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Home My WebLink AboutPermit Building 2006-05-11Status 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: COM2006-00465ISSUED: 0511112006 APPLIED: 0412012006 EXPIRES: 1212612006VALUE: $ 6,930.00 SITE ADDRESS: 354 26TH ST ASSESSOR'S PARCEL NO.: 170336141 PROJECT DESCRIPTION: Addition to Single Family Residence Addition Residential Phone 541-935-8466 Owner: Address: Phone Number: 541-729-55f 8REED WILLIAMS 354 26TH ST SPRINGFIELD OR 97477 Contractor Type General Electrical Mechanical Plumbing Contractor RATZLAFF CONSTRUCTION INC OWNER OWNER OWNER License 117655 Expiration Date 09130t2006 TION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Fronfyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure ' Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: , -,, f '1\'tfu.,S)"l,..?v ' t3,oo t sq rt tst rfiibr: sq Ft 2no ft'oor: Sq Ft Basemdirt: re0OO 70R-3 VN Electric Sq Ft Garage/Carport Path I Sq Ft Other: nla Occupant Load: r2.00 s.00 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Sidewalk Type: Downspouts/Drains: REQUIRED PARKING Total: Handicapped: Compact: Partially Improved Yes Notes: Storm drainage piped into existing to curb face 412412006 CAS DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Page 1 of3 Curb and Gutter E:\LL \ lSH H\S USE:1 \NY 1BU IrUIIlIrll\U tt\rt I(1YrA rtul\ I Status Issued 225 Fifth Street, Springfield, OR 541-126-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2006-00465ISSUED: 0511112006 APPLIED: 0412012006 EXPIRES: 1212612006VALUE: S 6,930.00 Description Dwellinss Type of Construction V Wood Frame $ Per Sq Ft or multiplier $99.00 Square Footage or Bid Amount 70.00 Value $6,930.00 $6,930.00 Date Calculated 04t20t2006 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0o/" Administrative Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Exhaust Hoods Fire SF Fee - Residential Fixture Minimum/Adj ustment Mechanical SDC Sanitary/Storm Admin Storm Drainage Impervious Area + l0oh Administrative Fee + 8olo State Surcharge Storm Sewer - lst 50 Feet Water Line - lst 50 Feet Total Amount Paid Amount Paid Total Value of Project Date Paid Receipt Number 1200600000000000521 120060000000000063s 1200600000000000635 1200600000000000635 1200600000000000635 r200600000000000635 120060000000000063s r20060000000000063s 1200600000000000635 1200600000000000635 1200600000000000635 1200600000000000635 1200600000000000635 1200600000000001001 r200600000000001001 1200600000000001001 1200600000000001001 $54.60 $10.00 $20.1s $r5.84 $43.00 $12.00 $84.00 $9.00 $3.s0 $14.00 $36.00 $r.43 $28.58 $9.00 $7.20 $45.00 $4s.00 4t20t06 5fiu06 5nt/06 5nu06 snu06 5fiu06 5nu06 5nu06 5ny06 5fiu06 5nu06 5nU06 5nu06 6t30t06 6t30106 6t30t06 6t30t06 $438.30 Fees Paid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 04t2U2006 04t2u2006 04t2u2006 04t2U2006 04t27t2006 04t24t2006 04t21/2006 05n0t2006 APP DLM No Planning issues. Storm drainage piped into existing to curb face 412412006 CAS See documents for Plan review comments. APP APP APP LLH TAJ CAS 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. Paee 2 of3 Eq-L L:u Valuation Descrintion Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2006-00465ISSUED: 0511112006 APPLIEDz 0412012006 EXPIRESz 1212612006VALUE: $ 6,930.00 nsnecfions Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete' Rough Plumbing: Prior to cover and including required testing' Underfloor Plumbing: Prior to insulation or decking' Underfloor Drain: Prior to cover or placement of concrete' Final Plumbing: When all plumbing work is complete' Rough Mechanical: Prior to Cover FinalMechanical:Whenallmechanicalworkiscomplete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete' Storm Sewer Line: Prior to filling trench' water Line: Prior to filling trench and including required testing' By signature'I state and agreeo that I have carefully examined the completed application and do herebY certifY that all information hereo n 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 SPring{ield and the Laws of the State of Oregon pertaining to the work described hereinn 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 th at all required inspections are req uested 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 L h Owner or Co Page 3 of3 Date 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone y of Springfield Official Receipt vevelopment Services Department Public Works Department RECEIPT #: 1200600000000001001 Date: 0613012006 11:45:23AM Job/Journal Number coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 Description Water Line - lst 50 Feet Storm Sewer - lst 50 Feet + 8% State Surcharge + l0%o Administrative Fee Amount Due 45.00 45.00 7.20 9.00 Item Total:$106.20 Type of Payment Paid By Received By Batch Number Number How Received Amount Paid Check RATZLAFF CONSTRUCTION INC. ddk 501 0 In Person Payment Total: $106.20 $r06.20 cReceintl Page I of I 613012006 l,wprl Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37 69 Inspection Line TY F FIELD Building/Combination Permit PERMIT NO: COM2006-00465ISSUED: 0511112006APPLIED: 0412012006EXPIRES: 1111112006VALUE: $ 6,930.00 SITE ADDRESS: 354 26TH ST Springfield TYPE OF WORK: Single Family Residence ASSESSOR'SPARCELNO.: 1703361418500 TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Addition to existing single family residence (Kitchen) PhoneNumber: 541-729-5518Owner: Address: REED WILLIAMS 354 26TH ST SPRINGFIELD OR 97477 'l Contractor Type General Electrical Mechanical Plumbing Contractor RATZLAFF CONSTRUCTION INC License l I 7655 Expiration Date 09130t2006 Phone 541-93s-8466 OWNER OWNER OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available Special Instruction: # ofStories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: 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 Sq I 70R-3 VN 13.00 Electric Path I nla 3N1\l )'N! NNOS HINV3 ffi,-{gH ant 1z\u0 1\|'lU U\r\X3 11vl \S t'l0 Htl ARKING\3\uOt'tr 3 REQUIRED P Total: Handicapped: Compact: 12.00 s.00 Partially Improved yes Sidewalk Type: Downspouts/Drains: Notes: Storm drainage piped into existing to curb face 412412006 CAS PUBLIC IMPROVEMENTS Page I of3 Curb and Gutter I vO\ 2-001- )n'ter' L U I Ll-rrN rJ I 1\ r LrElv!.A'-!-!l-rllJ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line FIE Building/Combination Permit PERMIT NO: COM2006-00465ISSUED: 0511112006APPLIEDz 0412012006EXPIRES: l111112006VALUE: $ 6,930.00 Description Dwellines Type of Construction V Wood Frame $ Per Sq Ft or multiplier $99.00 Square Footage or Bid Amount 70.00 Value $6,930.00 $6,930.00 Date Calculated 04t20t2006 Fee Description Plan Review Residential -Mechanical Issuance Fee- + l0oh Administrative Fee + 87o State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Building Permit Exhaust Hoods Fire Fee - Residential Fixture Minimum/Adj ustment Mechanical SDC Sanitary/Storm Admin Storm Drainage Impervious Area Total Amount Paid Amount Paid $s4.60 $10.00 $20.1s $rs.84 $43.00 $12.00 $84.00 $9.00 $3.s0 $14.00 $36.00 $1.43 $28.58 $332.10 Total Value of Project Date Paid 4t20t06 snu06 5nU06 5nu06 5fi1106 5nu06 5ny06 snu06 5nu06 snu06 5nu06 5nu06 snu06 Receipt Number I 200600000000000s2 l 1 200600000000000635 I 200600000000000635 l 200600000000000635 l 200600000000000635 1200600000000000635 l 200600000000000635 1200600000000000635 120060000000000063s 1200600000000000635 1200600000000000635 1200600000000000635 I 20060000000000063s Fpps Peid Plan Reviews Initial Review Planning Review Public Works Review Structural Review 04t2U2006 04t2u2006 04t2u2006 04t21/2006 04t27t2006 04t24t2006 04t2u2006 05/10/2006 APP DLM No Planning issues. Storm drainage piped into existing to curb face 412412006 CAS See documents for Plan review comments. APP APP APP LLH TAJ CAS 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. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Pase 2 of3 Rennired Insnections I Valuation Description I 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: COM2006-00465ISSUED: 0511112006APPLIED: 0412012006EXPIRES: 1llll12006VALUE: $ 6,930.00 Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Plumbing: Prior to cover and including required testing. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 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 ring 4- \\-s t9 Owner or Contractors Signature Date Page 3 of3 q 5%/t)45-ll4? ... "I$ru- Ai*^pVe*3225 FIFTH STREET o SPRINGFIELD, OR 97477 c PH:(541)726-3753 o FAX: (541)726-3689 E LE CTRI CAL P E RM IT AP P LI CATI O N City Job Number Date 3. CONII'LET'E ?-EE SCHEDULE BELOIII Z & LEGAL DESCRIPTION JOB DESCRIPTION Service [ncluded 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 B. $ 106.00 $ 19.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. 00NTRACTORTNSTALT'A:IION ONLY Electrical Contractor Address Phone 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsA/olts Reconnect Only Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps City Supervisor License Number Expiration Date Constr Number Expiration Date Si gnature of Supervising Electrician $ 63.00 $ 7s.00 $ 125.00 $ 163.00 s375.00 $ s0.00 $ s0.00 $ 69.00 $r00.00 Owners Name Address City @ 37#7 vr',on"-53/K OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Signature: D. E. Pump or inigation Sign/Outline Lighting Li mited Energy/Resi dential Limited EnergyiCommercial Minimum Electric Permit Inspection Fee is $45.00 * Surcharges /! 50.00 50.00 25.00 45.00 $ $ $ $ 4. SUBTOTALOFABOVE 7o/o State Surcharge 10% Administrative Fee TOTAL 5 { V(o s5D Inspection Request: 726'37 69 Shared Drive(T:)/Building Fonm/Elecu'ical Pennit Application l-03'doc I. I,ACAT'ION OF INSTAI,LAT'ION A. Nerv Residential - Single or l\l.ulti-Family per drvelling unit. (1 t,Z - e^Z/ < /703?c/y' < ^ KrTc '- ' &B/t ^L, New Alteration or q) /7 One Circuit S\$ t\ 1\ (Service/feeder not included ) -Each Installation tu 43.00 3.00 l-q?o JOT]RNAL ORJOB NUMBER: NAMEORCOMPANY: LOCATION: TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS x NUMBER OF DFU'S 0 x B. IMPROVEMENT COST: NUMBEROF DFU's 0 COST PER S.F $0.323 COST PER S.F $0.323 COST PER DFU $25.07 $19.07 NUMBER OF UNITS 0 NTIMBER OF LTNITS 0 ADM. FEE RATE 5Yo C}IARGE $28.58 DISCOUNTRATE 50% $28.58 DISCOT]NT $0.00 CITY OF ; fIINGFIELD SYSTEMS DEVELOPMEI*- I'VORKSHEET coM2006-00465 Reed Williams 354 26th St 170336r4r8500 STNGLE FAMILY RESIDENCE BUTLDTNG SIZE (SF, 71 LOT S\ZE (SF):0 0 I. STORM DRAINAGE DIRECT RL]NOFF TO CITY STORM SYSTEM IMPERVIOUS S.F. x 88.47 RTINOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CIry STANDARDS IMPERVIOUS S.F 0.00 ITEM I TOTAL-STORM DRAINAGE SDC 2. SANITARY SEWER- CIry A. REIMBURSEMENTCOST: x ITEM 2 TOTAL. CITY SANITARY SEWER SDC 3. TRANSPORTATION A. REIMBURSEMENT COST: x x x x x x $0.00 COST PER TRIP $ r 9.09 COST PER TRIP $84. I 9 $0.00 NEW TRIP FACTOR r.00 NEW TRIP FACTOR 1.00 ADT TzuP RATE 9.57 B. IMPROVEMENT COST: ADT TRIP RATE 9.57 SUBTOTAL $28.58 xx xx ITEM 3 TOTAL - TRANSPORTATION SDC 4. SANITARY SEWER- MWMC A. REIMBURSEMENT COST: NUMBEROF FEU's 0 B. TMPROVEMENT COST: NUMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINI STRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBToTAL (ADD ITEMS 1,2,3, & 4',) 5. ADMINISTRATIVE FEE: $0.00 $28.s8 CHARGE $1.43 TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: Cheryl Slaymaker 4/2412006 COST PER FEU s82.03 $28.58 $0.00 $0.00 $0.00 $0.00 $30.01 I 070 1091 1092 1093 1094 I 054 I 055 1054 I 0s6 a trl t-1oU slF V) rq COST PER FEU $865.3 r PREPARED BY DATE TOTAL SDC CHARGES FIXTURE TYPE MISCELI.ANEOUS DFU TYPE TOTAL DRAINAGE FD(TT]RE UNITS 'EDU lsa BEFORE 1979 1979 DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OF NEW FXTURES x UN]T EQUIVALENT: DRAINAGE FXTURE UMTS FOR CALCULATE ONLY THE NET ADDITIONAL NO. OF FIXTURES I.INIT NEW OLD NUMBER OF EDU'S 20 DRAINAGE FIXTURE UMTS 0 2 1979 toa mit set at I 67 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 1980 l98l 1982 1983 r 984 1985 I 986 1987 1988 I 989 I 990 l99l t992 1993 1994 I 995 1996 1997 I 998 't999 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 2 VALTIE / IOOO $0.00 CREDIT RATE $5.29x CREDIT FOR IMPROVEMENT (TF AFTER ANNEXATION) VALUE/ IOOO CREDITRATE $0.00 x $5.29 TOTALMWMC CREDIT 2001 $1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0.28 $0.09 $0.05 BATHTUB 0 0 3 0 DRINKING FOTNTAIN 0 0 1 0 FLOOR DRAIN 0 0 3 0 INTERCEPTORS FOR GREASE / OIL / SOLIDS /ETC.0 0 3 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC.0 0 6 0 LALINDRY TUB 0 0 2 0 CLOTHESWASHER / MOP STNK 0 0 3 0 CLoTTTESWASHER - 3 OR MORE (EA)0 0 6 0 MOBILE HOME PARK TRAP (I PER TRAILER)0 0 12 0 RECEPTOR FOR REFRIG / WATER STATION / ETC.0 0 1 0 RECEPTOR FOR COM. SINK / DISHWASHER / ETC.0 0 3 0 SHOWE& SINGLE STALL 0 0 2 0 SHOWE& GANG GTUMBEROF HEADS)0 0 2 0 SINK: COMMERCIAL/RESIDENTTAL KITCHEN 0 0 3 0 SINK: COMMERCIAL BAR 0 0 2 0 SINK: WASH BASIN/DOUBLE LAVATORY 0 0 2 0 SINK: SINGLE LAVATORY/RESIDENTTAL BAR 0 0 1 0 URINAL, STALL / WALL 0 0 5 0 TOILET, PUBLIC INSTALLATION 0 0 6 0 TOILET, PRryATE INSTALLATION 0 0 3 0 YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALT]E 00 0 2000 Construction Contractors Board permit g.Loi*tes- O -OO t{6 i- 700 Summer St hlE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Address: J >z6{L s+- Issued by:\4 Date:o LI statement: lnformation Notice to Property owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residenttal construction permit applicants who are not licensed with the Constntction Contractors Board to sign thefollowiig statement before a building permit can be issued. This statement is requiredfor residential building, electrtcal, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will beJited with the permit. Fill in the appropriate blanks and initial boxes I and 2, andeither box 3A or 38: EJ l. I own, reside in, or will reside in the completed structure. ry 2. I understand that I must become licensed as a construction conhactor if the stucture is sold or offered for sale before or on completion. E- :A.. My general contractor is LpTLLA#G^dQ-ila 6rs (Name)(ccB #) I \Mill insnuct my general contactor that all subcontactors who work on the stucture must be licensed with the Construction Contractors Board. OR n 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 informetion 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. 5 -\l^oG (Signature applicant)@ate) (White copy to issuing agency peftnitfile, pink copy to applicant.) Property_owner.doc 06-0 l -04 Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOIE: This lnformation Natice to Propedy Owners about Construction R6sponsibilrties was developed by lhe Canstruction Cantractors Board in accordance with oRS 701.055{5J, passed by the 1989 Aregon Legislature. . If you are actirrg as your own coatractor to construct a new home or make a substaitial improvement to an existing structure, you can prevent.many pioblems by being aware of the following responsibilities and cotlcsrns. f mploYer Responsibilities you will, in most iaslpnces, be ruled.to be an i'enployer" and the cgntractors youconffact with will be "euployees" if you u.qg poiltacp{$ not Licensed with the consoirion Contractors }oard to do iabor in constructing or to assist in the "olutru"tion'ri i*pro,r*ment of a residential structure. As the employer, yod must comply with the following: Oregonrs Withholding Tax Law: As an employer, you must withhold income taxes &om bmployee wages at the time "*pi"y"** are paid. fou will be liablE for-the tax payments even if you don't actually withhold the tax from your employees. For more infornration, call the Departnent of Reveirue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurtnce pu'po'*i'l ;.h";&otattemptoyees'Formor1information,calltheoregonEmpioymentDeparfmentat503-947-l488. nolding utE-The oregon Business ldentification Number (BbI) is a combitred number for both Oregon Wifhl Unompl,o,ymsnt Insurance Tax. To frle Qr a BIN, call 5-03-945-8091 or wlwv.dor.state.or.us/fonrspaJ'htmll for the lvorkersn compensation Insurance: As an employer, you are subject to the oregon workers' Comporsation Law, and must oblain workers' compensation insuranc" for your employees. If you fail to obtain workers' compensation ;;;;;,-t;;ouro u" subjeci to penalties and be liabie for all ciaim costs_ if one of your errployees is injured on the job. For more information, call the Workers' Compensation Division at thi Departnent of Consumer and Business Services at 503-947 -7 81 5 . U.S. Internal Revenue Service: As an employer, you must withhold Heral incorre tax from employees"wages- you will be liable for the tax payment even ifyou didn't actually withhold the tax. For a Federal EIN number, call the IRSd 1-800-8294933 or visit their web siie at w*w-irs.gov. .. iJ - : other Responsibilities ard Areas of concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code reqqf,T?r1s that$ly be brought to your atter:tion through inspections. . ,r, , , r i Liabitity and property Damage fnsurance: Contact your insurance agent to see if you have'adequat0 instnance - "or,rrugi for accidents and omissions such as falling tools, paint over spmy, water damage from pipe punctures, fire or. work that must be redone. !. : ! Time:MakesureyouhavesufficienttimetosuperviseyourempIoyees:] Expertise: Make sure you havi'the skills to act as your own ge,neral confractor, 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 questions call the Consfruction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_owner.doc 06-0 1 -04 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone c"v of Springfield Official Receipt --,relopment Services Department Public Works Department RECEIPT #: 1200600000000000635 Date:05/11/2006 8:44:46AM Job/Journal Number coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 coM2006-00465 Description Fire Fee - Residential Storm Drainage Impervious Area SDC Sanitary/Storm Admin Building Permit Fixture Exhaust Hoods Minimum/Adjustment Mechanical -Mechanical Issuance Fee- Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 8% State Surcharge + llYo Administrative Fee Amount Due 3.50 28.s8 1.43 84.00 14.00 9.00 36.00 10.00 43.00 12.00 15.84 20.15 Item Total $277.50 Payments: Type of Payment Paid By Check Number Received By Batch Number Authorization Number How Received Amount Paid CreditCard REED WILLIAMS djb 912468 In Person $277.50 Payment Total : -52775-0- cReceintl Page I of I 511112006