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Home My WebLink AboutPermit Plumbing 2004-04-13Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Ftx 541 -7 26-37 69 Inspection Line PERMIT NO: COM2004-00413ISSUED: 0411312004APPLIEDz 0411312004EXPIRES: 10/1312004 YALUE: SITE ADDRESS: 285 S 37TH ST ASSESSORTS PARCEL NO.: 1702314207800 PROJECT DESCRJPTION: Replace 50lf sanitary sewer Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New Residential Owner: ALMEIDA GRACE BIRD Address: 3716 OREGON AVE SPRINGFIELD OR 97478 Contractor Tvpe Plumbing Contractor TRENCHLESS PIPE SERVICES INC License 155663 Expiration Date 051281200s Phone 541-741-1744 CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: R-3 SETBACKS Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: %o ofLot Coverage: you to A loti follow rule {ication s adopted Certe r. Th by the ose ru e set IN OAR 0090. Yo calling 952-00 u may the cente 1-oo obtain lQthrough r.(l ioP'tes of tn" rules I Note: the telePhone Utility Notilication Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: VN $ Per Sq Ft or multiplier Square Footage or Bid Amount ARI(ING Total Value of Project Pase I of2 Description Type of Construction Value Date Calculated [L DUrt-Lrt1\u lI\r(Jt(1vfAr rrJr.r I Overlay # Street EXPIRE IF UNDER THIS OR IS Paved Drive SO DAY PEBIOO.Handicapped: Compact: 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 PERMIT NO: COM2004-00413ISSUED: 0411312004APPLIED: 0411312004EXPIRES: 10/1312004 VALUE: tr'ees Pe Fee Description + l0Yo Administrative Fee + 7oh State Surcharge Sanitary Sewer - lst 50 Feet Total Amount Paid Amount Paid $4.50 $3.1s $4s.00 $52.65 Date Paid 4n3t04 4n3104 4n3t04 Receipt Number 1200400000000000470 1200400000000000470 1200400000000000470 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. leouired fnsnections 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 70f .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. '7A' 7uJ4'' ic'.. Gt'ftr-c' pgeuer'5' /- tl -{z / oron". { Contractor#gnatrre Date Pase2 of2 T Construction Contractors Board permit #: (OW Z-O- I -OC) L4 I 3 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Address: 28 5 S . j7 th. S r. r insfl e ld Issued by:bG Date:0 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, exempt from licensing under ORS 701.010(7), need not submit thts 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 Xr. ffz I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction conhactor if the strucfure is sold or offered for sale before or on completion. 3A. MygeneralcontractoriS Trerchless Pipe Servicesr Inc. (Name) 1 \q66" (ccB #) I will instruct my general conffactor that all subconfiactors who work on the strrcture must be licensed with the Construction Contractors Board. OR n 3B. I will be myown 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. L;ru* */,El^4 -f 3/o/ (Signature of permit applicant) @ate) (llthite copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 03/l 1/03 Acting as Your Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Noffj This tnformation Natice to Propefty Owners about Construction Responsibitities was develaped by the Construction Contractats Board in accordance with ARS 7A1.055{5}, passed by the 1989 Aregan legisfafure. If you are acting as your own contractor to conskuct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being arvare of the following responsibilities and concems. 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 conffactors not licensed with the Construction 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 thc following: Oregon's Withholding Tax Larv: As an employer, you must wrthhold rncome taxes from employee waSS 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 empioyees. For a State Business II) number, call the Business Informatron Center at 503-986-2200.,l\ Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpocgs on the wages of all employees. For more information, call the Oregon Employmant Department at 503-947-1488. \ lYorkers' Compensation fnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtaln workers' compensation insurance for yogr empioyees. If you fail to obtain workers' compensatioir., insurance, you.could be subject to penalties and be liable for 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 503-947-7815. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax paymant even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and Property Damage fnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accideirts and omissions such as falling tools, paint over spray, water damage f,rom pipe punctures, fire or work that must be redone. Time: Make sure you ilurr* sufficient time to supervise your employees" Expertise: Make sure you have the skills to act as your own general conffactor, to coordinate the work of rough-in and finish kades, and to notifu building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Canstruction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Properfy_orvner.doc 03/ I I 103 225 Fifth Street Springlield, Oregon 97477 541-726-3759 Phone crty of Springfield Oflicial Receipt _ .velopment Services Department Public Works Department RECEIPT #: 1200400000000000470 Date: 0411312004 10:59:26AM '" Job/Journal Number coM2004-00413 coM2004-00413 coM2004-00413 Description + 1oh State Surcharge + l0% Administrative Fee Sanitary Sewer - lst 50 Feet Amount Due 3.15 4.50 45.00 Item Total:$s2.6s Payments: Type ofPayment Paid By Uhecl(Number Authorization Received By Batch Number Number How Received Amount Paid Check GRACE ALMEIDA djb 2048 In Person Payment Total:$s2.65 $s2.65 rs 411312004 Page t of 1 *pBrucltSt-o