HomeMy WebLinkAboutPermit Building 2009-8-19
CITY OF SPRINGNELD
Building/Combination Permit
PERMIT NO: COM2009-01137
ISSUED: 08/1912009
APPLIED: 08/0512009
EXPIRES: 02/1912010
VALUE: $ 40,000,00
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1223 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO.: 1703264415000
Springlield TYPE OF WORK: Single Family Residence
TYPE OF USE:
PROJECT DESCRIPTION: Kitchen, Bath, and,Laundn:,Additionquires you to
ATTEN lIUI~: 'J"'~V" ,~.. ,-' urn
. ,,___ _,.I~. o~nn\prl bv the Oregon II y,
Owner: BOLT DAVID L & JANE;';;'iification coe~t~~'1 ~~~~~~~~e~;~~ ;;2-001:
Address: 1223 CENTENNIAL BLVD OAR 952-0 - , 'es of the rules by
O 9 90 Y U may obtain COpl
SPRINGFIELD R 747,70__,;,~~ .100 ~pnler. {Note: the telephone
- r~r fnr the Oreqon Ul\lILY l'JU~1l1V~HI'-'"
num I eONTffi,\,GTt(i)R'INF(i)RMATION .
Contractor Type
Contractor
License
BUILDING INFORMA nON I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
R-3 Height of Structure
NOTICE: !y-p.~RrH~~' RE IF THE WORK
Vil!lIS PERM\",:~!~r'!m: PI PERMIT IS NOT
AUTHOR IZElFangflTypeJ-l1 S
COMMENCE.IE,n~}\:!?a~ii':~N?ONED FOR
Y 180 D,SprmkledrRulldmg: No
AN t'\l r L-1IlVU':'
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
30.00
44.00
0,00
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction: Stormwater to tie into existing system
Additiou
Residential
Phone Number: 541-746-6786
Expiration Date Phone
Lot Size: 6,534
Sq Ftlst Floor: 176
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupaut Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
23.50
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuation Descriotion I
Description
$ Per Sq Ft
o~ multiplier
Square Footage
or Bid Amouut
Type of-Construction
Pa!!e I of 3
Value
Date Calculated
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Bid Amonnt
$1.00
40,000,00
Use Bid Amount
Total Value of Project
Fpp" P~irlJ
Fee Description
Plan Review Residential
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliauce
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Buildiug Permit
Exhaust Hoods
Fire SF Fee - Residential
Fixture
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC Sanitary/Storm Admin
Storm Drainage Impervious Area
Amount Paid
Date Paid
$254,83
$80.41'
$33,50
$79,00
$55,00
$36,00
$392,05
$13.00
$8,80
$95,00
$22,05
$28,99
$5,42
$57.43
8/5/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
8/19/09
Total Amount Paid
$1,161.48
I Plan Reviews I
Initial Review
08/05/2009
08/1012009
.APP LLH
Plannin!! Review
08/10/2009
08/1112009
APP DDK
Public Works Review
08/10/2009
08/12/2009
APP LKW
Structural Review
APP CJC
08/10/2009
08/18/2009
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01137
ISSUED: 08/19/2009
APPLIED: ' 08/05/2009
EXPIRES: 02/1912010
VALUE: $ 40,000.00
$40,000.00
$40,000,00
08/1 012009
Receipt Number
2200900000000000883
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
3200900000000000592
No Planning Issues,
Stormwater to tie into existing
system
As noted on plans
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
Rp(ll~~,n~ttjow
Footing: After trenches are excavated,
Foundation: After forms are erected but prior to concrete placeme~t,
Post and Beam: Prior to 1100r insulation or decking.
Floor Insulation: Prior to decking:
Pa!!e 2 of3
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CITY OF SPRINGFIELD
Status
Iss u ed
Building/Combination Permit
PERMIT NO: COM2009-01137
ISSUED: 08/1912009
APPLIED: 08/05/2009
EXPIRES: 02/1912010
VALUE: $ 40,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Shear Wall Nailing: Before covering sheathing with finish materials,
Framing Inspection: Prior to cover and after all rongh in inspections have been approved..
il .
Wall Insulation: Prior to cover,
Ceiling Insulation: Prior to cover,
Final Building: After(all required inspections have been requested and approved and the building is complete,
Undertloor Plumbing:, Prior to insulation or decking,
Undertloor Drain: Prior to cover or placement of concrete,
Rough Plumbing:, Prior to cover and including req~ired testing,
Final Plumbing: Wheh all plumbing work is complete,
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete,
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Rough Electric: Prio~1 to Cover
Final Electric: When 'all electrical work is complete,
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By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true arid correct, and I further certify that any and all work performed shall be done in accordance with
the Ordin~nces of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will ~e made of any str~cture without permission of the Community Services Division, Building Safety,
I further certify that only co~tractors and employees who are in compliance with ORS 701.005 will be used 011 this project.
I further agree to ensure that all required illspectiolls are requested at the proper time, ,that each address is readable from the
stn;et, that the permit card i~:located at the front of the property, alld the approved set of pia liS will remain 011 the site at all
times during construction. '
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Owner or Contractors Sigllature
Date
Page 3 of 3
:i
Electrical PermWApplication
225 Fifth Streett Springfield, OR 97477tPH(541)726,3753+FAX(541)726-3689
SPRINGFIELD" -
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Permit no, ( V..-- /1.3 '7 I
I Date: tf" r /9 ~ () 9
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is ~uspended for 180 days. '
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?i\itoCAL::,GOVERNMEN:r''f'AP,I''.ROVA[!}{~V'''i!~'?!Jj;~).i'';,1 1~'iift.'jt\f,jiT~~~~!'.j'(~0'!;I'EE~SC::HED,CJJ]E:~1&1j;~ii;!,~~'6i.~~iJ!1!jl
I Zoning approval verified? 0 Yes 0 No I 1':N~.nib~1;~'i"ini~Jii~:~;r~jjr'ii~':;~(,J;',f'IQiy,1 ':P)~tt,1 ::Total':!
r~ ~l~~i",~i~i~ ~ CAtEGORy;"~'OFiJfCONS1:RUCmION~~:;f,~~';.;;l<:\'\ ':ll ,'.' '.'q;'~"~'~~;i.___;_-~'''';>.:;-/'~:'<'':'O:;-T;.,-~:'i,','':- ",Ie" ""JY,,'_,^.: ;',,,-'..-, I -Al,\,~~;':"l,
'1.: ,~p_s_t:~i<'
~. 'd" I' I 0'0 I 0 C ," 1 I Residential, per umt, service included: I .
eSI entia ovemment ommerclal
i!-~~f.!l_OB~SIT:E',lINIiORMA'llONI?AND!JIEO.CA'liION~tlifff,~JI 11,000 sq ft or less (4) $134,00 $ 1
I - -t- ,I V Each additional 500 sq ft ar partlOn I
Job site address I J. A. 'I C e?(f e "h"?"q f i1(tl1d1 thereof $ 25,00 $
I City:::7? /' / d I'State: ?? J( I ZIP: r 77"7A 1 Limited energy (2) $ 32,00 $ I
I Referenc~'/~ H 'tto~loL I I Ea~h ~anufa~tured home or modular $63.00 $ I
I'''', '.', " DESC InTION OF"WORK"""",. ,",,'>,' ~ , ,,. dwellmg service ar feeder (2)
. ",", r, I' '-'i"'" < , ~" 'fJ1iVho',<
1e\L \-\'i'hon ~. '...:;; -<,,, \ " \., I Services or feeders: installation, alteration, relocation I
II~ I I I 200 amps ar less (2) $ 81,00 $ 1
I ' ;PROp,ERTYOWNER:';,:" " , ." I I 201 to 400 amps (2) $ 95,00 $ I
I Name: D4f./J-.J ~::r;,??,..73~/t- I 1401 to 600 amps (2) $158,00 $ I
I Address' fA -" 7. -' -+- - / ,=/iv / I I 601 ta 1,000 amps (2) $205,00 $ I
, '- -f, 'l "- e'H/,~ 7t' ~f <? ]7 cY
I City: c;- plfl d I State: 0 jQ I ZIP: "1?7<?71 ] Over 1,000 amps ar volts (2) $489,00 $ I
I Phone:".?? 7""c' 6 7 c;r Z I Fax: I I Reconnect anly (2) $ 63,00 $ I
I E-mail: . I I Temporary services or feeders: installation, alteration, relocation I
This installation is being made ,'on residential or farm property I 200 a1!'I'i'Tfr~E2) - - E \ ' h~!!,qplr ,p,jl( I
owned bJ: me 0; a member ofIT)Y immediate family, This I 201 ta ~f'l!1I"1!~MIT SHAll t}\l" ;' ,$ ;ll7,1l0 t '0>1 I
property IS not ,Intended for sale, exchange, lease, or rent OAR I . lED UNUttl Tfll J PEe ',:.1. .., I I
479,540(1) a~9,560(l), h 401 ta 6tlQJllj'~m, _ ~ '" ;;sA W0 ,II$~~~.IDR $
Sigtiature, _,Ik~ li~ "~ I Over 60€@IMME~~0~fr~\~'6',vices ar feeders sectian above I
1';,CONTRACT:ORdNSTAl:lAifION,' , :' " ,:,,' I Branch AN'iI,tV:l'!!'JJli'tleration, exlension per panel I
1 Bu~ss name: 1: I I a. Fee for branch circuits with purchase of a service ?r feeder fee: I
I Addres~ ./ I I Each branch circuit 1 I $ 6.00 I $ I
I City: ~ I State: ~ ZIP: I b, Fee for branch circuits without purchase of a service or feeder fee: I
I Phone: ............ ~x: I First branch circuit (2) " I $ 55,00 $ I
I E-n:tail: ~ii I I Each additional branch circuit t' I $ 6.00 $ I
, CCB license g.o/ ri'-gfD license no,: I I Miscellaneous fees: service or feeder not included I
I Sign~ervisor's license no';: .__...;.~~'.. _ .' .1 I Each pump or irrigation circle (2) $ 63.00 $ I
I pr;;: f" . Ion, I LI~ III"..~ UIG~UII I(AVV 1,",'-1LHI'e~1 ~E1h6Tfi'gn or outline lighting (2) $ 63.00 $ I
nnt name 0 slgnmg superV1S~rd]()\IV f.tllp~ ~'")ntprl h" fhp. Or~ gc :-: '_'~:~::~' ','
I Signature of signing supervisot:!otiJication Cent~ Those rul"s JifE sSigryill:\'ircuit ar a limited-energy panel; $ 63,00 $ I
' _ ,_ _ __" _~. ~_. _~.' .... r" )alteratlOll, or extensIOn (2)
III \....rul vvr...-vv I -vv I V \111 UU.,i" '.J:-,tJ q J_'''' ,-
0090, You may ot'\ain cn,~;:2 0: ':1' IEacha~d,ditianal inspectian; (I) $58,00 $ I
calljtjr. ti1e C8~n!:f. {;.. -:, l. -. +: "1~~~;t~~,~~1 (~;~1ii'~AR~l1iC'1{NT~1"uS~E~Wi.~:,:~ry;.'t'0~.-1~.t.P;iq'~;;1'5;:~' I
b ~ ''I . ,i~' -~.;iM~__"""" ,~.. ""~ (t:'1t~. ... Ji.IC . '1;'.., , ",~~., .~"(ol,;'~" _~"'"f'~~17 .".."1-'
,nurn C7C;~: 1"ff;' " " ' .' ~,,' ) '\AjuE~\er subtotal ofabave fees (;; / rv
vi & ,::. -, .)0_ -.::::.~~'i $ .
t\~ (Mimmum Permit Fee $58,00)
~~r\o/l(B)EnterI2%SUrCharge(.12X[A]) $ I
~ '-t::J'\ ,I (C) Technology Fee (5% of[A]) $, I
~ ' .1 TOTAL fees and surcharges (A through C): $ -71< IS 7
440,2584,) (9/08/COM)
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1137
COM2009-01137
COM2009-0 1137
COM2009-0 113 7
COM2009-01137
COM2009-01137
COM2009-01137
COM2009-01137
COM2009-0 1137
COM2009-01137
COM2009-01137
COM2009-01137
COM2009-01137
Payments:
Type of Payment
CreditCard
cReceintl
REqEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
3200900000000000592
Date: 08/19/2009
Description
Fire SF Fee - Residential
Storm D~lainage Impervious Area
Sanitary Sewer - Reimbursement
"
Sanitary Sewer - Improvement
SDC Sa~hary/Stonn Admin
Building' Pennit
Fixiure .' '
,
I st Appliance
Exhaust ~oods
Add, AIt,Or, Extend Circ
Add, Alter, Extend Circ Ea Add
,
+ 5% Technology Fee
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+ 12% State Surcharge
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Paid By
JANE D, BOLT
Item Total:
<':heck Number Authorization
Received By Batch Number Number How Received
nJm 638349 In Person
Payment Total:
Page 1 of 1
11 :00:32AM
Amount Due
8,80
57.43
28,99
22,05
5.42
392,05
95,00
79,00
13,00
55,00
36,00
33.50
80.41
$906,65
Amount Paid
$906,65
$906,65
8/19/2009
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Constructioll CO'l1tractors Board
700 SummerSt l'/E Suite 300
PO Box 14140
Salem oR. 97309-5052
Phone: 503-378-4621
Web Address: www.ccb:state.or.us
Permit#:07 - /1 5-'7
Address: 12 ::2-,3 cJc;J-n-;v;V"! r/L
, Issued bY:C~' . - ..' Date:
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. ' Statement: 'Information Notice to Property Owners
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, About Construction Responsibilities'. ,
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,Note: Oregon Law, ORS liJl, 055(4) requires residential construction permttdpplicants who,are not
, licensed With the Construction Contractors Board to .sign the following statement before a building
," permit can be issued. This statement is'requiredfor residential building, el~ctrical, mechanical and
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plumbing permits, Licensed architedand engineer applicants, exemptfrom licensing under'
ORS 701,010(7), need not submit this statement, This statement will befiled;with the permit, ,.
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Fill ih the appropriateblaDks and irntial ,boxes I 'and i, and either box 3A or 3B:
J]bftl'16wn,reSidejn, or will re'side in the completedstructur~"
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I uni:lerstand that! must become licensed as 'a constniction,contractor ifthe,structure is sold or
offered for sakbefore or on completi~ri. "
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D ' 3A. My general csmtractor is
(Name)
,
I'
(CCB #)
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I will ins~ct my' general contractor that alrs~bcontractors who work on, the struc~e must be
, licensed with the'Construction Contractors Board, , " "
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OR
3B. ; I will be my qwn general contractor..
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e If! hire ,subcontractors, I ~ill 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 wjththe CC~ and will imniediately notify the'office issuing this building permit of the
name of the' contractor.
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I hereby certify that the, above information is correct and tliat I have read and do ~nll:erstand the Information
Notice toPrQperty Owners ai!out,Construction Responsi!Jilities on the reverse side ofthis form.
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(Si,gnature of permit applicant).. ! (Date)"
(inzite copy to issuing agency permi!file,pink copy to applicdnt.)
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PropertLowner.doc 06-01-04,
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Acting ai Yo'uF,:OwnQeneral.Contra~tor?l;
"'~_'.~""'A,,"'(",',~"',\'-;-f"""''''''''''''-' ., '~::-:'. .,.,..'-.-.
-. ' -. , "" ' INFORMATION'NOTICE TO PROPERTY OWNERS' ,;' ".; ) L
ABOUTGONSTRUCTION'RESPONSIBILlTIES ..',. ,--" ,
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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 W89 Oregon Legislature,
, '..-~>-:.rl~' '..~,,',"~- _-;~1~'~'t"'l.;' ;","~,~:P--~4',.~'__ ':""'-~"'_\"'l.t.';_:.....~,.-~~"~'~>:"'.:::..,..
If you are actmg as your own c9ntr!.\ctor to construct a new home or make a subSWll1allmprovement to an eXlstmg
structure, you can prevent marty problems bY,bCiil!fawareof the fol1oWi~g responsibilities anqeoncems,
.' Employer Responsibilities ,
'~-,"~t t - ~~ '-\.'.'!" ~~'''' '.' ~ r..,/, .., :', 't' :' '-', , . . _ '..\... \ .. " '".... ' .. ~ ~ ,- :... , '.. ~
y ouwj1l,.in ,mos..t,iI?-s!ancfi~, beJuleqto be ~I;1,~~mployer" and theconJra?tors YOl!?2ntract VI\ith"y..ilf.be,"/lmpfoyees" ij
you use contractors,nqpic~f\s,e<j With .t1J,<,Constructiori Contractor.s Board,to,do ,l~bor,in eO!1slfucting,or to assist in the
.., '- - ~_' - .... -.~, _ - _' '... . . . " . '.' 4. ....;', . r.t, . ,.':.'1 '. " " ' ,_'
construction,?r i~vrw.eII)i?nt, ~f:: ~~sidential struqt!-\l'e:, ;\s,~b~,~mP!R~e,rl YOl!~ustcom.l?\.Y ~~~~, ~~e fO~l~~,ing:
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Oregon's With~oiiiiig fai ta~~ Asari ~~plo~~r, Y6U;~u~r,J;thh6ld'in~ofue tixes fr~memJloY\e-'~~:~6s ~t the time
, employees are paid, you will be)i~bk for the. tax vayments e~en if you pon:t ac~lly witi)hold the tax from your .
employees. For more information; Jfall'the Depari:iTIeni'ofReven'Ue at 503c378'4988,~'.;' ;I._~I' "'--1: ;',,;. ;, ,.':',
Unemployment Insll,rance ~ax: As ail emp]oyei}youcilre-required to:pay a tax for unemPIOymehtli~suraricip~~ei ~\
,on the ~a~~;~:~~.~l1,el~:,lo.;ue:~, ~or mo~~ i;~,~o~at!~,n.' c~,~~~e. ~:~~;~.,E:~P:~;m:~t~e~artme.~\~~,~0~~~~7~~488~\~;0
The Oregon Business, Identification Number (BIN) is a combined,',1).umb~r, for, both, C)J'egon Wjthholding 'and' , ,.\
Unemployment Insurance Tax, To file for a BIN, call 503-945-~09l or.www.dor.state.or.us/formsoav.htmll for the
appropriate forms, ' "':r;.",~. ~,;""
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Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
and must obtain workers' eompensation insurance for your employecs, If you fail to obtain ''Workers' compensation
. . _.'" ...':':rl"..,., "l...r,~' _ "'~'~,',',-::-.',_ '.1"lr- }~~ 'L.~.,_ ,,. ."... ~.*... ,." -,
insurance, you could be' sulijec(to 'penalties' and be'liable 10r all claim costs' if one'of your elnpl6yees' is 'injured oil tht
job, For mbre informaiion,: call the Workers' Compensation Division:iIt the'Department ofGonsumer'arld Business
Services at 503-947-7815,
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V.S, Internal Revenue Service: As an employer, you must withhold fedefliFinconie tax' from empioyees'wages,
You will be liable for the tax payment even if you didn't actually withhold the tax, For a Fe(!eral EINnumber, call the
IRS 'at 1 c800cSi9=4933 or.visit their web site,at w\vw.irs,Qov,,- -',;__ ';." - "" ',:" ,'" '>, "
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, '," ~ ,. 6ther.Responsib!ljties:ari.lfAr~a$,of Concerp.~ ;;'C , "-1',
Code Compliance: As the permit holder for this project, you 'are responsible for re~ojVihg: :iny 'failure' to' meet c~de
requirements that may be bro1,1ght to your attention through jnspections,.. '
~ ;.,~~.' 'L. ~;...:', :J~::...c".~n. _ --{.jfT_f'i, ~ t:!;"i'.:.~O'-'~".....~ l. .', ..,
. ,--"...- .:.,~,~.''I,A.,. -.....'...}-'-- '",...,..,.....',. 'f;"..r "....'.,~:;~~, ,....-....-.. '-"_<'_ '"". ,...... . ,"' ....
, Liability and Property Damage InsurilIlC'e: 'Contact' yout'insuranc.;: age'1it to see' if you have adequate-msurance
coveragc for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or
work that must be.rj:gone, ,-" ~, ' ',>-, " \-,' '
.,~.,~ .\_ \~ ""-\ .-...?'J' . _. ~ _ __. .'~ . ~:..t."~~i.. ... \. '. ~~.r'~'-:;'...--' ::~\
Time: Make sure you' n~e, sufficient time to superVise your emp]oyees:,~"', " ,1,;-'" ,.' , " i" i\":' ':.
, . '~"i)"'\\~'-'~,,'~i"\:' ~.;...." n\ .,..;., 1,1;'; '.s., ,-<1", ," ..~,,~;t., ,
Expertise: Make sure you have the skills to act as your' own general contfilCtor, to coordihate the wgrk of rough-m
and finish trades, and to notify building c:fficials as the appropriate times so they can perform the required inspections,
If you have additional questions call the Construction Contractors Board (503-378-462 l) or \'trite the agency atPO
Box 1'4140, Salem, OR 97309-5052,
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Property_owner.doc 06,01,04