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Home My WebLink AboutPermit Plumbing 2005-12-05Building/Combination permitStatus Issued 225Fitth Street, Springfield, OR 541-726-3753 phone 541-726-3G76 Fax 541 -7 26-37 69 Inspection Line PERMIT N ISSUED: APPLIED: EXPIRES: VALUE: O: COM200S-01687 12t05t200s 12t05t2005 06/0st2006 SITE ADDRESS: tl3t 34TH ST Springfield TYPE OF WORK: plumbing OntyASSESSOR'S PARCEL NO.: 1702303409701 PROJECT DESCRTPTIoN: Reprace approx l00rf sanitary sewer rine TYPE oF usE: Repair Owner: Address: Contractor Type Contractor OWNER C.ORI FITZGERALD PO BOX 71022 EUGENE OR 9740r_0148 Residential PhoneNumber: 54l_736_7436 License Expiration Date phone REQUIRED PARKING Total: Handicapped: Compact: # of Units: Primary Occupancy Group: R_3 Secondary Occupancy Group: Primary Construction Type Vly Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o ofLot Coverage: rilv N $ Per Sq Ft or multiplier Square Footage or Bid Amount Yaluation Descrintion Description TYPe of Construction Pase 1 of2 Value Date Calculated [Tr I Building/Combination permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Fee Description + llyo Administrative Fee + 7%o State Surcharge Sanitary Sewer - lst 50 Feet Sanitary Sewer Each Addfl 100, Total Amount paid PERMIT NO: ISSUED: APPLIED: EXPIRES: VALUE: coM2005-01687 12t05t2005 12t05t2005 06t05/2006 To Request an inspection call the 24will be made the same working day, day. hour recording at 726-3769, All inspections requested after 7:00 Sanitary sewer Line: prior to firing trench and incruding required testing. IZ Amount Paid $s.90 $4.13 $4s.00 $14.00 $69.03 Total Value of project Date Paid t2t5t0s t2/5t05 t2tst05 12t5t0s Receipt Number 2200s000000000016s7 22005000000000016s7 220050000000000r657 2200s0000000000r6s7 linspection requested a.m. will be made the before 7:00 a.m. following work Owner or Contractors Pase 2 of 2 Date Construction Contractors Board Permit #:Cc>Placrof- O/ 6& 7 Address: lz>l 3 tl+L 5l Issued by:\<Date: lZ - -S -O f 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 70L010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: Q'r. ffz I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the strucfure is sold or offered for sale before or on completion. tr 3,A.. My general contractor is (Name)(ccB #) I will insfirrct my general conhactor that all subcontractors who work on the stnrcture must be licensed with the Construction Confractors Board. i-z oR -Xl 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. IS (Signature of :),) QYhrte copy to issuing agency pennitfile, pink copy to applicont.) Property_owner.doc 06-0 I -04 700 Summer St IYE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us t General c]otr*ctor?Acting as Your Own General ( INFORMATION NOTICE TO PROPERTY OWNCNS ABSUT CONSTRUCTION RESPONSIBILITIES t Ifyou are existing skucture, SmPloYer ResPonsibilities you-will, in most instanoes, be ruled to be an "employsr" and the sontractors you contract with witl bp "employees" if I you uso contractors ,ot ti".*"d with the construction conEactors Boardlo do labor in constructing or tq ap;i;t in the constr*crion or improvrment of a residential structure. As the employer, you must cSmply with the forlowing: oregon,s withholding Tax Law: As an employer,'you must withhold income taxes from employee wages at the time "*pioy**, are paid. fou will be liable for the tax-payments evsn if you don't actualty withlold the tax from lour- employees" For more information, call theiSifime;t of Revenue at 503-3?84938' I ' :i : Unemployment Insurance Tax: As an employer, you are required to pay a tax for rmenrployrnent insurence purpos€-\ on the wages of all employees. For rnore information, call the oregon Employment Department at 503-947-1488. t.- The Oregon Business Identification Number (BrhI) is a combined nurnber for,bo{&'Oregon'\Mithbolding a1d\ Unemployment Insurance Tax. To file for a BIN, cali 503-945-8091 or www.dor.state.or,us/fogrlspay,hhnll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation instrance for yogr employees. If you fail to obtain workers' compensation insurance, you could be subjeci to penalties and be liable for all claim costs if one of your employees is inj911d on the job. For more information, call the Workers' Compensation Division at the Depahment of Consumer and Business Services at 503-947 -7 815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax Aotn empldyees' *g"q. "- you will be liable for the tax payment even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their web site at $uu.JIsgav- Other Responsibitities and Areas of Cancerils Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requlre{nents that may be brought'to your attention through inspections Liability and property Damage fnsurance: Conthct your insurance agent'to see if you have adequate insuzdie aor.rug" for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire cr work that must be redone. Time: lvlake sure you have sufficient time to supervise your employees. '; i 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 notify building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at PO Box 14140, Salem, OR 97309-5052. ,i-r; I i..,. Property_owner.doc 06-0 I -04 NorE: This f nfarmation Natico to propefiy awners about Constructio'n Responsibitities was developed by the canstruction cantractars Board in accordance with oRS 7a1.055(5), passed by the 1989 oregan Legislature' | ,, 225 Fifth Street Springfield, Oregon 97477 541-726-3759 phone ^tty of Springfield Oflicial Receipt.-evelopment Services Department Public Works Department RECEIPT #:2200s000000000016s7 Date: 1210512005 t0:10:t3AMJob/Journal Number coM2005-01687 coM2005_01687 coM2005-01687 . coM2005_01687 Description Sanitary Sewer - lst 50 Feet Sanitary Sewer Each Addtl 100' + 7Yo State Surcharge + l0% Administrative Fee Amount Due 45.00 14.00 4.13 5.90 Type ofPayment Paid By CORI CORU FITZGERALD Description Sanitary Sewer - lst 50 Feet Sanitary Sewer Each Addtl 100' + 7Yo State Surcharge + l0o/o Administrative Fee Item Total:$69.03 By Batch Number Number How Received Amount paid In Person Received Cash Change Job/Journal Number coM200s-01687 boMzoos-oroaz coM2005-01687 . c-oM2005_01687 djb djb In Person Payment Total: $80.00 ($ 10.e7)-T6mr Amount Due 45.00 14.00 4.t3 s.90Item Total:$69.03 Type ofPayment NumbefPaid By Cash Change CORI FITZGERALD CORU FITZGERALD Received By Batch Number Number How Received Amount paid djb djb $80.00In Person In Person Payment Total: ($ r0.97) $69.03 q ;( i jt ;; pl 'iirr 121512005 Page 1 of 1 tPrtltrtotrlro ., I I t-