRoyer ResponsibilWes 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. As the employer, you must comply with 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 lax from your employees, For a State Business ill number, call the Business Information Center at 503-986-2200, " Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpos~s on the wages of all employees, For more information, call the Oregon Employment Department at 503-947-1488. 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 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. Internal Revenue Service: 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, , , - Othell" Responsibilities and AJreas of ConnceJrDs Code Compliance: 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, Liability and Property Damage Insurance: 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. 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 notij'y 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 ,< 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone _."~"H~_.FIIILO... ,_' co, ....~'... ~......, L !', i ....~~ 1 .. .. -~, j ..... "'-..~~ . '-' Job/Journal Number COM2U03-01154 COM2003-01154 COM2003-01154 COM2U03-01154 COM2003-01154 Payments: Type of Payment Cash Change Job/Journal Number COM2003-01154 COM2003-01154 COM2003.0 1154 COM2003-01154 COM2003-0 1154 Payments: Type of Payment Cash Change J .- Receipt #: 1200200000000002485 Description Manufactured Home Placement ManufHome State Issuance Manufactured Home Connection + 7% State Surcharge + 10% Administrative Fee Paid By CESAR LOPEZ CESAR LOPEZ Received By djb djb Description Manufactured Home Placement Manuf Home State Issuance Manufactured Home Connection + 7% State Surcharge + 10% Administrative Fee Paid By CESAR LOPEZ CESAR LOPEZ Received By djb djb Check Number Batch Number Authorization Number Check Number Batch Number Authorization Number City of Springfield Official Receipt, Development Services Department' Public Works Department - Date: 11/18/2003 9:54:33AM Amount Paid Item Total: 160,00 30,00 45,00 14.35 20,5U $269.85 How Received In Person In Person Payment Total: Amount Paid Item Total: $270,00 ($0,15) $269.85 Amount Paid 160,00 30,00 45,00 14,35 20.50 $269.85 How Received In Person In Person Payment Total: Amount Paid $270,00 ($0,15) $269.85 . . 1~ (JI 1~ . ! 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