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Home My WebLink AboutPermit Miscellaneous 2005-12-15 . . CITY 0.. ~rRINGFIELD Building/Combination Permit PERMIT NO: COM2005-01737 ISSUED: 12/15/2005 APPLIED: 12/15/2005 EXPIRES: 06/28/2006 VALUE: $ 300.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 404 MANSFIELD ST ASSESSOR'S PARCEL NO.: 1703233406000 Springfield TYPE OF Single Family Residence TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Replace window header at rear dormer Owner: COY CHUCK A Address: 404 MANSFIELD ST SPRINGFIELD OR 97477 Phone Number: 541-514-2220 Contractor Type General Electrical ,~I~IQ\'I" I CONTRACTOR lN19~1l'O~ IO'i Q1\\'\>>. S\\p..\.l. LI. ~~\\.W / .- Contractor ~ ?~\\,,^\1 ~\)~\\ i\\\S ~~\\ BILL KRPALEM~~\\O\\\t~~OUO\\ \S f>.~f\~\) 167490 OWNER _ ~,~""f.~C~:,; ,..:11\00. \I~I~rrmMNG lNFORMA nONI Expiration Date 12/02/2007 Phone 514-2220 VB # of Stories: Height of Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Lot Size: Sq Ft Ist Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: # of Units: Primary Occupancy Group: Secondary Occupancy Yrimary Construction Type Secondary Construction # of Bedrooms: R-3 nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Setback: Side 1 Sethack: Side 2 Setback: Rearyard Setback: Solar Setbacks: Total: HandIcapped: Compact: ou\O eo,uiles'l \,\\\X\\'1 \<:l'oN 1 _ .",nOt' tnt\"(\ IPUBLIC IMPROVEMENTS' ole~:d'o'l \\'I~u~~s '3-113 ~~i-oO\- '1"\ t:-,. '3-00? ...",ose (\1'-\'1 \eS '0'1 1'-' ... \U1eS ,,\E,~iaewaik\.Type: 'ne lU 13 \ \\0" ee,' \0 \\'1' v . <; 0' ' "'01' o .' '3-\\01' \-nbw -ut~abise?" '01' ~O\\\I\\ 95'2.-00 o'ow~POo\l3~.\\!i!! ~o\\\iC'3-\\ il' Of>' 'lOu (1'1'3-'1 131'\13\. \~ 1'\,\\\1\\'1 AA). 0090. , \\'113 C 0\1390 ?,?,'2.-'2.'3 C"clII\1'9 \01 \\'113 . \-'000- ",,'0131 '131 IS I'u'" eel" Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: Street Storm Sewer Available: Special Instruction: Notes: 1 of 3 . . CITY OF SPRINGFIELD Building/Combination PerOOf PERMIT NO: COM2005-01737 ISSUED: 12/1512005 APPLIED: 12/15/2005 EXPIRES: 06/28/2006 VALUE: $ 300.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descriotion I Description Tvpe of Construction Bid Amount Use Bid Amount S Per Sq Ft or multip6er S1.00 Square Footage or Bid Amount 300.00 Value Date Calculated Total Value of Project S300.00 S300.00 12/15/2005 Fees Paid I - " . Fee Description + 10% Administrative Fee + 7% State Surcharge Building Permit + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ . Minimum/Adjustment Electrical Amount Paid Date Paid Receipt Number $4.50 $3.15 $45.00 $4.50 $3.15 $43.00 $2.00 12115/05 12115/05 12/15/05 12129/05 12/29/05 12129/05 12/29/05 2200500000000001706 2200500000000001706 2200500000000001706 1200500000000001869 1200500000000001869 1200500000000001869 1200500000000001869 Total Amount $105.30 I Plan Reviews I . To Request an inspection caD the 24 hour recording at 726-3769. AIl inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. wiD be made the following work day. FramIng Inspection: Prior to cover and after all rough in inspections have been approved. Final Building: After all required inspections have been requested and approved and the building is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. " ,. . 2 of 3 . . CITYul' :srRu~unl~,LD Building/Combination Permit PERMIT NO: COM2005-01737 ISSUED: 12/15/2005 APPLIED: 12/15/2005 EXPIRES: 06/28/2006 VALUE: $ 300.00 Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line By signature, I state and agree, that 1 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 wiD be made of any structure without permission ofthe Community Services DIvision, Building Safety. 1 further certify that only contractors and employees who are in compliance with ORS 701.005 will be used .~. on this pro' t. I _ I Jiu't er. gree to ensure that all r uired inspections are requested at the proper time, that each address is readable from /fhe st t, th.:tzermit car . located at the front of the property, and the approved set of plans wiD remain on the site / at~ ;:dU;construc o~ - 0~~ L )6wner or Contracto;:S Date ! r - 3 of 3 . . . . Permit #: CO/lJl\ z.o~'- 0 17'37 Address: l./Ol{ W1AN'S Frf=-z..~ <;.I Issued by: De Date: /2 - Z. '7 - c r- -. . . \, l '. " ". ." . .' Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the folloWing statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the <>P'''''p.;ate blanks and initial boxes I and 2, and either box 3A or 3B: ~l. 1'8:' 2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. D 3A. My general contractor is (Name) (CCB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR ~ 3B. I will be my own general contractor. IfI 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 notify the office issuing this building permit of the n ejOf the contractor. , rtify that the above in~ ation is correct and that I have read and do understand the Information "'P?lc~" 'C ,"""',' ...","",IIiOK" ,... ~~.;:;~ r'~ ~ (Sign~permit a plicant) I ~ - ~ ~ (White CODY to . suing agency permit file, pink copy to applicant.) PropertLowner.doc 06-01-04 . . . Acttnrril~~r a~'1( @1lllJl""Owrrn GerrnteJl"~n.<Cl!J)rrnttJl"~cttl!J)Jl"? ! J' -' . INF~RI\1iATI(jN-NOTICE TO PROPERTY OWNERS / ') ) 'S .' ~Q!,l! CON~TRUC"!lpN RESPONSIBILITIES .., .. ., NOTE: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon 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. JEmlPnoyer RespoJl]silbilities ., You will, in most in.stances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board 10 do labor in constructing or to assist in the construction or improvement of a re~idential structure. As the e~ployer, you must comply wit.h tbe following: Oregon's Witllboiding Tn 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 Department of Revenue at 503-378-4988. ". Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purpose~. on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. ~., The Oregon Business Identification Number (BIN) is a combined number for both. Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation 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 federa1.income tax from employees' wage;:---- 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 W\"w.irs.l!Ov. Other lResjponsibJilitnes amll Ar.eas of Concem~ 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 Insurance: Contact your insurance agent to see 'if you have adequate insW'3J]ce coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire:; or work that must be Tedone. . . , , -- , , ~~. Time: Make sure you have sufficient time to supervise your employees.. . :,'. '. . - . . . Expertise: Make sure you have the skills to act as yoUr own 'genera1 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 (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. . . ~~ , r. ~t'-. ~/_ owner.doc 06-01-04 . 225 Fifth Street SpririgfieId, Oregon 97477 541-726-3759 Phone "!'~lIII!!!F'!IiL.'!' ...._' .' u..., ~.: ,jjj.ty of Springfield Official Receipt .veIopment Services Department Public Works Department Job/Journal Number COM2005-01737 COM2005-01737 CpM2005-01737 CpM2005-01737 P~yments: T)pe of Payment Cash Change Job/Journal Number COM2005-01737 COM2005-01737 COM2005-0 1737 COM2005-01737 . Payments: Type of Payment Cr.sh .,. C;range ':I' ) ) . , {~ :1 '" 'a' 'j: .1 12/29/2005 f.t. RECEIPT #: 1200500000000001869 Date: 12/29/2005 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Paid By CHARLES COY CHARLES COY Received By djb djb Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Minimum/Adjustment Electrical Paid By CHARLES COY CHARLES COY Received By djb djb 1 of 1 Item Total: l;hecK Number AuUlOTizatlon Batch Number Number How Received In Person In Person Payment Total: Item Total: l;hecK Number AuUlorization Batch Number Number How Received In Person In Person Payment Total: 1:47:32PM Amoont Due 3.15 . 4.50 43.00 2.00 $52.65 Amount Paid $53.00 ($0.35) $52.65 Amoo nt Due 3.15 4.50 43.00 2.00 $52.65 Amount Paid $53.00 ($0.35) $52.65