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Home My WebLink AboutPermit Plumbing 2004-12-21 . 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line ~~ r ~ . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00507 ISSUED: 12/21/2004 . APPLIED:. 04/30/2004 EXPIRES: 06/21/2005 VALUE: -. Status Issued SITE ADDRESS: 4866 MAIN ST ASSESSOR'S PARCEL NO.: 1702324100300 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Sanitary sewer hookup and septic removal. Owner: VAUGHNTERIL Address: 4866 MAIN ST SPRINGFIELD OR 97478 Contractor Type Plumbing Contractor OWNER . t~_,nTlrc. . I CONTRA'C:'TOR1N.FORM,A;rmnl1'IRE IF THE WORK.;, r,l,'J .! I IDER -THIS PERMIT IS NOT AUTHORIZED L\l'1censeBANrEN~i[/lt\9.i) Date COMMENCED UK ,<> /'I uv ~ _... ......-.....nn BUILD1N8:~JidiWAh~)N f~" Phone # 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 Patb: Sprinkled Building: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: n/a , DEVICLvmlENT INFORMATION I REQUIRED PARKING Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: ~_t;'!!!!Pact: to % of Lot Cover~ON: Olagon- nIqUIRID~r .' fotlOW'NIeS,J",'J:.JbytheOregonUti~ - ~ ...__...dGeOrA.At~a:. I PUBLIC IMPROVEijitf4~~1~O'itirough 0AR952~i- . . 0090. You nllSI~",ilOR.I!l8 of the ruleS by :.. " 'calllngthetw;~~=~= numberfC!f OVl~:""~\~~ eenterI81~' ',-, Street Improvements: Storm Sewer Available: Special Instruction: Notes: I Valuation DescriDtion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amouni Value Date Calculated Total Value of Project Paee I on Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Pbone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 10% Administrative Fee + 10% Administrative Fee + 7% State Surcharge + 7% State Surcharge In Lieu of Assessment 151+ Sanitary or Storm Sewer Cap Sanitary Sewer - 1st 50 Feet Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement Sanitary Sewer Each Addtll 00' SDC Sanitary/Storm Admin Total Amount Paid . . CITY OF ~rKll~GFIELD Building/Combination Permit PERMIT NO: COM2004-00507 ISSUED: 12/21/2004 APPLIED: 04/30/2004 EXPIRES: 06/21/2005 VALUE: L.Fpp.s P3irlJ Amount Paid Date Paid Receipt Number 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 2200400000000001537 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. $4.50 $7.30 $3.15 $5.11 $6,507.32 $45.00 $45.00 $493.56 $649.08 $28.00 $57.13 12/21/04 12/21/04 12/21104 12/21/04 12/21104 12/211041. . 12/21104 ',. 12/21/04 12/21/04 12/21104 12/21/04 Sanitary Sewer Line: Prior to lilling trench and including required testing, Septic Tank Pumped: After septic tank has been pumped and filled. Please provide the inspector with receipt and verification from company performing pump and fill. $7,845.15 I Plan Reviews I I Rp.llUirerllnsnpdions I 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 tbe State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of tbe 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. ~M'_'xLJj')~ Ow~er or Contracto~ Signature Date j ,5..- ::7/--cJ <j. , Paee 2 of2 - I i \ .I ", " " " . - 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.nr.us Issued by: ')::.~ Date: t2.-z./-0Y . Pennil#': Co...-, '2..0_- 00 5'07 Address: LJ gbb yY14/N 'S, 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 befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: 18r1. W2. 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. If! 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. '"4.2 <-.7e:;J( !d-,a-I-o-l - (s{gnature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 Adnrrng fnl~ '(OHUlIf ((J)wrrn cGerrnell"fnlll ~lIDltll"fnl~lt@ll"? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES .. . "l_ \ 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. IEmjplloyer lRe!ijpollD.!iftlbillRtie!i 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 foDowing: Oregon's Withholding 'fax 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/formsnav.htmll. for the a""._".:ate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' C_u.,,~..sation 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 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 www.irs.l!ov. Otlluu Resfi}oIrnsJilbJillJitJies alIrntdl All"eals olT COllliCell"IrnS 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 coordinatc 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, Oregon 97477 541-726-3759 Phone . G~!., ~, ~ .JIL.ty of Springfield Official Receipt .elopment Services Department Public Works Department . , Job/Journal Number COM2004-00507 COM2004-00507 COM2004-00507 COM2004-00507 COM2004-00507 COM2004-00507 COM2004-00507 COM2004.00507 COM2004.00507 COM2004-00507 COM2004-00507 RECEIPT #: 2200400000000001537 Date: 12/21/2004 Description Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each AddtllOO' + 7% State Surcharge + 10% Administrative Fee + 7% State Surcharge + 10% Administrative Fee Sanitary or Stonn Sewer Cap Sanitary Sewer. Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Stann Admin In Lieu of Assessment 151+ Payments: Type of Payment Paid By Item Total: Check Number Authorization Received By Batch Number Number How Received Check 12/21/2004 STEPHAN JOKINEN djb 628 In Person Payment Total: Page I of I 10:16:23AM Amount Due 45.00 28.00 5.11 7.30 3.15 4.50 45.00 649.08 493.56 57.13 6,507.32 $7,845.15 Amount Paid $7,845.15 $7,845.15 l7-tS.2-:,:L-'11 ~ Fi f-I . ..,e,/..~ li.......u. '1.:"'il~1 V1 r---' ...' 1 i' ~ ,l l-'\~-- -. . i:5 I ". :,.., --f:-r'-<iS" -'~ -~ .. ~. .(,r/~t,-. Q" . 1:' ~O.; 'J'o I '--.fl G'I I' . 'I ro..(l 2' 6 ... {t' ..' r , , :~~>~ <<;1' ,: I . ./ .::." \ " . /," . ' _ . (., ,,,.,' P.,.~-t. II" . . .~~.j~ ~ ,-~-'~ Iii" ..:..:.'\(~";L~.~ ..__I~~I--,I! , .. I - I I ,. I ' ,._ ~o.,~ .' 1 ~..,~o c.~ ,;, " L,~. I 1 _~-= or.I..3 _H.,:"..",.l.. I I .." /af" .,.' . · ':1 016.';. " 12'5' .,.~,,~. ! "t~.. k. 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