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Home My WebLink AboutPermit Building 2006-02-13F Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00030ISSUED: 0211312006 APPLIED: 01/0612006 EXPIRESz 1212912006VALUE: $ 14,256.00 SITE ADDRESS: 2510 l6TH ST ASSESSOR'S PARCEL NO.: 1703243400110 PROJECTDESCRIPTION: Bedroomextension Springfield TYPE OF WORK: Bedroom TYPE OF USE: Addition , Residential 541-741-1535 AUTHORIZED UNDER THIS COMMENCED OR IS ABANDONED FOR License Expiration Date Phone L 0wner: Address: Contractor Type General Electrical KATHRYN MOFIELD I58O YOLANDA ST SPRINGFIELD OR 97477 Contractor OWNER OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I 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: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o of Lot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: R3 VN 144 nla s.00 44.00 Sidewalk Type: Downspouts/Drains REQUIRED PARKING Total: Handicapped: Compact: Curb and Gutter Partially Improved Yes Notes: Storm drainage piped into existing to curb face 111112006 CAS PUBLIC IMPROVEMENTS Paee I of3 uu1\ l l(AU r uK rNr uKNr/LL\:.lfJ t u rLulr\u rN r lltlly!,q!_!llN_l n law req\ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 [nspection Line Building/Combination Permit PERMIT NO: COM2006-00030ISSUED: 0211312006 APPLIED: 01/0612006 EXPIREST 1212912006VALUE: $ 14,256.00 Description Dwellings Fee Description Plan Review Residential + l0o/o Administrative Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Plan Review Residential SDC Sanitary/Storm Admin Storm Drainage Impervious Area + l0oh Administrative Fee + 57o Technology Fee + 87o State Surcharge Perm Serv/Fdr 200 amps or less Total Amount Paid Type of Construction V Wood Frame $ Per Sq Ft Square Footage or multiplier or Bid Amount $99.00 144.00 Total Value of Project Amount Paid Date Paid Value $14,256.00 $14,256.00 Receipt Number 1200600000000000019 r2006000000000001ss 120060000000000015s 1200600000000000155 1200600000000000155 1200600000000000155 1200600000000000r55 I200600000000000155 12006000000000001ss 2200600000000001 141 2200600000000001 141 2200600000000001 141 2200600000000001 141 Date Calculated 0110612006 $95.r6 $r9.24 $1s.39 $43.00 $3.00 $146.40 $95.16 s2.23 s44.57 $6.30 $3.r5 $s.04 $63.00 u6t06 2fi3t06 2n3t06 2n3t06 2n3106 2n3t06 2n3t06 zn3t06 2n3t06 8/15/06 8/15/06 8/15/06 8n5t06 $541.64 Fees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 0u09t2006 0u1012006 0U10t2006 0u10t2006 0u26t2006 0uLu2006 APP APP APP LLH TAJ CAS No Planning issues. Storm drainage piped to existing to curb face 1/11/2006 CAS 0t/10t2006 02t08t2006 OK RJB To Request an inspection call the 24 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Page 2 of3 Valuation Description I Reouired lnsnections Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00030ISSUED: 0211312006 APPLIED: 01/0612006 EXPIRESz 1212912006VALUE: $ 14,256.00 Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall lnsulation: Prior to cover. Ceiling Insulation: 'Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. Electric Service: Approval required prior to utility company energizing service. 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 Safefy. 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.rrr.. 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 propertyn and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Page 3 of3 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone C='v of Springfield Official Receipt *_. relopment Services Department Public Works Department RECEIPT#: 2200600000000001141 Date:08/15/2006 ll:01:02AM Job/Journal Number coM2006-00030 coM2006-00030 coM2006-00030 coM2006-00030 Description Perm Serv/Fdr 200 amps or less + 8% State Surcharge + l0o/o Administrative Fee + 5% Technology Fee Amount Due 63.00 5.04 6.30 3.15 Item Total:s77.49 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid CreditCard JEFF W. LOZAR ddk 016401 In Person $77.49 Payment Total: -57iiF cReceint I Page I of I 811s12006 *FFUra{tFt,lil.o Status: Issued 225 Fifth Street, Springfield, OR 541:726-3753 Phone 541-726-3676Fa'x 541:7 26-37 69 Inspection Line Building/Co mbination Permit PERMIT NO: COM2006-00030ISSUED: 0211312006 APPLIED: 01/0612006E)PIRES: 08/1312006VALUE: $ 14,256.00 SITE ADDRESS: 251016TH ST ASSESSOR'S PARCEL NO.: 1703243400110 PROJECT DESCRIPTION: Bedroom extension Springfield TYPE OF TYPE OF USE: Bedroom Addition Residential '* Owner: Address: KATHRYN MOFIELD 1580 YOLANDA ST SPRINGFIELD OR 97 NOTIGE: IS PER c0M ANY SHALL EXPI THIS RE Mll WgRK PhoneNumber: 541-741.-1535 IT lHE UNDER IS NOI License Expiration Date PhoneContractor TVpe Gengral Electrical Contractor OWNER owNER BUILDING INFORMATI( # of Unib: Primary Occupancy Group: Secondary Occupancy Ptimary Construction Type Secondary Construction*# of Bedrooms: Frontyard Setbaclc Side l Setback: Side 2 Setback: Rearyard Setback: Solar Setbacls: Street Storm SewerAvailable: Speciat Instruction: 5.00 44.00 Partiallv Improved Yes Sidewalk Type: Downspouts/Drains Curb and Gutter R:t vN # of Stories: Height of Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Overlay Dist: # Street Trees Paved Drive Rqd: Yo ofLot Coverage: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: REQUIRED PARKNG Total: Handicapped: Compact: - Notes: Storm drainage piped into existing to curb face 111112006 CAS PUBLIC IMPROVEMENTS 1of 3 t, 144 l',lote: t on Util Status: Issued 225 Fifth Street, Springfield, OR 541:7263753 Phone 541-7263676Fax 541:7 26-37 69 Inspe ction Line Buildin g/Co mbin ation Permit PERMIT NO: COM2006-00030ISSUED: 0211312006APPLED: 01/0612006E)3IRES: 08/1312006VALUE: $ 14,256.00 F Description Dwellines Type of Construction V Wood Frame $ Per Sq Ft Square Footage or muftiplier or Bid Amount $99.00 144.00 Total Value of Project Amount Paid Date Paid Value $14,256.00 $14,256.00 Date Calculated 0u06t2006 Fee Description Plan Review Residential + l0Yo Administrative Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Plan Review Residential SDC Sanitary/Storm Admin Storm Drainage Impervious Area Total Amount $95.16 $t9.24 $15.39 $43.00 $3.00 $r46.40 $9s.16 $2.23 $44.s7 $464.15 u6t06 2lt3106 2n3t06 2n3t06 2n3t06 2fi3106 2n3106 2n3t06 2n3t06 Receipt Number 12006000000000000r9 1200600000000000155 1200600000000000155 12006000000000001ss 1200600000000000r55 12006000000000001ss 1200600000000000155 1200600000000000155 1200600000000000155 Plan Reviews Initial Review Planning Review Public Works Review Structural Review 0U09t2006 0ut0t2006 0u10t2006 APP APP APP LLH TAJ CAS No Planning issues. Storm drainage piped to existing to curb face 1/11/2006 CAS 0u10t2006 02t08t2006 OK RJB To Request an inspection call the24 hour recording at 72G3769. 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Reouired I 2of3 'B}I'OFIILD II Valuation Description I r ees raro I 0u1012006 0u26t2006 0utU2006 Status: Issued 225 Fifft Street, Springfield, OR 541:72G3753 Phone 541-7263676Ftx 541:7 26-37 69 I nspe ction Line CITY OF SPRINGFIELD Buitdin g/Co mbination Permit PERLIT NO: COM2006-00030ISSUED: 0211312006APPLIED: 01/0612006E)PIRES: 08/1312006VALUE: $ 14,256.00 Ceiling Insulation: Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. '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 certiS that any and all work performed shall be done in accordance with the Ordinances of the City of SpringfieH and the Laws of the State of Onegon pertaining to the wuk described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Servhes Division, Building Safety. I further certiff 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, thd the permit card is located at the front of the property, and the approved set of plans will remain on the site at all during construction or Date 3 of 3 t 2zstr'ifth Street Springfield, Oregon 97 477 541-726-3759 Phone r-ity of Springfield Official Receipt .velopment Services Department Public Works Department RECEIPT#: 12006000000000001ss Date: 0211312006 11:04:12AM Job/Journal Number coM2006-00030 coM2006-00030 coM2006-00030 coM2006-00030 coM2006-00030 coM2006-00030 coM2006-00030 coM2006-00030 Description Storm Drainage Impervious Area SDC Sanitary/Storm Admin Plan Review Residential Building Permit Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 8% State Surcharge + l0%o Administrative Fee Amurnt Due 44.57 2.23 95.16 146.40 43.00 3.00 15.39 19.24 Item Total:$368.99 of Payment Paid By KATHRYN MOFIELD ddk Received By Batch Number Number How Received 2078 Amount Paid In Person $368.99 Payment Total: -$3 6-85t' \: :. 2/13/2006 lofl rea :( l1 225 FIFTH STREET . SPRINGFIELD, OR 97477 o PH:(541)726-3753 o ELEC:TRICAL City Job Number I. LOCANON OF INS'TALLATION 3. COLTPLE'I'E 25to ItrsT 5?{ttoe [r e 'l OI? LEGAL DESCRIPTION A. Nerv t7- 03 - 2,Ll-311-tlo ULE drvelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 B.Services or Feeders - Installation, Alterations or Relocation: City JOB DESCRIPTION REI ftoou xTail5l oi) Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 daYs' 2. coNrRACroX rNs'rA LLAT'ION ONLY Electrical Contractor Address Phone Supervisor License NumbPr Expiration Date Constr. Contr, Expiration Si snatu./e of ,Supervisin g Electrician owners Name I (h?[lRl,r,r Mo 6Er\ Address 75 P t tr 5, Pnon")ll-l $ OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Signature: 200 Amps or less 201 Amps to 400 AmPs 401 Amps to 600 AmPs 601 Amps to 1000 AmPs Over 1000 AmPsA/olts Reconnect OnlY $ 63.00 $ 75.00 $ 12s.00 $ 163.00 $375.00 $ 50.00 J Installation, Alteration or Relocation 200 Amps or less $ 50'00 201 Amps to 400 AmPs $ 69'00 401 Amos to 600 AmPs $100'00 Over 600 Amps or I000 Volts see "B" above' D. Branch Circuits New Alteration or Extension Per Panel One Circuit $43.00 {3,- $3.00 3 - C q Tenrporarp' Services or Feeders Each Additional Circuit or with tService or Feeder Permit 46/o Stut" Surcharge 10% Administrative Fee TOTAL E.Nliscellaneous (service/feeder not inclutled) -Each Installation Pump or irrigation $ 50'00 Sign/Outline Lighting $ 50'00 Limited Energy/Residential $ 25'00 LimitedEnergy/Commercial - $45'00 Minimum Electric Permit Inspection Fee is $45'00 * Surcharges 4. STJBTO:TALOFABOW llh rD Inspection Request: 726'3769 Shared Drive(T:)/Building Forms/Electrical Pennit Application l-03.doc " ^..,,.,y",eny $ 19.00 225 FtmH STREET . SPRINCFIELD,OR97477 . PH:(5,11)726-3753 . FAX: (541)726-3(t89 E LE CTRI CAL P ERMIT AP P LI CATI ON Ciry Job Number ?nn '7-nab' fDb .,D SPFlIPAFIELO ZON INITIALS DATE SOURCE Date Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder Iustalla txPiHt TH IS PERMI r $J63.00 201 Amps to 400 AmPs $ 75.00 401 Amps to 600 AmPs s125.00 601 Amps to 1000 AmPs $ 163.00 Over 1000 AmPs/Volts $375.00 Reconnect OnlY {L @, fr LEGAL DESCRIPTION JOB D ulcL c+w6L Permits are non-transferable and expire if work is not started within 180 days of issuance or if rvork is Suspended for 180 daYs 1 A. Ncrv Resiclential - Siugle or i\'Iulti-Fantil.v pcr d*'elling unit' s r06.00 B. s r9.00 ss0.00 $ 50.00 $ 69.00 $ 100.00 $ 43.00 $ 3.00 Electrical Contractor Address CiF/Phone Supervisor License Number .,.2) ,) Expiration Date /0 'i -c'7 ..1,, ^o,Eulil[(.h\K, 1'/r?qzt s 50.00 7 3-5 . : :.:,..C. Temporarl' Services or Feeders' '' ' ' Constr. Contr. Number .t b[,7 7 Expiration Date 5-i b-o8 Signature of Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 AmPs 401 Amps to 600 AmPs Over 600 Amps or 1000 Volts see "B" above. D. Br:rnch Circuits New A-lteration or Extension Per Panel , One Circuit' Each Additional Circuit or with Service or Feeder Permit E. )'Iiscellaneous (Serviceit'eederuotincluded ) -[ach Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial N{inimum Electric Permit Inspection Fee is S'15.00 * Surcharges 4. SWTOTAL OF ABOVE 8% State Surcharge l0% Administrative Fee 5olo TechnologY Fee tnclan Owners N Address Ciry s 50.00enole 771'/43ct INSTALLATION instailation is being made on propertv I own which not intended for sale, lease or rent, flaU> }'tacq.i- @ q s s0.00 $ 25.00 $ 45.00 11 q{ Signature: .I.11 TOTAL Shared Drive(T:)iBuilding Fonns/Electrical Perrnit Application 8-06.doc 1. COIVTLA CT O R I]',-S?){ILA T I O N O'\Il I' C)+{^f,5i Inspection spz- \ JOURNAL ORJOBNUMBER: NAME OR COMPANY: LOCATION: TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING TINITS I. STORMDRAINAGE DIRECT RTINOFF TO CITY STORM SYSTEM CITY OF SPRINGFTELD SYSTEMS DEVELOPMEN. -/ORKSHEET coM2006-00030 Mofied 2510 I Street t703243400110 SINGLE FAMILY RESIDENCE 0 BUILDING SIZE 138 LOT SIZE (SF):0 RTINOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CIry ST.ANDARDS IMPERVIOUS S.F. x 138.00 IMPERVIOUS S.F. 0.00 NUMBEROF DFU's 0 B. IMPROVEMENT COST: NLIMBER OF DFU's 0 ADT TRIP RATE 9.57 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 x COST PER S.F $0.323 COST PER S.F $0.323 COST PER DFU $25.07 $ 19.07 NUMBER OF UNITS 0 NUMBER OF UNITS 0 CHARGE w.57 DISCOUNT RATE 50o/o M4.57 DISCOT}NT $0.00 x x x x x ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER - CIry A. REIMBLiRSEMENT COST: ITEM 2 TOTAL - CITY SANITARY SE\ilER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: $0.00 COST PER TRIP $ 19.09 COST PER TRIP $84. I 9 s0.00 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 xx xx ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER - MWMC A. REIMBURSEMENTCOST: NUMBEROFFEU's 0 x x B. IMPROVEMENT COST: NUMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATTVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC suBTorAL (ADD ITEMS 1,2,3, & 4) 5. ADMINISTRATIVE FEE: STIBTOTAL $44.57 FEE: CherylSlaymaker Utl/2006 $0.00 s44.57 CHARGE $2.23 COST PER FEU s82.03 $0.00 $0.00 s0.00 $0.00 2.23 $0.00 $46.80 I 070 l09r r092 r093 1094 I 054 I 055 I 054 I 056 1079 r 078 U) E]aoO & E]Fa r! IU COST PER FEU $865.3 r ADM. FEE RATE 5Yo PREPARED BY DATE TOTAL SDC CHARGES x TOTAL SANITARY ADMINISTRATION FEE: DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OF NEW FDffURES x UNIT EQUIVALENT: DRAINAGE FD(TURE UNITS FOR CALCULATE ONLY TIIE NETADDITIONAL NO. OF FIXTI]RES LINIT FIXTLTRE TYPE NEW OLD MISCELLANEOUS DFU TYPE NTIMBER OF EDU'S TOTAL DRAINAGE FIXTT]RE T]MTS lsa toa unit set at I 67 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 20 DRAINAGE FIXTURE LNITS 0 2 1979 +EDU BEFORE 1979 $5.2e $5.29 $5.1 e $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 IS LAND ELGIBLE FORANNEXATION CREDIP (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) 1979 1980 l98l 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 r995 1996 1997 1998 I 999 2001 2 VALUE / IOOO $0.00 CREDIT RATE $5.29x CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / IOOO CREDIT RATE $0.00 x $5.29 TOTAL MWMC CREDIT$1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 BATHTUB 0 0 3 0 DzuNKING FOUNTAIN 0 0 1 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS /ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 0 LALNDRY TI]B 0 0 2 0 CLOTTMSWASHER / MOP STNK 0 0 3 0 CLOTT{ESWASHER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SHOWER SINGLE STALL 0 0 2 0 sHowER, GANG CNUMBER OF HEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 0 0 3 0 SINK: COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 0 0 1 0 URINAL, STALL / WALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 6 0 TOILET, PRIVATE INSTALLATION 0 0 3 0 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE 0 $0.00 2000 Construction Contractors Board Permit #:C-OlYtz.tc*6 - CPO.f 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 WebAddress:ry$!31!94gg Address:ZSto tL+L- si- Issued by:t-ilhil{Date J ^lToLI & a Statement: lnformation Notice to Property Owners About Gonstruction Responsibi lities Note: Oregon Law, ORS 701.055(4) requires residential 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, 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: l. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction conhactor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) I will instnrct my general contractor that all subcontractors who work on the strucfure must be licensed with the Construction Contractors Board. OR N 38. I will be my own general contractor. 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 notiff the office issuing this 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. ignature of applicant)@ate) (White copy to issuing agency permitrtk, pink copy to applicant.) Property_owner. doc 06-0 I -04 Acting fis Yd ur Own Gemeral Contractor? INFORMATION ilOTICE TO PROPERTY OWNERS ABOUT CON$TRUCTION RE$PON$IBILITIES aclrng as yolrr own contractor to conskuct a new horne or make a substantial impr*vement to an existingIfyou are structure, you can preyent rnany problems by beiag awae cf the following fesponsibilities and concern s. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you conkact with will be;'emplgyees" if you We contractors not licensed with the Construction Conkactors Board to do labor in constructing pr to assist in the conskuction or improvement of a residential strucfure. 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 empioyecs are paid. You will be liable for the lax payments even if you don't actually withhold the tax from your ernployees. For more information, call the Department of Revenue at 503-378-4988. i i Unemployment Insurance Tax: As an employer, you are required to pay a tax forrmemplolment insurance purposes!- on the wages of all employees. Sor more information, call the Oregon Employrnent Department at 503-947-1488. j -r-]:-The Oregon Business Identification Number (BIhi) is a combined nurnber for bo& Oregon.l{ithholding and Unemployment lnsurance Tax. To {ile for a BIN, call 503-945-8091 or wwrv.dor.state.or.us/formspay.htmll for the appropriate forms. i . Workers' Compensation fnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liab,le for all claim costs if one of your ernployees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumtir and Business Services at 503 -947 -7 &l 5. U.S. Internal Revcnue Service: As an employer, you must withhold Heral ircome tax &om enipioyees' wager)t 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 1-80018294933 or visit their web site at iquu.irs.ggy. Other Responsibitities and Areas of Concerns Code Compli*nce: As the permit holder for this project, you are responsible for resolving arry failure to meet code reqyreme"nts that nny be brought to yly attentioa through inspecfions Liability and Property Damage fnsurance: Contact your insurance agart to see if 1ou have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage frcm pipe punctures, fire or work that must be redone. Time: Make sure you,have suflicient time to supervise your employees. Expertise: Make sure you have the skills to act as your'own general contraitor, to coordinate the work of rough-in and finish kades, and to notifo 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) ar write the agency at PO Box 14140, salem, oR 97309-5052. . .,_i { r:,crc.i{ Property_owner.doc 06-0 l -04 NOfA This lnfarmation Notice to Prcperty Owners about *anstructian Responsrb/ffrbs was developed by the Constructian Canlractors Eoard in accordance with ARS 7A1.055f5J, passed by the 1989 Oregon Legislatura.