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Home My WebLink AboutPermit Plumbing 2005-06-07Building/Combination Permit Status Issued 225 Fifth Street, Springlield, OR 54l-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00685 ISSUED: APPLIED: EXPIRES: VALUE: 06t07t200s 06t07t2005 12t07t2005 :"{,k #& SITE ADDRESS: 2275 9TH ST ASSESSOR'S PARCEL NO.: 1703261204307 PROJECT DESCRIPTION: Backflow device Springfield TYPE OF WORI(: Backllow Device TYPE OF USE: New Residential Owner: Address: Contractor Type Plumbing BRYAN KLABO 2275 9TH ST SPRINGFIELD OR 97477 Contractor OWNER PhoneNumber: 541-7264012 License Expiration Date Phone )NTRACTOR INFORMATION BUILDIN # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R-3 nla{ PLtrtuu Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: c in OAR 952-001 0090. You maY obtain copies ru calling the center.(Note : the telePhone number for the Oregon Uti lity Notification Center is t-soO-gga'23441' Sidewalk Type: Downspouts/Drains: REQUIRED PARJSNG Total: Handicapped: Compact: Notes: $ Per Sq Ft or multiplier Square Footage or Bid AmountDescription Type of Construction Page I of2 Value Date Calculated t-[1v t L(rr[l-lrl\ r lNr! (rt(.iYrA I l(r].\ | Valuation Description I F Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2005-00685ISSUED: 0610712005 APPLIEDT 06107/2005 EXPIRESz 1210712005 VALUE: ['ees Pa Amount Paid $4.s0 $3.15 $14.00 $31.00 Total Value of Project Date Paid 6t7t05 617105 6t7tus 6t7tos Receipt Number 1200s0000000000079s 120050000000000079s 120050000000000079s 1200500000000000795 Total Amount Paid $52.65 To Request an inspection call the24 hour recording at 726-3769. All inspection 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. Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. 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, and that NO OCCUPAI\ICY 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. 3xeac^ (LL b-7- 5 Reouired Insnect ffisignature Pase2 of2 Date Fee Description + l0o/o Administrative Fee + 7o/o State Surcharge Backflow Device Minimum/Adj ustment Plumbing 225 Fifth Street Springfield, Oregon 97 477 541-7j26-3759 Phone lity of Springfield Official Receipt evelopment Services Department Public Works Department RECEIPT #: 1200s00000000000795 Date: 0610712005 t:25:22Pl[t Job/Journal Number coM2005-00685 coM2005-00685 coM200s-0068st: coMzoo5-00685 Description + l%o St^te Surcharge + l0% Administrative Fee Backflow Device Minimum/Adj ustment Plumbing Amount Due 3.l s 4.50 14.00 31.00 Item Total:$52.65 Payments: Tvpe ofPayment Paid By CheckNumber Received By Batch Number Authorization Number How Received Amount Paid Check BRYAN KLABO djb 7828 In Person $52.65 PaymentTotal: ffi I L 6t7t2005 Page I of I Construction Contractors Board pennit #:CO,v.'aF - -OO 6(f 700 Summer St ItlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Address: ZZ-7 f ?*t- s I Issued by:-o< Date: 6-7'oY Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed.with the Construction Contraitors 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 andingineer applicants, acemptfrom 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 1 and 2, andeither box 3A or 38: ( f . I own, reside in, or will reside in the completed structure' lk z- I understand that I must become licensed as a construction contractor if the stnrcture is sold or tr 3A. My general contractor is (Nune)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed wittr ttre Construction Contractors Board' OR 38. I will be my own general contractor' name of the contractor' If I hire subcontractors, I will hire only subcontractors licensed with the construction contractors Board. If I change my mind and hire " g"""."r contractor, I wilr contract with a contractor who is licensed with the cci ;J wil immedi"ai.rv ""rffy the office issuing this building permit of the I hereby certify that the above information is correct and that r have read and do understand the rnformation Notice to property owners about coort.o.tion Responsib,ities on the reverse side of this form' L-7-{ (Signature of (White permit aPPlicant) ' copy to issuing agency pennitfile' pink copy to @ate) applicant.) PropertY-owner.doc 06-0 1 -04 _x Acting as tour Own Generat Cdntractor? rNFoRMATror NbrtcE To pRopERTy owNERS ABOUT CONSTRUCTION RESPONSIBILITIES If you are acting as your own contractor to consfruct 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. 3 mployer Responsibilities You will" in most instances, be ruled to h an o'efiiplo. yer'o and the contractors you contract with will be .,erqployees,, ifyou qse contractors not licensed with the Construction Contractors Board to do labor,i" *"rt ""tirgt, to assist in theconsfruction or improvement of a residsntial structure. As the emproyer, yoq must .o.pry *itn #;ur;il oregon's \ilithholding Tax Law: As an employer, you must withhold income taxes from employee wages at the timeemployees are paid' You wili be liable for the tax payments even if you don't actually withhold the tax from yourempIoyees.Formoreirrformation,calItheDepartrnentLfR"*n.,.at5o3.3784988.. unomployment Insurance Tax: As an employer, you are'required to pay a tax for unemploynrentkrsrrtance purposesi,on the wages of all employees. For rnore'inforrnation, call the oregon Employment Deparfmen t at 503-942-14gg. The oregon Business Identificatisn Number (B[NI) is a combined number for both oregon withholding ,;+unemplcyrnent Insurance Tax. To file for a BlN, call 503-g45-gsri;a ffi;*r",".*.trr* r* lor theappropriate forms. workers' corirpensation rnsurance: As an emproyer, you ire subject to the oregon workers, compensation Law,and must obtain workers' compensation iniuran;" fo. v;* "*pr"v"es. If vo, aii to obtain workersi compensationinsurance, you could be subjeci to penalties ";il; fubil;;jr-claim corts if onJoryo* emproyees is injured on the 'J*,"1T"||fr;-'#X11*, call the workers' co*p"r*tio, bivision ui rr,* **#**r oi'c*ur** td Brrin.*s u's' rnternal Revenue service: As an employer, you must withhold federar income tax from ernployees, wage$..*You will be liable for the kx payrnent even iiyou alon't actually withhold the tax. For a Federal EiN number, call ,he -\IRSatl-800-S2g4g33orvisiitheirwebsiteairr*r,.jrr.g;y.-+:'r' rrr"urvreL.Eu:rA' rurareceratrrNnu other Responsibilities and Areas of concerns cade compliance: As the permit holder for this project, yoLI are resp*nsible f<rr resolviirg any failure to rneet coderequiremen{s thai may be brought to your attention ilrrrud iipections. Liability and Property Damage rnsurance: contact ydur ihsurance agent to see if you have.adequate insurancecoveras*, &:r acciden:s ancl *missions such as falling tootu, p*int over spray. water damage irom pipe punctures, fire orwcrk that must be redone. Timc:Makesurevcuhavesuf}lci*ntti:ltclosuprrvisr3ourernplo3rees.'.1.\..| H'xpertis.c: rtut" t*'* r'tttt ha'c t!:c skills 10 ircl ac )'o.rr orlTr ger:erul conkactrir, to coclrdinatc rhe rvi;rk *i rouSrh-lnand tlnish trades' :rnrJ l,, not1tr)v bL:ilding officrals u,u tlru *pp.*frr*t* tirnes so tt "y *on prrli:rm trre requiretr inspectir:ns. #:?ix ul:xilf ;?ff:xil.{he cons|rr:c{io* cr:ntr*cr*rs saarti (5s3-3 7E4621} cr wrire the agency ;rt po Properry_ouler.doi: r,\O I I -ll.l TE:,VO Ihls ln{ormation toNatice Ownars ConstructionaboutPraperty r,v3s theResponsibi/ilies developed by Construction Contractors tnBoard accordance wit?t sOR 701 the 989055(5)passed by Legislature,Oregon