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Home My WebLink AboutPermit Building 2003-8-28 ......GP.~~~!!i~ ,i ,. _ _ " ... . .a_, Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF ~rK11'\jul'IELD Building/Combination Permit PERMIT NO: COM2003-00797 ISSUED: 08/28/2003 APPLIED: 08/19/2003 EXPIRES: 02/28/2004 VALUE: SITE ADDRESS: 4795 FRANKLIN BLVD SPACE 6 Eugene ASSESSOR'S PARCEL NO.: 1803022002900 TYPE OF WORK: Manufactured Home in Park TYPE OF USE: New Residential PROJECT DESCRIPTION: MH in park Owner: RIVERSIDE MOBILE HOME COURT LLC Address: 2100 STONE CREST DR EUGENE OR 97401 Owner: SHARA PHILLIPS Address: 4795 FRANKLIN BLVD SP61 EUGENE OR 97403 I CONTRACTOR INFORMATION I Contractor License OWNER A ACTION MOBILE HOME MOVING & DElV142807 OWNER Contractor Type Electrical Manuf Home Inst Plumbing # of Buildings: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I BUILDING INFORMATIlf,",Q\\~ \'I' .~,J ~Q\ . # of St:\.~1':J..?\\\~'C.\\w.\\ \~'i\ l\\)'\~~~~~~\1et(tl.~b'\)~'C.\) ~ VN\\\~\\Q\\\t flI~Y'il~ (>.'0 ~'C.~~~~IfjP~' C'iJ~ \'O\}~gy Path: (>.~'{ I DEVELOPMENt ",~uNvlATION I Phon'~ Number: 541-863-4178 Expiration Date Phone U5/IJ5/2004 541-935-1786 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING Overlay Dist: \lIteS 'I O\lt.R\al: # Street Trees Rqd: "I~~ teo; e"on ll~ndicapped: 0" v Ot '" . W" Paved Drive Rqd:~,'Ote9 .", \\'Ie atE. SEeompact: ~ .\~IO'" \ed Vl t\lleS 9l::;2.-IJI; % of Lqt\€'~erage:.dO? ,\'lOse \'I Of>..~' \lIeS \ ~\\O~_~~~~Oc~~\~~,o \\'It~~~s ot\~~~~\'IOfle _ I PUBLIC IMPRo.VEMEIYJSJI)b\a;' ~~o\e', \':~ ~\o\i\iCa"~. .. ,,' v - en\e,,, I 1\111 ~ :\4') 009v" ,,\\'Ie c O':Sjl!ewalk~l'YPe: . Ca\\lfI", t \\'Ie . floOQ-j ",bet \0 'et is DownspoutsID.rains: fI\l'" cefl' Page 1 00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Tvpe of Construction Fee Description + 10% Administrative Fee + 7% State Surcharge Manuf Home State Issuance Manufactured Home Connection Manufactured Home Feeder Manufactured Home Placement Total Amount Paid . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00797 ISSUED: 08/28/2003 APPLIED: 08/19/2003 EXPIRES: 0212812004 VALUE: I Valuation Descrintion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Fpp<. PIiILI Amount Paid Date Paid Receipt Number 2200200000000001452 2200200000000001452 2200200000000001452 22(10200000000001452 2200200000000001452 22~10200000000001452 $25.50 $17.85 $30.00 $45.00 $50.00 $160.00 8/28/03 8/28/03 8/28/03 8/28/03 8/28/03 8/28/03 $328.35 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection n:quested 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 Rpnnirptf ln~nlP:,rUalll.l 1 Manuf Home Set Up: When installation of all piers or stands is complete. 2 Final Manuf Home 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. 4 MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. Paee 2 of3 ~~ . . CITY 01' ~rKlI'\ju1'1J!,LD Building/Combination Permit PERMIT NO: COM2003-00797 ISSUED: 08/28/2003 APPLIED: 08/19/2003 EXPIRES: 02/28/2004 VALUE: 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 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 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. JZl ~A! ~\t~~ ;/J 'l' ,.J X-' ()~ . I Owner or Contractors Signature Date Page 3 of3 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00797 COM2003-00797 COM2003-00797 C0M2003-00797 COM2003-00797 COM2003-00797 Payments: Type of Payment Cash Change Job/Journal Number COM2U03-00797 COM2003-00797 COM2003-00797 COM2003-00797 COM2003-00797 COM2003-00797 Payments: Type of Payment Cash Change II:-'.'h~. "',"","1.,' ,.. ... . ~ . " , , -..- .,-,'-,." .. ,.~.,,~' ,.. Receipt #: 2200200000000001452 Description Manufactured Home Placement ManufHome State Issuance Manufactured Home Connection Manufactured Home Feeder + 7% State Surcharge + 10% Administrative Fee Paid By SHARA PHILLIPS SHARA PHILLIPS Received By djb djb Description Manufactured Home Placement Manuf Home State Issuance Manufactured Home Connection Manufactured Home Feeder + 7% State Surcharge + 10% Administrative Fee Paid By SHARA PHILLIPS SHARA PHILLIPS Received By djb djb L'heck Number Batcb Number Authorization Number Check Number Batch Number Autborization Number City of Springfield Official Receipt Development Services Department , Public Works Department' . Date: 08/28/2003 2:49:41PM Amount Paid . Item Total: 160,00 30.00 45,00 50,00 17.85 25,50 $328.35 How Received In Person In Person Payment Total: Amount Paid . Item Total: $330,00 ($1.65) $328.35 . Amount Paid 160,00 30,00 45,00 50,00 17,85 25.50 $328.35 How Received In Person In Person Payment Total: Amount Paid $330,00 ($1.65) $328.35 ' . ".'. . 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 #; COWl Z.ee ~ oc> 7 9 7 Address; 1./77 ') ~ [d,-:;- Issued by; -,....,~ :d: b( 'i?~ Zf' --03 Date, Statement: Information Notice to Property Owners About Construction Responsibilitie!s 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 befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. ~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! 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 immedia1ely 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 ofthis form. 5Z~fiN'. @Jla" '5' J. '{, Os . (Signature dfpermit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) r'_l'onLowner,doc 03/11/03 Adinng lll~ tllU i()Iwnn Gennemll <e!ttJrllldlDJr? 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, JEm]!lllloyel!' JRes]!lIoll1lsnbillntnes 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 Withholdiug 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 tax from your employees. For a State Business ill number, call the Business Infonnation Center at 503-986-2200, Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees, For more infonnation, 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 infonnation, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815, U.S. Internal Revenue Senice: 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,',. Other Respoll1lsnbilides and Areas of COll1lcel!'llls Code Compliance: As the pennit 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 notify building officials as the appropriate times so they can perfonn 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