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Home My WebLink AboutPermit Plumbing 2004-05-03Status Issued 225 F'ifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-00509ISSUED: 0510312004APPLIED: 05/0312004EXPIRES: 11/0312004 VALUE: SITE ADDRESS: 1345 llTH ST ASSESSOR'S PARCEL NO.: 1703264405200 PROJECT DESCRIPTION: Replace approx 40lf sanitary sewer Springfield TYPE OF WORI(: Plumbing Only TYPE OF USE: New Residential Owner: ROEHL NICHOLAS F Address: 3205 WESTERN DR EUGENE OR 97401 Contractor Tvpe Plumbing Contractor BRAUN EXCAVATING INC License 101388 Expiration Date 10117t2007 Phone 541-935-5940 CONTRACTOR INFORMATION ION # of Units: Primary Occupancy Group:R-3 # of Stories: Type: Energy Path: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: Secondary Primary Secondary # of Bedrooms:g\)1 c0}.r t'J\ENCED SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: in OAR 952-001{01 Street Improvements: 0090. You maY Storm Sewer Available: Special Instruction: Notes: calling the center.(Note:&a Hcphone number for the Oregon Utility Notification Center is 1 -800-332 -234r';1. $ Per Sq Ft or multiplier Square Footage or Bid Amount Sidewalk Type: Downspouts/Drains: REQUIRED PARIilNG Total: Handicapped: Compact: Total Value of Project Page I of2 DEVELOPMENT INFORMATION Description Type of Construction Value Date Calculated \t ATTENTION: lollow rules Valuation Description I Building/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: COM2004-00509ISSUED: 0510312004APPLIED: 05/0312004EXPIRES: 11/0312004 VALUE: Fee Description + l0Yo Administrative Fee + 77o State Surcharge Sanitary Sewer - lst 50 Feet Total Amount Paid Amount Paid $4.50 $3.1s $4s.00 $s2.6s Date Paid 5t3t04 5t3t04 513104 Receipt Number 1200400000000000606 1200400000000000606 1200400000000000606 Plan Reviews 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. I Sanitary Sewer Line: Prior to filling trench and including required testing. Reouired Insnections 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.#Z r' Owner or Contractors Signature Date Pase 2 of 2 T t}J rees raro I Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us 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 .01 0(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 3,A' or 38: l. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. EI- le. My general confiactor tt F /oEzE (Name))(ccB #) k K 9," I will instruct my general contactor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR I will be my own general contractor. If I hire subcontractors, I will hire only subcontactors 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 nurme 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.4-z szl/ (Signature of permit applicant) @ate) (White copy to issuing agenq pennitfile, pink copy to applicant.) Permit #:Cbiill Zo< --' gOtO ? Address:Dq f tt; =1- Issued by:><Date: S/r,/ovT/ Property_owner.doc 03/ I I /03 Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RE$PONSIBILITIES t\rofB This lnformation Notice to Property Owners about Construction Responsr0ilifies lvas develaped by the Canstructian Cantractors Baard in accardance with ORE 7A1.055(5j, passed by the 1989 Oregan Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. Employer Responsibilities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed rvith the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must wrthhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees.F<rraStateBusinessIDnumber,calitheBusinesslnformationCenterat503-986-2200. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unenrployment insurance purposeo on the wages of all employees. For more infarrnation, call the Oregon Employment Department at 503-947-i488. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation l^qw, and must obtain workers' compensation insurance for your empioyees. tf you fail to obain workers' compensatiot insurance, you could be subject to penalties and be liable fbr all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-78 I 5. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, sall the IRS at 866-816-2065 or fax them at 801-620-?115. ' '' ._*. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder fcr this project, you are responsible for resolving any failure to rneet code requirementrs that rnay tre brought to your attention through inspecti*ns. Liability and Property Damage fnsurance: Contact vour insurance agent to see if you have adequate insurance coverage foraccidents and omissions such as falling tools, paint ovsr spray, water darnage from pipe punctures, fire or work that must be redone. Time: Make sure you have sufficieirt time to supervise your employees. I : . -r. Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notifu building officials as the appropriate times so they can pe,rform the required inspections. If you have additional questions call the Construction Confractors Board (503-37S4621) or write the agency at PO Box i4140, Salem, OR 97309-5052. Properfy_owner.doc 03i I 1103 225 Fifth Street Springfieid, Oregon 97 477 541-726-3759 Phone anty of Springfield Official Receipt -velopment Services Department Public Works Department RECEIPT #: 1200400000000000606 Date: 0510312004 9:0e:3eAM Job/Journal Number coM2004-00509 coM2004-00s09 coM2004-00509 Description + 7%o State Surcharge + l0% Administrative Fee Sanitary Sewer - 1st 50 Feet Amount Due 3. l5 4.50 45.00 Item Total:$52.65 Payments: Type ofPayment Check Number Authorization Paid By Received By Batch Number Number How Received Amount paid Check NICHOLAS ROEHL djb 5321 In Person $52.65 Payment Total: -Sffit s1312004 Page I of I snr:*D