HomeMy WebLinkAboutPermit 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
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