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Home My WebLink AboutPermit Building 2004-08-02Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676F2x 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00950ISSUED: 0810212004APPLIED: 08/0212004EXPIRES: 02102/2005VALUE: $ 500.00 SITE ADDRESS: 6685 SIMEON CT ASSESSOR'S PARCELNO.: 1702341105900 Springfield TYPE OF WORJft Interior TYPE OF USE: Alteration Residential PROJECT DESCRTPTION: Finish bonus room- insulation and sheetrock owner: uNDERwooD cHRrsropHER M & SARA KAddress: 6685 SIMEON CRT SPRINGFIELD OR 97478 Contractor Tvpe General # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: hOAR Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: PhoneNumber: 541-744-9674 Expiration Date Phone Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: tF1 \S NOl t0R nla Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Bid Amount Type of Construction Use Bid Amount $ Per Sq Ft Square Footage or multiplier or Bid Amount$1.00 s00.00 Total Value of project Value $s00.00 $500.00 Date Calculated 08t02t2004 \ ANY 180 OAY Buitding/C ombination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-00950ISSUED: 0810212004APPLIED: 08/0212004 EXPIRESz 0210212005VALUE: $ 500.00 Fees Paid Fee Description + l0oh Administrative Fee + 7%o State Surcharge Building Permit Amount Paid $4.50 $3.15 $4s.00 Date Paid 812t04 8t2t04 8t2t04 Receipt Number 1200400000000001171 1200400000000001 171 1200400000000001171 Total Amount Paid $s2.65 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. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Floor Insulation: Prior to decking. Dryrvall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that atlinformation hereon is true and correct, and I further certify that any and all work performed shall be done in accordance withthe Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, andthat NO OCCUPANCY wilt 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 projectI further agree to that all required inspections are requested at the proper time, that each address is readable from thestreef that the card is located at the front ofthe property, and the approved set of plans will remain on the site at alltimes during Contractors Paee2 of2 L 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 x,(gYvr7oo OO ?tO Address:lYl€q_nt C Issued by::b<Date:g-241 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 thefollowing statement before a building permit can be issued. Thts statement is required for 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 and2, and either box 3A or 38 E l. I own, reside in, or will reside in the completed structure -.Ft- Z. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) ,x I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR 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 notify the office issuing this building permit of the name of the contractor. I hereby certify that information is correct and that I have read and do understand the Information Notice to Property about Construction Responsibilities on the reverse side of this form. of permit (White copy to issuing agency permit file, pink copy to applicant.) )(Date) Properfy_owner.doc I 2-09-03 tr Acting asY-our Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS. ABOUT CONSTRUCTION RESPONSIBILITIES NOIEi Tttis lnformation Notice to Property Ouvners about Canstruction Responsiii/ilres was developed by the Construction Contractors Soard in accardance with ARS 701.055(5/, passed by the 1989 Oregon Legislature. If you are acting as your o\+Tl contractor to construct a new hqme- or mgke a ,ubsruniial improvement to an existing structure. you can prevent rnany proMems by being awarb of the follor*'ing responsibitities dld concems. Employer Responsibilities You.will, in most instances, be ruled to be an "ernployer" anrd the eontractors you contragt rvith yrill be "employees" if you us€ conlractsfs not licensed rvith the Construction Contractors Board to do labsrin constru-c1ing or tp assist in the construction or improvement of a residential struoture. $,s the employer, you mus(comply wi{h the fqllowing: '. l Oregon's lVithholding Tax Lax': As an employer, you must rvithhold income taxes from "*ptoy". *ugbi ut the time emplo.vees are paid. You rvill be liable tbr the tax payments even if you don't actually x:i$hold the tax irgm you5 "*ploy".,.Formoreinformation,ca11theDepartmentofRevenueatsog:::gags8.., Unemployment fnsurance Tax: As an employer, you are required to pay a'tai'for unetrrploynrbnt'irigurdnc" pu.poeui on the wages of all employees. For more information, cail the Oregon Employment Department at 503-947-i488..- ._. : :,. -:' ,:a ,,it:.,t. . I. The Oregon Business Identification Number Gfl.{) is a combined number for both Oregcini lVi&holding and Unemployment Insurance Tax. To file for a BlN.call 503-945-8091 or w*rv.dor.state.or.us/formspay.htn:l I for the appropriate forms. Workers' Compensation Insurance: As an emplover, you are subject to the Oregon Workers' Compensation Law., and must obtain worlers' cornpensation insurance for your empioyees. If'ygu fail to obtain workersl compensation insurance. -vou coukl be subjeci to penalties anri be liable for all claim costs if one of J'our empioy"., is injured on the job. For more information. call the \Yorkers' Compen5ation Division at the Department of Consumer and Business Services at 503-947-78 I 5. . 'r. ,- Li.S. Internal Revenue Service: As an employer, you must withhold federal incotne tax from employees' wagei. You rvill be liable for the tax payment ev-en if you didn"t actually rvithhold the tax. For a F'ederal EIN number. call the Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this prcject, you are responsible for resolvirtg any failure to meet code requirements that may be brought to your attention through inspections.' . r' Liabitity and Prripert-v Damage fnsuranee: Contact your insriiance agent to see if you liave 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 rgdone. , :, Time: Make sure you have sufficient time to supen ise your employeeS. Expertise: Make sure you have the skills to act as -vour olvn 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 quesfions call the Construction Contractors Board (503-3?84621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owoer.doc I 2-09-0-1 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt :velopment Services Department Public Works Department RECEIPT#: 1200400000000001171 Date: 0810212004 |:21:26PNI Job/Journal Number coM2004-00950 coM2004-00950 coM2004-00950 Description + 7% State Surcharge + l0% Administrative Fee Building Permit Amount Due 3. 15 4.50 45.00 Item Total:$52.6s Payments: Type of Payment Paid By uhecl(Number Authorization Received By Batch Number Number How Received Amount Paid Check CHRIS UNDERWOOD djb 2t74 In Person $52.65 PaymentTotal: ffi 8/2/2004 Page I of I tlxraa!rc