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Home My WebLink AboutPermit Plumbing 2004-6-29 ....:~,~!-~~~!.r~. 1 i' Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line -. .. CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00794 ISSUED: 06/29/2004 APPLIED: 06/29/2004 E.\:PllmS: 12/29/2004 VALUE: SITE ADDRESS: 1329 LA WNRIDGE AVE ASSESSOR'S PARCEL NO.: 1703252204500 Springfield TYPE OF WORK: Baektlow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Install backtlow device Owner: METCALFE GINA L & SCOTT M Address: 1329 LAWNRIDGE AVE SPRINGFIELD Ol{ 97477 Contractor Type Plumbing Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setbaek: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: I .cONTRACTOI~:2FORI\1:~'ION , License Expiration Date Phone I BU!LDlNG INI~~_I,{MATlON g ~o"ct: # OfSI(lri~S:C:\lp.W~ IF THE WORK R-t~18 PERM\'ti~It.\:!itHJtl '~ERMIT IS NOT .~ut"Ol\'Ztmi!dMOiiRJ ~HI vlltl~~ENtt,&~~~BANDONED fOR ~~~ ,tit) ~rg~' Path'- Sprinkled Building: ilIa Lot Size: Sq Ft I st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFOR~IATION I REQUIRED PARKING Overlay Dist: Total: # Strel'l Trees Rqd: Handicapped: Paved Drive I{qd: ~Compact: 'Yo of Lnl cn\Trage~~WII~~ ~~. ~""~,\Q!Il"'w ..QlW I P~B1:IC I~P~J.~~~I. ~"".-O~~ \1f \0\\0 ~Ol\cet\ .oO~Q~~~ ~o\\\\ce: 2.()Q~ ~\f\,~'f ~.~nft \1' O"'~ 95 f1IP.'i o'O'IP> ~\Q$~ &\\VI-" ()09~\:~ \t\0 :~;0~~~). c al\OI ~ t\ultt'O cel\\81 \5 I '~ah,~atiol1-.!)e~cri~~iol1 I $ Per Sq 1'1 or multiplier Square Foutag\: or Bid Amuunt Description Type of Construction Value Date Calculated Tot.ll Value of Project P:ICC 1 of 2 -1IttIr&f~.':~~~';' - ,.~..--..~ . . CITY OF SPKll'l~t<l~L1J Building/Combination Permit Status Issued PERMIT NO: COM2004-00794 ISSUED: 06/29/2004 A I'PLI ED: 06/29/2004 EXPIRES: 12/2912004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Dale Paid Receipt Number S4.50 SJ.15 $14.00 $J1.00 6/29/114 6/29/114 6/29/114 6/29/04 1200400000000001002 1200400000000001002 1200400000000001002 1200400000000001002 Total Amount Paid $52.65 I .Plan Rc\'ic'~~.1 To Request an inspection call the 24 hOllr recording at 726-3769. All inspection rcqttested before 7:00 a.m. will be made the same working day, inspections rcqllcstcd after 7:00 a.l11. will be made the following work day. I . RC"lIir'c~1 ,.Insn~nons I BackOow Device: Prior to eovering and pro\'ide a ,'opy of I he lest reporloll sile at the time of inspection. By signature, 1 state and agree, that I have earcfIlO)' examilled till' eompleted applie:llion and do hereby certify that all information hereon is true and correct, and I fu!"thl'l" cCl"tif~' 111:11 any and all work performed shall he done in accordance with the Ordinances of the City of Springfield and the l.aws of the Slale of Oregoll p"rtaillillg to the work described herein, and that NO OCCUPANCY will be made of any strllelllre wilholll permissiono!' the Commllnity Services Division, Building Safety. 1 further certify that only contractors and employe"s who are ill l'omplianee wilh (lRS 701.005 will be used on this project. 1 further agree to ensure that all required illspeeliolls are re(l"est"d at tbe prop,'r lime, Ihat each address is readable from the street, that the permit card is located at tbe 1'1'0111 of Ibe properly, alld the apl,,'o"ed set of plans will remain on the site at all times dUrin~nstruetion. ~~ tfy;f~ Owner or Contractors Signature Dale PallC 2 01'2 [' 225 Fifth Street Springfield, Oregon 97477 54t-726-3759 Phone . s~ .:. ' .ay of Springfield Official Receipt "elopmcnt Services Department Public Works Department RECEIPT #: 120040000000000!002 Date: 06129/2004 2:21:36PM Job/Journal Number COM2004-00794 COM2004-00794 COM2004-00794 COM2004-00794 Description + 7% State Surcharge + 10% Administrative Fee Backflow Device Minimum/Adjustment Plumbing Payments: Type of Payment Paid By CreditCard SCOTI METCALFE 1 tern Total: Check Numbl'r Authorization Received By Balch i\'umbcr Number How Received Amount Due 3.15 4.50 14.00 31.00 $52.65 Amount Paid djb 000424 141851 III Person Payment Total: $52.65 $52,65 6/29/2004 Page 1 of I . . 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#: COl11z.ott -007 9t.f Issued by: /32- '7 -:h~ LA-w/V I'Ll ~~ AV Date: Ie, -z, '7 -0 'I -. . . . . . . ". .,' " ,.' 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 slalement before a building permit can be issued. This statement is requiredfor 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 I and 2, and either box 3A or 3B: 0Yl. ~. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structttre 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 rnust 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 immediately notify the office issuing this bttilding 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 Notiee to Property Owners about Construction Responsibilities on the reverse side of this form ( y c.{."","" or po=" ,,,ti,m'l ro;J, 7 Q I (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 12-09-03 , '\ .' . A~tnrrng~a~ )f01llllf Owrrn GerrneIr'all CorrntIr'a~t'lJ)Ir'? '.. fNFO'RM~TlbN 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. lEmployer Responsibilities 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 tax from your employees. For more information, call the Department of Revenue at 503-378-4988. '. Unemployment Insurance Tax: As an employer, you are required to pay a tax' for unemployment insurance pu~es on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. ~ The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compens-ation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liahle 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 Serviee: As ~n employer, you must withhold federal income tax from employees' wag~s.. You will be liable for the tax payment ~yen' if you didn't actually withhold the tax. For a Federal EIN number. call the IRS at 866-816-2065 or fax them at 80 l-620~ 7115. . .... Other Responsibilities and Areas of Concerns 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 Tedone. '. , 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 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 12-09-03 225 rIml ~'TREET . SrRINGrIELD, OR 97477 . rH:(541)72G<'753 . fAX: (541)72G-%89 ~1 ~( e) -,) 'I'"=I~ l~J ~J <;:J) Assessors Mar ..)T~t~ .~I~ ~') ,/1 ~; Owner \.~-~ 1M.c\ cAu=-~ ~l ~\ ~l ~: f~ .'!~l '''- l ~l ~l ~ ~~ ~ ~) Contractor .,e' >:-......::~ ~ Addreso, ~ City g;:: ~ .,~. 12i ~l e.ll ~ ~ ~ Si!,'11aturf' ~l f.!'\\ ' ~j ~ ~ r~:j Date of Application ~{ . ~J Checked for Delinquencie< ~J ~l , . SPRINGFIELD = -=> n " /' II . I [\/\ ....._-.. / ..............., I 1,.-:..:::, \.--- ---./ I l_ .".~ 0"'~ . CITY OF SPRINGFIELD, OREGON City Job Number (Om ZOot( -0 0 7 ~ 1..( Job Locatior j Zl1 L.AJrJe'(/c,E A;::: &QLIAIl,Fi-ELIJ De 9){j77 Ol{)DO 170~ Z5ZL Tax Lot Addresf \ ?:::L CJ ~ \\U."O(, ,0::- City'-~I~hHI~ Ms Phonp (scrJ;;a - ,<)7 SS ()~ Zip 97177 Statp BACKFLOW PERMIT IJ;\gJl~~~~-WtI9f\M..F~~tl~1!:1~;~~~Charge & Administrative Fcc) 11'115 ~~ OER 11'115 PttlW' AU11'10RIlEO U~R 15 A6AliOOliE.O rOR Contractor Information COMMEliC~~ PE.RIOO. Ali't 160 0" ~onp' ~ ~tr.-.\:-.ggu\f99~Jl t.iTENTION: 0 ~d bY \hll orll901l set torttI rs Registrationl~\~~~:~~$;~~~7. "fho~,~~~es /' \,ov....o 001-vuI6t'" otuw.~,e-. , in OAR 952- otain copies \e~ . 090. '{aU may a er lNate: \hll \9 ilIr.IdlOR By signing this permit/application, I a~eea.\l\nw1!1lf~iU@i'Jllll~~~eoackflow prevention devise has been installed and is visible fWJffillpeM:l~}l1llf.~~~tate that all information on this permit/application is correct. cente c- ~~)~ _ Da'p ~!J~I ! - For Office Use b~25-~t..j ~ecked for Historical Statu< c..--- Shared Drive: (T: ~I"uilding Fol'TTlSi&cknow Prevention 1-03.doc