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Home My WebLink AboutPermit Miscellaneous 2005-10-3 . Status: Issued 225 Fiftb Street, Springfield, OR 541-726-3753 Phone , 541-726-3676 Fax 541-726-3769 Inspection Line . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM200S-01349 ISSUED: 10/03/200S APPLIED: 10/03/200S EXPIRES: 04/03/2006 VALUE: SITE ADDRESS: 6117 MAIN ST ASSESSOR'S PARCEL NO.: 1702343400400 Springfield TYPE OF Single Family Residence TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace water line Owner: Address: MORRISK PO BOX 10074 EUGENE OR 97440 Contractor Type Plumbing Contractor OWNER .' # of Units: Primary Occupancy Group: Secondary Occupancy P"rimary Construction Type Secondary Construction # of Bedrooms: Fron tyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: Notes: Description Tvpe of Construction 'CONTRACTOR INFORMATION I License Expiration Date Phone , BUILDING INFORMA nONI R-3 # of Stories: Height of Type of Heat: Water Type: Range Type: Energy Patb: Sprinkled nla Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Paved Drive Rqd: % of Lot Coverage: IPUBLIC IMPKvv l!,!vfENTSI Sidewalk Type: DownspoutslDrains I Valuation Descrintion I $ PerSq Ft or multiplier Square Footage or Bid Amount Value Date Calculated 1 of 2 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM200S-0l349 ISSUED: 10/03/200S APPLIED: 10/03/200S EXPIRES: 04/03/2006 VALUE: Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project F~~s Paid I . Fee Description + 10% Administrative Fee ~ + 7% State Surcharge Water Line - 1st 50 Feet Amount Paid Date Paid $4.50 $3.15 $45.00 1013/05 10/3/05 1013/05 Receipt Number 1200500000000001442 1200500000000001442 1200500000000001442 Total Amount $52.65 I Plan Reviews , To Request an inspection call the 24 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 trencb 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 wiD 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 ofthe property, and the approved set of plans wiD remain on the site at all times during constructiolL I 1/ ~~/., /k/17/Y~ /t)/3/oS'- Owner or Contractors Signature Date 2 of 2 e\ ) '. " '. " . .. ~ ' . 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 Pennit#: C~~5 - 0/3'.tf7 Address:--4:>//7 ~h./A) W/ Issued by: /~~_. - Date:/O/?.i15 . f' JY -:; ff/J/)f / I 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: %1. ;e:g 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. o 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. 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 notify 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 ofthis form. .Y! r J11M/u;'~ /oi3105" (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 . Adlillng ..tai~'1t'1intr OW-JIll <GteJIlltell"~n CC!.1l:Il"~(C1l:@Il"'l '. . . ~ , f - .. " \. . . " '., 'INFORMATION NOTICE TO PROPERTY OWNERS .. .AB()U-i CQN~TRUCTION 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. Emplloyer lRe~polIll.~nbmtfie~ You will, in most instances, 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 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 following: Oregon's Withholding 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 Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes': 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/formsoav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cvwl',..sation 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 federal income tax from employees' wages. 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\vw.irs.l!Ov. OUneIr IResjplolIllsiiibliillitiies amll Area~ of COlIlcerlIllS 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 insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. ' \ . -- , . Time: Make sure you have sufficient time to supervise your employees. - . 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 (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property_ owner.doc 06-01-04 225 Fifth Street Springfield, bregon 97477 S4l-726-37S9 Phone " Job/Joomal Number COM2005-01349 COM2005-0 1349 COM2005-0 1349 Payments: Tl1le of Payment Cash i ~l : - 10/312005 . RECEIPT #: 8!'~"~~~~-T_"':''''''_____.. 1Iit' ' i.'. -". j .....ity of Springfield Official Receipt .evelopment Services Department Public Works Department 1200S0000000000l442 Date: 10/03/2005 Descrlplloa Water Line - 1st 50 Feet + 7% Slate Surcharge + 10% Administrative Fee Paid By K MORRIS Received By dim I of I lIem Total: l:beck Number Autbortzation Balch Number Number How Received In Person Payment Total: 11:49:14AM Amoo nt Due 45.00 3.15 4.50 $52.65 Amount Paid $52.65 $52.65