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Home My WebLink AboutPermit Plumbing 2004-09-15Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-01140ISSUED: 0911512004APPLIED: 09/1512004 EXPIRES: 03/1512005 VALUE: SITE ADDRESS: 425 26TH ST ASSESSOR'S PARCELNO.: 1703361420300 PROJECT DESCRIPTION: Replace 18 ft. of water line Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Repair Residential Owner: DIAZ TERWILLEGAR Address: 425 26TH ST SPRINGFIELD OR 97477 Owner: DIAZ BONNIE L Address: 425 26TII ST SPRINGFIELD OR 97477 Contractor Tvpe Plumbing Contractor OWNER License Expiration Date Phone CONTRACTOR INFORMATION BUILDIN( # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: o/o 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 Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: N0TICE: THls PERMIT SHALL E-xPLRlll THE WoRK AUTHoRiz;o ur'loEn THt!.I^ERMIT lS NoT COMMENCEDbN IS ABANDONED IOR ANY 1BO DAY PERIOD. REQUIRED PARKING Total: Handicapped: Compact: PUBLIC IMPROVEMENTS Page 1 of2 - law requires You to the Oregon UtilitY rules are set forth Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line Building/C ombination Permit PERMIT NO: COM2004-01140ISSUED: 0911512004APPLIED: 09/1512004EXPIRES: 03/1512005 VALUE: Description Type of Construction Fee Description + l0o/o Administrative Fee + loh State Surcharge Water Line - lst 50 Feet Total Amount Paid Total Value of Project Date Paid 9n5t04 9n5104 9fi5t04 Value Date Calculated Receipt Number 2200400000000001166 2200400000000001166 2200400000000001166 $ Per Sq Ft or multipHer Square Footage or Bid Amount Amount Paid $4.50 $3.15 $45.00 $s2.6s Plan Reviews To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Water Line: Prior to filling trench and including required testing. By signature,I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction.Z4 H 7-/5-t/-----E-- Owner or Pase 2 of 2 Date Valuation Description I Fees raro Keoulreo rnsDecuons I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone ^'ty of Springfield Official Receipt * evelopment Services Department Public Works Department RECEIPT#: 2200400000000001166 Date: 0911512004 9:47:53AM Job/Journal Number coM2004-01r40 coM2004-01140 coM2004-01140 Description Water Line - lst 50 Feet + 7Yo State Surcharge + l0o/o Administrative Fee Amount Due 45.00 3. l5 4.50 Item Total:$s2.65 Payments: Type of Payment Paid Bv CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check TERWILLEGAR dlm In Person Payment Total: $s2.6s -Ss2.o-f 756 9n512004 Page I of I mtrao Construction Contractors Board permit u,utzr.4 -O///O 700 Summer St I\tE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 WebAddress:ry$1!4!4q a aAd&ess: Issued by:Date: Statement: Information 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 buildtng, 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 befiledwith thepermit. Fill in the appropriate blanks and initial boxes I and 2, md either box 3A 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. tr 3A. My general contractor is (Name)(ccB #) F w ,4 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 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. 7 J-L( of permit applicant) (lVhite copy to issuing agency peftnitfile, pink copy to applicant.) @ate) Property_owner.doc 06-0 I -04 a :'i General Cbitracto n? , tT\-1 TICE TO PROPERTY OWNERS ON RESPONSIBILITIES If you are existing strucfure, Employer Responsibilities You will, in most instances, be ruled to be an o'employer" and the conkactors you con&act with will be "ernployees" if you rr{ie conffactors not licensed with the Constructio* Conkactors 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 foll,owing: Oregon's \[ithholding Tax Law: As an employer, you must withhold 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. For more information, call the Departmant of Revenue at 503-3784988. Unemployment Insurance Tax: As an employer; you arsrequired to pay atax for unemployrnent insurance O*oilti on the wages of all employees. For more informatioa, call the Oregon Employrnent Department at 503-947-1488.>{ The Oregon Business Identification Number (BIhQ is a combined number for both &egon Withholding and UnemploymentlnsuranpeTax.Tofi1eforaBIN,ca11503.945.80910rtm}1forthe appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Comperrsation Law, and must obtain workers' compenqatlorr insurance {-or yow employees. If you fail to obtain workers' compensation insurance, you could be subject to'lienalties and be 'iiable for all claim'bost} if one if your'employees is'injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-94?-78 i5. Li.S. Internat Revenue Service: As an employer, you must withhold federal income tax from ernployees' *ug"X You will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, callthe IRS at 1-800-829{933 or visit their web site at luuuJlsiggv Other Respon$ihllitie$ and Areas of Concerns Code Compliance: As the permit hoider for this project, you are responsible for resolving any failure tr: meet code reqilirements that may be brought to your attention through inspections. Liability and Property Damage Insufirnce: Contact your insurance agenf to see if you have adequate insurance coverage for accide*ts and omissio*s such as falling tools, paint over spray, water damage fram pipe punctures, fire or work that must bered*ne. 'i Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sxre you have the s(ills to aci as youi own general cfiltractor,'to coordiiiale the work of rough-in and finish trades, axd tr: nr:tify building officials as the appropriate times so they can perf,orrn the required inspections. If you have additionai questions call the Construction Coctractors Board (503-3784621) ar write the agency at PO Box 14140,Salem,OR 97309-5052. hri j. , ., .jL! ij Property_owner.doc 06-0 1 -04 NOTE: This tnfarmation Notice to Properly Awners about Constructi6n Responsibilities 'vas devetoped by the Construction tonfracfors Eoard in accordance witll ORS 701.05Sf5J, passed by the 1989 Aregon Legislature. -+a I