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Home My WebLink AboutPermit Plumbing 2008-5-15 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FA-'\: (541)726-3689 ~1 A~ ~_oo6?Y Ol CIty Job Number L-L-' ~ e..o c:::::> 0 0:.0; Job Location II d-g 51 0z Y a ~ C';:$.' /8020 Z 2 b U! Assessors Map .~, ~; n.~" (!"), " I'.'.... .":...1 ~: ~) .S' t;:, OJ), f'\-l: ~! U' . ~~ ? ~\ O~ ~j 0, ."~, ,I...,...' ~: Cl:) >, CL), $..-1 j ~i ~: 0; ,1' \~L.,I: If n 't 1 ~ ~J ".......Y'l: 'U) ~~ M! , \ . SPlX1at<JG:?; S:Cl,...:J1 /,,/1 ~>," '1\} ~ .)&' Tax Lot o s CO<=:) Owner {;~1/10 'b~ Address ((;)-R is (Q ~'---=?~ City ;::?,LJ /"Yu:LC'r lcR U ( Phonp 7C(7~~V I ZIp 97l(7i S tatI' C5~ BACKFLOW PREVENTION DEVICE PERMIT FEE: $63.50 Contractor Information ATTENTION: Oregon law requIres you to /~ follow rule$ adopted by the Oregon Utility (/ ~tification Center. Those rules are set forth Contractor ill OAR ~'::;~-fjfi HiG I\) 1I1/uugn VAN tlO~-UU1. 0090, You may obtain copies of the rules by ,..~"jno !J.,~ ':'~~!ef. fNcte:h~9Iephefts number for the Oregon Utility Notification Cen!mt~$ 1-800-332-2344).l:ip Addres~ City Construction Contractors Registration # Expires By signing this permit/applic~ I agree t~_~Jll.~~ inspection once the backflow prevention device has b~en installed ~nd-tS-Vi?i~~vspectlon (726-3769):-- J also s that all information on thIS permlt/apPhc1s.correc:/ /' \ ./- _ Signature _ ~ <-'" ~'<:::' ~ _Date'::> /r r/ () rI ~ ---- --/ ./ For O{{~tlef: / / THIS PERMIT SHAll EXPIRE IF THE WORK S- / /r/ () ? AUTHORIZED UNDER THIS PERMIT IS NOT Date of ApplIcation / / COMMENCED OR I::> AfjAWtif~ED ran Checked for Delinquencif'<; ~ AN:)h~M~~~fi~~"a1 Status ~ Shared Drive (T )/BUlldmg Fonns/Backflow PreventIOn 1-08 doc CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2008-00694 ISSUED: 05/1512008 APPLIED: 05/15/2008 EXPIRES: 11/15/2008 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1128 S 69TH PL ASSESSOR'S PARCEL NO.: 1802022603000 Springfield TYPE OF WORK: Backflow Device PROJECT DESCRIPTION: backflow device TYPE OF USE: New Residential Owner: GENE DRAKE Address: 1128 S 68TH PL SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Landscape Contractor OWNER License BUILDING INFORMATION I # of Units: ATT # of Stories: Primary Occupancy Gro~~; ENTf~;1)regon laWl!' h,t of Structure Secondary Occupancy q.foH~r' rules adopted by tffA' udMMRIJ to Primary Construction 1j~~~~~/on ~ter. Those ~l IPijJ.Jtil", Secondary Constructio~ifg'~eYi 52-001-0010 throUBfPlJA. a@tfortll # of Bedrooms: cali;ngO~ may obtain COPi~~~~ !001. nUmber fo~tChennter. (Note:~ftritm& ll,JLdmg' nla e "1'0",,\,, !:.'1iHl. ........ "enter;s 11~ORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Phone Number: 541-747-8884 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: NOTICE: tllftMlM, /D. THIS PERM'T SHAll EXPIRE WM wvnwpouts rams: AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED fOR ANV 1sn DAY PERIOD. I Valuation Description I Notes: Description $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pa!!e 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2008-00694 ISSUED: 05/15/2008 APPLIED: 05/15/2008 EXPIRES: 11/15/2008 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 I Fee Description + 10% Administrative Fee + 12% State Surcharge + 5% Technology Fee Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $5.00 $6.00 $2.50 $16.00 $34.00 5/15/08 5/15/08 5/15/08 5/15/08 5/15/08 1200800000000000498 1200800000000000498 1200800000000000498 1200800000000000498 1200800000000000498 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 Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. 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 o~ ~riY of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUP ~~~ will be made of any structure without permission of the Community Services Division, Building Safety. I further certify tl at only contractors and employ.e s who are in compliance with ORS 701.005 will be used on this project. I further agr ~ns~.\I;' that all required insoectio s are requ cd, at the proper time, that each address is readable from the s~reet, th .)h~P~JI1it 5"rd 7teaat the fron e perty, and the approved set of plans will remain on the site at all tomes ( SQns DC :n/ ~ !7 j,~ t ) owne~- ~ I? . ;;;c Cnntcact.es Signato" Date Pae: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 Address Pernut#. COf"V\Z:C~O- 00694 1/2/ .s, b )-1-'- ?L ~ cr Date: s-;jo/cy I t Issued by' Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requIres residentzal constructzon permit applicants who are not licensed wIth the Constructzon Contractors Board to sIgn the following statement before a buildzng permit can be Issued. This statement IS required for residential building, electrzcal, 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 1 and 2, and either box 3A or 3B: ~. J2(' 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 lure 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 c actor. ct and that 'I have read and do understand the Information esp nsi . on the reverse side of this form, ( /' .7/ <:::..e. ~ (Signature of permit applIcant) 5//},/ (Date) (White copy to Issuzng agency permit file, pznk copy to applzcant.) Property_owner. doc 06-01-04 , . , , j \ \ A~tingj a~) Y ~tir()wn General Contractor? ~ ... ...._... "i... ' , p / INFORMATION NOTICE TO PROPERTY OWNERS ABO_UT' 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 actmg as your ovvn contractor to construct a new home or make a substantIal Improvement to an eXIsting structure, you can prevent many problems by bemg aware of the followmg responsibilitIes and concerns. Employer Re~pon~ibiUties You Wlll, m most mstances, be ruled to be an "employer" and the contractors you contract with WIll be "employees" If you use contractors not h~ensed with the ConstructIOn Contractors Board to do labor in constructmg or to assist m the constructIOn or Improvement of a resIdentIal structure. As the employer, you must co~ply with the following: Oregon's Withholding Tax Law: As an employer, you must WIthhold mcome taxes from 1;1uJ:.1loyee 'wages at the tIme employees are paId. You will be hable for the tax payments even If you don't actually Wlthhold 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 reqUlred to pay.a tax for l.memployment msurance purpos~ 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 comb1l1ed number. for both Oregon WIthholdmg and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or .\vww.dor state.or.us/formsnav.htmll for the appropriate forms. - - - \-Vorkers' Cmnpensationllllsurance: As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must obtain workers' compensatIon insurance fc;>r:. your empl~yees. If you fail to obtain workers' cvwpensatlon Insurance, you' could be subject to penalties and bi:fluib}e for all chlim cosfs 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' wa~ You wIll be lIable for the tax payment even If you didn't actually WIthhold the tax. For a Federal EIN number, can~~s~ "" IRS at 1-800-829-4933 or VISIt theIr web SIte at Vl\'VW.ITS'gOV: , . , " Otlbter Re~lP({}lIl~.ibillnties ~nMll Arre2~ ~f COIDl(Cerrlill~ Co4lle 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 Jlnsmrancc: Contact your Insurance agent to see If you have adequate Insurance coverage for aCCidents and OllliSSlons such as fallIng tools, pamt 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. ~ r ..... Expertise: Make sure you have the skIlls to act as your own' general contractor, to coordinate the work of rough-In and fimsh trades, and to notIfy buIlding offiCIals as the appropnate hmes so they can perform the reqUIred mspectlOns. If you have addItIonal questions call the Construction Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner doc 06-01-04 225 Fifth Street Springfie1d, Oregon 97477 . 541"726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2008-00694 COM2008-00694 COM2008-00694 COM2008-00694 COM2008-00694 Payments: Type of Payment Cred ItCard c Recemt 1 RECEIPT #: 1200800000000000498 Date: 05/15/2008 DescnptlOn Backflow DevIce MinImum/AdJustment Plumbing + 5% Technology Fee + 12% State Surcharge + 10% AdminIstrative Fee PaId By GENE DRAKE Item Total: Check Number Authorization Received By Batch Number Number How Received dJb 027362 In Person Payment Total: Page 1 of 1 9:54:24AM Amount Due 1600 3400 250 600 500 $63.50 Amount PaId $63 50 $63.50 5/15/2008