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Home My WebLink AboutPermit Plumbing 2006-08-01Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line GFIELD Building/Combination Permit PERMIT NO: COM2006-00968ISSUED: 08/01i2006 APPLIED: 08/01/2006 EXPIRES: 0210112007 VALUE: SITE ADDRESS: 2103 sTH ST ASSESSOR'S PARCEL NO.: 1703262102600 PROJECT DESCRIPTION: Replace approx 25lf water line Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Repair Owner: Address: Contractor Type Plumbing Contractor GARY ALAN MUSTIN Expiration Date 06t24t2008 Residential Phone 541-463-7568 WENDY EAGLEWOLFE 1430 WILLAMETTE ST #195 EUGENE OR 97401 PhoneNumber: 541-746-4192 License t29990 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: #of \o l' b'l Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh 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: R-3 VN nla 6ra \$e ,t \o \q Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: Handicapped: Compact: Fronfyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: C ( $ Per Sq Ft or multiplier Square Footage or Bid Amount PUBLIC IMPROVEMENTS Valuation Description Description Type of Construction Paee I of 2 Value Date Calculated E I'UILL'II'\U I1\T TJI(,IYTA I I\-'T\ I $jfft*,'*l:lll' I o Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00968ISSUED: 0810112006 APPLIED: 08/0112006 EXPIRESz 0210112007 VALUE: Fee Description + l0oh Administrative Fee + 57o Technology Fee + 8oZ State Surcharge Water Line - lst 50 Feet Total Amount Paid Amount Paid Total Value of Project Date Paid 8nt06 8nt06 8nt06 8nt06 Receipt Number r20060000000000r r74 1200600000000001 174 1200600000000001 174 1200600000000001 174 $4.s0 $2.2s $3.60 $4s.00 $5s.35 Fees Paid Plan Reviews 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. Water Line: Prior to filling trench and including required testing. 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 Divisiono 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 properfy, and the approved set of plans will remain on the site at all times during ction. Pase 2 of 2 Date l(eourreo lnsDecuons I Construction Contractors Board Permit *: COtvt Zs.--,6 - OO ? 700 Surnmer St ItlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 5$478-4621 Web Address: ryww.ccb.state.or.us 03-S +(,- S FAddress Issued by:bK Date:o6/ Statement: lnformation Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701 .010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: #r El- r. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. -V ro. MYgeneral contractor is &*Uy nrwsr ( ^/tz??qo (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the strucfure must be licensed with the Construction Contractors Board. OR tr 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. tl hE @ate) file, pink copy to applicant.) Property_owner.doc 06-0 I -04 copy to issuing agency permtt, Act*mg fis Your Own Gemeral Cdntractor? INFORT$ATI*N ru*YICg T* P&#PgreTY SWI!{ERS AHSIJT C*N$TRL'S?!Sri{ Kg$p*r-isr*I LIYI gs */OfEj l$is fnfsrrafi*n pdo#sa f* trrop*dy Oi,yners ahout *anstruction &esponsibilrfies w&.s doreloped by the Co*sfruc#on Corlracfors Soard in a*cardance wili? #n'S 7CIr.&$5{5J, pass*d by the ?989 Oregnn legfslafure- {f y*x are a*ting &s y1li;r 6wx c*nkact*r t* *onstyxct a i}*w k*n:* *r makc a si}bstantixl impr*ve::t*nt tE: a:r existing $trllclure, y*u *an pr*?"rfit many problerns hy being awal& of the following re*pcnsi'bilities a*d csllfer11s" ffi xrlpX*y*r &*$p*xrsibiliti*s y*6 will, in merst instanc*s, be rulcd to be an "empl*ysr" a.nd the cnntra*t*rs y*u c*ntract rvith sdli be "'einployees" if ysl: u$e cofitractors *ct li*ensrd with the C*nstrustion Contraot*rs Board t* c}* lab*r in conskucfing or lG assist in tke *erfistructiq)rl or ixrp*:vement of a reside$tial sku*ture. "&s the *:npt*yer, y*le rnust ccrnply wi*ic the fellowingl ffreg**rs Withhsld*;3g ?xx $,xl,t,: As ax *mpI*yer, y*u rn*st witl:h*Icl ir:c**:* taxes f:r*txr emptr*yee wilg*s at th* time **ptroy*** are p*rid. Y** witrl he liabtr* {*r the t{ix p*yrnrfits even if y*u d**'l **lua}}y withh*trd the tax fr*m yorx emptr*y**s" pqlr rfl*r* ixfc:m.ati*n, call the fi*p*rtrne*r? *f R-*ve*rle at 5{}3-3?84$8&" Ltrnempt*y*xex* X*suraxnee Yxxt As *m *r:X:}*yer, ys& are req*ired to pay a tax for unemplcament insarance purpo$es *n the wages *t'all exrpl*y*es. F*r *r*re ixlf*rmati*n, *a11 tlte Sreg** Kmpi*3.ment S*pau*::c*rt at 5*3-94?-l'{'8S. ?he gr"reg*n Exxin*ss n*1entifi**ti*n N*rnber {eil',Q is a **rnbined nurnber for both Oregon Withholding and Un*:::p!*yment lns*ran*e T;u. Tc) fil* Srr a BIN, *ai? 5*3-S;t5-E*91 or :y$p:..d$f,$14tq.qi".il .h$d-! fr:r the appropriate forms. W'orkers, Coxrpcn*ati*n Ins$ra&ce: As ax e:xpl*ye*:, y*t; are *l;bje*t t* th* {-}r*gcn W*rkers' Compensation l-aw, and n"prst obtai:: workers' *ompexsiltior: insu:"ane* f*r y*w e:nplcyees. trf y** tbil to clbtain w'orkers" compensation i:lsurancr, you cculd he subje*t t* penalfies and be liable f*r all claim costs if oxe of your empl*yees is idurecl on the j*t:. Fcr m*re i*&rr:tatian, *ail tl"ra W*rk*rs' Ccr*pcnsatio:: tr)ivisi*n at the Dcpartment of Consumer and E::sir:css Services at 5*3-94?-7S i5. {i.$, Imter:ratr Rev*nu* Serviee: &s an rn:pl*y*r, ytlu fi?ust rrithh*ld flederal ineome tax &om empl*yees' wages' ygr: will be liclt)tre fi:r the tax pit3:xe:rt ev*n if y** didfi't x*txally withhold the tax. S*r * Fedffial EtrN number, call the IRS at 1-S*0-&2r-4933 *r visit their web site at,!glvsr-U$.ggy- Other Responsibilities and Areas CIf Concerns C*d* Cormplixy1c*: A* th* permit h*leier fe:r *xs pr*je*t, y*u are rcsp**sitrr}r ftir ress:!trvi&g any t'xilrre to r:teet c*d* reqxireme*t* that n:*y be i:ror:ght t* y*xr at{er*li** t}ircugh lnspe*ti*ns Li*bility amd Fr*p*rty llamage fnsuraar*e: C*nta*t y*ur insurarce agent lo see if y*u have adequate insuranee cov$r;;g* f,xr x**id**ts and *mi*s{*ns sx*h *x falling to*ls, p*int *v*r spray} r a{er qtarr:age fr*m pip* punetures, fire *:r w*rk that l:llxst bc reqlone . Tirne: hdak* sure you have suf,l!*ient tirne t* supervrse vour en:ptroye*s. .f,xpertise: Makc sure ,vou have thc skills tc act as your ow't'l genrral contract*r, ro coordinatc the work of rough*rn and finish kades, and tc n*:ti$,"kuitrding *ffici*Xs as the appr*pri*te limes s* llr*y **n p*r{eirm the r*quire*i i**p**ti**s. If yo* hav*: adEirtional ql.lesti*ns e;rll the C*r:stru*ti*n C*n&aetr:rx S*xrd {5*3-3?8-462tr} *r writ* th* *gency at PO 8*x t;$i4S, Salen':, {}R 9?3*9-5052. Froperty**wner.d*e *6-* t -*4 I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Cit'. of Springfield Official Receipt I, ,lopment Services Department Public Works Department RECEIPT#: r200600000000001174 Date: 08/01/2006 8:25:27AM Job/Journal Number coM2006-00968 coM2006-00968 coM2006-00968 coM2006-00968 Description Water Line - I st 50 Feet + l0% Administrative Fee + 8% State Surcharge + 5olo Technology Fee Amount Due 45.00 4,50 3.60 2.2s Item Total $5s.35 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check W EAGLEWOLFE djb ln Person Payment Total: $s 5.3 5 -ffi 958 cReceintl Page I of I 81112006