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Home My WebLink AboutPermit Plumbing 2008-3-18 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2008-00367 ISSUED: 03/18/2008 APPLIED: 03/18/2008 EXPIRES: 09/18/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1036 NANCY AVE ASSESSOR'S PARCEL NO.: 1703272205600 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New Residential PROJECT DESCRIPTION: water line. Owner: HANCOCK JOSEPH E Address: 1036 NANCY AVE SPRINGFIELD OR 97477 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 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: ATTENTIf"'lI\''1 ,,,.,- ....., t"'~(t"'ln t,..., I PUBLIC I~~gQV:E-MENm~rE>~1 u," ;:h~e~ ,fires you to - -, I vt-lIfe 1- Y v '--renon I' I Street Improvements: m OAR 952001 I hcSid~w.{!Jk Ty'p-e.All/ty 0090. You - -OOI0thrl)lla~ "1\~lC!sfhforth Storm Sewe{\f\JWrh!e: Cal/in may obtam cc9owns)toutsbDJ.'lti~s,:, Special Instrl!J7ti.on~.t: nUmb; ~he center. (Not.~~et~ of the rUles by ,'I .) PERMIT r or the Ore 0 . e telephon Notes: [;~rHORIZED JNHALL EXPIRE I Center IS 1.jOO~3~~~~~0)tif1catlo~ . ,v1MFMf'r-... DEf? TWD I> F TH/= I~~')f, . II~~'Y 180 ri ....lJ ul11S AB \ rtH~if7 . v ,n. AY PERIOD. ANDON~f)Vr::fWlWVirn Description I $ Per Sq Ft Square Footage or multiplier or Bid Amount Description Type of Construction Value Date Calculated Pal!:e 1 of2 Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2008-00367 ISSUED: 03/18/2008 APPLIED: 03/18/2008 EXPIRES: 09/18/2008 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid-l Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Water Line - 1st 50 Feet Amount Paid Date Paid Receipt Number $5.00 $6.00 $2.50 $50.00 3/18/08 3/18/08 3/18/08 3/18/08 2200800000000000330 2200800000000000330 2200800000000000330 2200800000000000330 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. LReouired Insoections . Water 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 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. n _ 11-~, L- X- , '(7'ner or Contractors Signature ;3 ) I g: ) 08: Date Pal!:e 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 Penntt #. t a - r::fJ :!:>(; f Address\ o'S Cp \J0rY\~ ~'--'--" Iss~r> -" .~ f\'\-- . Date: 3/1 ~/ 0 V ,ea"J[ '( T\ U c Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requzres residentzal construction permzt applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permzt can be zssued. This statement is requzred for residentzal building, electrical, mechanical and plumbing permits. Licensed archztect and engzneer applicants, exempt from licenszng under ORS 701.010(7), need not submzt this statement. This statement will be filed wzth the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: D 1. D 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. o . 3B. I will be my~: general contractor. CY\um b ~ .on\;J If! 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 issumg tms 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. it /- u ~ 3/lfl/~ (Sigrlatureorpermit applicant) / I / (Date) (White copy to zssuzng agency permit file, pznk copy to applicant.) PropertLowner.doc 06-01-04 ,.. ..... t '\ \ _~_ '-...... t Acting as '1( our (}wn General Contractor? ~- ~.. \: /; : , / I INFORMATION NOTICE TO PROPERTY OWNERS ABOl.)T CONST~UCTION RESPONSIBILITIES I... N.O.....TE This Information Notice to Property Owners about Construction Responsibilities was d~veio~~~ by the , Construction Contractors Board in accordance with 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 substantlallmprovement to an eXIstmg structure, you can prevent many problems by bemg aware of the followmg responslbilitles and concerns. Empioyer 1Re~pOlill~ibinitie~ You WIll, m most mstances, be ruled to be an "employer" and the contractors yo~. contract with wIll be "employees" if you use contractors not lIcensed WIth the Constru'(tlOn Contractors Board ,to do labor m constructmg or to a,sslst m the constructIOn or Improvement of a resIdential strqcture. As .tllne employer, YOlll must co~ply with the following: .- .' ... ~ ~ OregoJlll's Withholding Tax Law: As an employer, you must Withhold mcome taxes from emp1~ye~ w~ges at the tIme employees are paId. You mll be hable for the tax payments even If you don't actually WIthhold the tax from your employees. For more mfonnation, call the Dep(ululent of Revenue at 503-378-4988. UnempBoyment Inslllrance Tax: As an employer, you are required to pay a tax,for unemployment msurance purposes on the wages of all employees. For more mformation, call the Oregon Employment Department at 503-947-1488. " The Oregon Busmess IdentificatIOn Number (BIN) IS a combmed ~umbcr for ,bo~h, 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 appropnate forms. " Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CompensatIon Law, and must obtain workers' cV1UpensatlOn insurance for your employees. If you fall to obtain workers' compensatIon msurance, you could be subject to' penaltIes and-be luible for all claIm costs If one of your employees IS mjured on the Job. For more mformatlOn, call the Workers' CompensatIon DIV1sIon at the Department of Consumer and Busmess SerVICes at 503-947-7815. u.s. IntemaB Revenue Serv;ice: As an employer, you'n\ust withhold federal mcome 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 1-800-829--4933 or V1SIt their web SIte at \\-'\VW.IfS.!!OV. .: . -- " ' , <Other lRes,ponsilhilUiies 3UIuil Areas .of COlJ1lcerltlS Code Compliance: As the permIt holder for thIS proJect. you are responSIble for resolvmg any faIlure to meet code reqUirements that may be brought to your attentlon through mspections. Liability and Property Damage Immrancc: Contact your msurance agent to see if you have adequate 'insurance coverage for accldents and omISSIons such as fallmg tools, pamt over spray, wa1er damage from pipe punctures, fire or work that must be redsme . ' . . '. -" Time: Make sure you have suffiCIent tIme to supemse your ~mployees. \ Expertise: Make sure you have the sloJls to act as your own general contractor, to coordinate the work of rough-m and fimsh trades, and to notIfy bU11dmg offiCIals as the appropnate times so they can perform the reqUIred inSpectIOns. If you have addItional questIOns call the ConstructIOn Contractors Board (503-378--4621) or wnte tbe agency at PO Box 14140, Salem, OR 97309-5052. Property_owner doc 06-01-04 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2008-00367 COM2008-00367 COM2008-00367 COM2008-00367 Payments: Type of Payment Cash cRecemtl RECEIPT #: DescriptIOn Water Lme - 1st 50 Feet + 5% Technology Fee + 12% State Surcharge + 10% Admmlstratlve Fee Paid By JOSEPH HANCOCK City of Springfield Official Receipt Development Services Department Public Works Department 2200800000000000330 Date: 03/18/2008 Item Total: Check Number Authorization ReceIved By Batch Number Number How Received nJm In Person Payment Total: Page 1 of 1 8:22:18AM Amount Due 50.00 250 600 500 $63.50 Amount Paid $63 50 $63.50 3/18/2008