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Home My WebLink AboutPermit Plumbing 2003-05-21City of Springfield Plumbing Permit Status: Issued 225Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: PLM2003-00030 st2u2003 st2y2003 Lu2u2003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 826 sTHST 1703352109800 Replace less than 50 feet water line Springfield TYPE OF WORK: TYPE OF USE: Repair Residential OWNER/APPLICANT: RATHBUN LAWRENCE PETER 826 N 5TH ST SPRINGFIELD OR97477 t-744-7991 Description + l0o/o Administrative Fee + 7%o State Surcharge Water Line - lst 50 Feet 50 05121/2003ls 0sl2t/2003 45.00 05121/2003 Receipt Number 1200200000000001279 nr)$ ..*,liillffi$$-.tC.tL ^.<N\e: To Request an inspection call the 24how recording at 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made Required Inspections:\ 1 Water Line: Prior to filling trench and including required testing. By Signaturer l 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. I further certify that only contractors and employees who are in compliance with ORS 701.055 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, and that the approved set ofplans, if the site at all times during construction. or Contractors Signature Date 5'D.* 03 AFHUrIil"$ BEE RD 97478 EXPTRES 02/t8/200: iUh 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Development Services Department Pubtic Works Department Official Receipt Receipt #: 12002000000000 0127 9 Date: 0512112003 PLM2003-00030 PLM2003-00030 PLM2003-00030 Water Line - lst 50 Feet + llYo Administrative Fee + 7Yo Slate Surcharge 45.00 4.50 3.15 Item Total:$52.65 Check ILSE RATHBUN-MOSER In Person Payment Total: 52.65 $52.65 djb 5t2U2003 I l:38:47AM Page I of I cReceipt.rpt Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:ryfu!3!94 Permit #: Address: Issued by:\6 'ZOc -rO3 ZZG s+k s + Date:/,t Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires restdential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom 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: 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction contractor if the sfructure is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) E E x I will instnrct my general contactor that all subcontractors who work on the stnrcture must be licensed with the Construction Contractors Board. OR 38. I will be my own general conhactor. If I 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 noti8/ the office issuing this building permit of the name of the contractor. certify that the above information is that I have read and do understand the InformationI hereby Notice to Owners about on the reverse side of this form. -#a/*o _3 (Date)of permit (lthite copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 03/l I /03 Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNER$ ABOUT CON$TRUCTION RESPON$IBILITIES JVOIE': Tftis lnfarmalion Nofice to Property Ovvners abouf Construction Responsibilities was developed by the Canstructian Contractars Board in accordance with ARS 7A1.055(5/, passed by the 1989 Oregon Legislaturo. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structwe, you can prevent many problems by being aware of the following responsibiiities and concerns. Employer 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 Conkactors Board to do labor in constructing or to assist in the conskuction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's lVithholding Tax Law: As an employer, you must \yithhold income taxes from employee wages at the tirne 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 ID number, call the Business lnformation 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 ernployees. For more information, call the Oregon Employment Department at 503-947-1488. lilorkers' Compensation fnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. tf 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 thejob. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-781 5. 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. !: 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 rnd Property Damage fnsurance: 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: Malc sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as yolr own general contractor, to coordinate the work of rough-in and finish trades, and to notifu building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at pO Box 14140, Salem, OR 97309-5052. Property_owner.doc 03i I 1 /03