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Home My WebLink AboutPermit Plumbing 2005-01-20Building/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: COM2005-00083ISSUED: 0112012005APPLIEDz 0t12012005EXPIRES: 0712012005 VALUE: SITE ADDRESS: 1129 7TH ST ASSESSOR'SPARCELNO.: 1703264313000 PROJECT DESCRIPTION: Approx 1001f water line Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Repair PhoneNumber: 541-746-5333 License Expiration Date Phone Residential 0wner: Address: Contractor Type Plumbing EARL REAVIS 1129 N 7TH SPRINGFIELD OR 97477 Contractor OWNER ]TORINFORMATION )RMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: R-3 Height of Structure VN Overlay Dist: # Street Trees Rqd: Paved Drive Rqd:Y o\.1to "/" bY the are ru\es bY e $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Heat: Water Type: Range Type:Sq Ft Garage/Carport Energy Path:Sq Ft Other: Sprinkled Building:nla Occupant Load: N01 R O Unf Ptn Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Type: REQUIRED PARKING Total: Handicapped: Compact: DEVELOPMENT INFORMATION Description Type of Construction Paee 1 of2 Value Date Calculated 1HE D Valuation Description I FIELD Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Rax 541-7 26-37 69 Inspection Line PERMIT NO: COM2005-00083ISSUED: 0112012005APPLIED: 01/2012005EXPIRES: 0712012005 VALUE: f,'ees Paid Fee Description + l0o/o Administrative Fee + 7Yo State Surcharge Water Line - lst 50 Feet Water Line - Each Addtl 100' Amount Paid $5.90 $4.13 $4s.00 $14.00 Total Value of Project Date Paid y20105 u20t05 u20t05 u20t0s Receipt Number 1200500000000000088 1200500000000000088 1200s00000000000088 r200500000000000088 Total Amount Paid $69.03 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. nsnections 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 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.t(h*iT,e/1l 2 o - 2oo > Owner or Contractors Signature Pase2 of2 Date Construction Contractors Board 700 Summer St I\tE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Pemrit *:(bvq k)e f -r)oo83 Address: ilZa a+L sJ- Issued by:\6 Date: l- ZO -Z@f Statement: lnformation 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. 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 submtt this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I amld2, and either box 3A or 38: A, &2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contactor if the sfrrcture is sold or offered for sale before or on completion. (ccB #) I will instruct my general contractor that all subcontractors who work on the stnrcfure must be licensed with the Construction Contactors Board. OR 38. I will be my own general contactor. 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. t i2** (Signatu." ofpermit applicant) @ate) (Vt/hite copy to issuing agency permitfile, pink copy to applicant.) Property_owner.doc 06-0 1 -04 , .N tr 3A. My general conffactor tt L-/ Acting as Your Own General 06ntractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUGTION RESPONSIBILITIES Ifyou are existing structure, Employer Responsibilities You will, in most instances, be ruied to be an "employer" and the contactors you confuact lrdth *ill ire:'s.mplpyees" if yourise contractors not licensed with the Construction Contactors Board to do labor in constructing olts qsqist in the constuction or improvement of a residential skucture. As the employer, you must comply with tle foliowing: Oregon's Withholding Tax Law: As an employer, you must withhold inconie taxes from employee wages at the fime employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-3784988. ; " ; Unemployment Insurance Tax: As an employer, you are required to pay a tax for uneruployment insurance purpos* , on the wages of ali employees. For more information, cail the Oregon Employmant Department at 503-947-1488. *rn The Oregon Business Identification Numher (BII',{) is a combined number for. both Orego,g, Withholding and Unemployment Insurance Tax. To file for a BIN, cali 503-945-8091 or www.dor.state.or.us/formspay.htmll for the appropriate forms. W'orkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must,oltain wo.rkers' compensation insurange for your employees. If you fail t9 obtain worker$'conlpensation insurance, you'bould be subject to penaities and be 1lable for all claim costs if one of yor employeesis irfiured on the job. For more information, call the Workers' Compensation Division at the Deparhtrant"bf Consunier artd Business Services at 503-947-7815. ,i U.S. Internal Revenue Service: As an employer, you must withhol'd federal inconle tax ftom oftplbyees' *ur"K You wil] be liable for the tax payment even if you didn't actually wi:hhold the tax. For a Federal EIN number, call the IRS at 1.800-82949t3 or visit their web site at rvww.irs.gov , .i. Other Responsibitities and Areas of Concerns. . Code Compliance: As the permit holder for this project, you are responsrble for resolving any faihire to meet code requirements that may be brought to your attention through inspections,' . ,ti,..,,'.:. ,. .' ,: ..1 .. .r-r . Li*bility aud Property Ilamage fnsurance: Contact your insurance agent to sed'iftou liare'adequate insuranc6 coverage lbr accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or wcrk that must be redone . ! '_ t '. i Time: I\4ake sure you,have su{fici*nt time to supenise y*ur employeos. r. : ... . . . Dxpertlse: &{ake sure you have tke skilld'to d*i as yourow*general condactbr,'tn cborditia'te t}ie workof 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 questions call the Construction Contractors Board 6A38784621) x write the agency at PO Box 14140, Saiern,OR 97309-5052. *, _..;,. ,::. ..:ryr. ; , i Property_owner" doc 06-0 I -04 NOTE: This lnfarmatian Notico to Prop*rty Awners about Construction Responsibilrties was developed by the Constructian Cantractors Board in accordance with ARS 7A1.055(5), passed by the 1989 Aregon Legislature. 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Eity of Springfield Official Receipt velopment Services Department Public Works Department RECEIPT #: 1200500000000000088 Date: 0112012005 t:29:27PM Job/Journal Number coM2005-00083 coM2005-00083 coM2005-00083 coM200s-00083 Description Water Line - lst 50 Feet Water Line - Each Addtl 100' + 7o/o State Surcharge + l0% Administrative Fee Amount Due 45.00 14.00 4.t3 5.90 Item Total:$69.03 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check DOROTHY REAVIS djb In Person Payment Total: $69.03 -$6-e-o-t 524 U20t200s Page I of I lrrllalg.D