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Home My WebLink AboutPermit Building 2005-6-28 -1IfIt&;~:~"lP"Q. f. ,. . '. . ~ . , ' .,' '" . . CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2005-00722 ISSUED: 06/28/2005 APPLIED: 06/13/2005 EXPIRES: 12/28/2005 VALUE: $ 57,888.00 225 Fifth Street, Springfield, OR 541-726.3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6801 MOSES PASS ASSESSOR'S PARCEL NO.: 1702341107300 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: Addition PROJECT DESCRIPTION: Second floor addition to existing residence Residential Owner: DUANE JACOBSON Address: 6801 MOSES PASS SPRINGFIELD OR 97478 Phone Number: 541-746-9615 , CONTRACTOR INFORMATION I Contractor Type General Electrical Contractor OWNER OWNER License Expiration Date Phone VN BUILDING INFORMATION I # of Stories: 2 Lot Size: HPM'~Otegon law 2iI(Sljres 'Sij1ttclst Floor: Tl\:IIlb'!f Hll!tl ado~od:e.t .meGlr~gorSIJYiittnd Floor: 603 ~f:l\Yel\:Centel. Those rules are SijtFtlORsement: b~~1l2:.o01-001 0 through OAR (SQ'1IIi~aragelCarport )e~'ma.lLobtain copIbUlul the sqiFJ Other: "PH~Ifi1~8 tfllJI~I!\~er. (Note!l(llie telef.Il.~UP~nt Load: , DEVELOrMEN~A';iION~23~4i~"--"-" REQUIRED PARKING # ofUnils: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: . # of Bedrooms: R-3 Frontyard Sethack: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Fullv Improved Yes Sidewalk Type: DownspoutslDrains: Curbside 5' Curh and Gutter Storm Sewer Available: Special Instruction: NOTICE: njl~ p(;n".;r. ". Storm drainage piped to existing to curb face.6120/IOuS'.C^-1i EXPIRE IF THE W AUTHORIZED UNDE ORK COMMENCED OR Is~1~~;ERM/T IS NOT . ANY 180 DAY PERIOD ONED FOR Notes: Pa2elof3 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Dwellinl!s Tvpe of Construction V Wood Frame Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge Building Permit Dryer Vent Fixture Furnace - up to 100,000 htu Minimum/Adjustment Mechanical Minimum/Adjustment Plumbing Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Clrc Add, Alter, Extend Circ Ea Add Total Amount Paid . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00722 ISSUED: 06/2812005 APPLIED: 06/13/2005 EXPIRES: 12/28/2005 VALUE: $ 57,888.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $96.00 Square Footage or Bid Amount 603.00 Value Date Calculated Total Value of Project $57,888.00 $57,888.00 06/13/2005 li'pp< PlWLI Amount Paid Date Paid Receipt Number 1200500000000000829 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 2200500000000000924 2200500000000000924 2200500000000000924 2200500000000000924 $261.20 $10.00 $49.19 $34.43 $401.85 $6.00 $42.00 $12.00 $21.00 $3.00 $127.96 $168.28 $14.81 $6.00 $4.60 $3.22 $43.00 $3.00 6/13/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 7/14/05 7/14/05 7/14/05 7/14/05 $1,211.54 I Plan Reviews I Initial Review 06/16/2005 06/16/2005 APP SKG Planninl! Review 06/16/2005 06/21/2005 APP TAJ No Planning review required. Property is solar exempt Public Works Review 06/16/2005 06/20/2005 APP CAS Storm drainage piped into existing to curb face 6/20/2005 CAS Structural Review 06/16/2005 06/16/2005 10 JB Forwarded to Jason Bush for review Structural Review 06/16/2005 06/20/2005 APP JB Approved as noted on plans 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. Pal!e 2 of3 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Rf'ouirf'tI ~ . CITY OF SPRIr'luI'IELD Building/Combination Permit PERMIT NO: COM2005-00722 ISSUED: 06/28/2005 APPLIED: 06/13/2005 EXPIRES: 12/2812005 VALUE: $ 57,888.00 Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to fioor Insulation or decking. Floor Insulation: Prior to decking. Shear WaD NaiUng: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections bave been requested and approved and the building Is complete. UnderOoor Plumbing: Prior to Insulation or decking. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Underfioor Mechanical. Prior to insulation or decking and Including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefully'examined the completed application and do bereby 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 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. O~~:::::::cto~i~ -, Paee 3 00 r -/ '1-0) Date 225 Fifth Street Spril}gfield, Oregon 97477 541-726-37S9 Phone Job/Journal Number COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 Payments: Type of Payment CreditCard " - '. " 7/14/2005 . RECEIPT #: ~ 2200500000000000924 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 7% State Surcharge + 10% Administrative Fee Paid By DUANE JACOBSON Received By djb Check Number Batch Number Page I of I """'ty of Springfield Official Receipt .velopment Services Department Public Works Department Date: 07/14/2005 Item Total: Authorization Number How Received 808000 In Person Payment Total: 11:17:43AM Amount Due 43.00 3.00 3.22 4.60 $53.82 Amount Paid $53.82 $53.82 " Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00722 ISSUED: 06/28/2005 APPLIED: 06/13/2005 EXPIRES: 12/28/2005 VALUE: $ 57,888.00 SITE ADDRESS: 6801 MOSES PASS Springfield TYPE OF WORK: Single Family Residence ASSESSOR'S PARCEL NO.: 1702341107300 ,,,,,,,,~TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Second floor addition to existing re~idence,t. 0 THIS PE.Ri,1IT SHALL EXPIREI~TH_E~.~~ Owner: Address: DUANE JACOBSON 6801 MOSES PASS SPRINGFIELD OR 97478 AU I HUtilLtU Ull.JULn 1111,,] I L1\1'iH I IV 1'11.,.1 I CO""ENCED OR IS A,Ph~ne.N!,mber:R 541-746-9615 ~ll\l D~I~UUI'cUIU ANY 180 DAY PE.RIOD. Contractor Type General Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: I CONTRACTOR INFORMATION' License Expiration Date Phone BUILDING INFORMATION' # of Stories: 2 Lot Size: R-3 Height of Structure 24.50 Sq Ft 1st Floor: Type of Heat: Forced Air Gas Sq Ft 2nd Floor: 603 VN Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Path I Sq Ft Other: Sprinkled Buil~!!!gj.. nlal Occupant Load: ATTFN I )lJN: Ore,aon aw reqUlr6~ yv,. Hi I DEVELOPMEN:f'INF('JRM1\TIeNVI"Y the oregonul . IW'Ir.JMJr.u~.. ..~.. ... .ose rules a'p "REQUIRED PARKING ~OAR 952-001-0010 through O<\ri .'"'. ' Overla 1M: vo~ may obtain copies of ~Ill' Total:. # Street \~'ifi~,!J't'~e center. (Note: thu . ", Hand, ,capped: , Paved Dr~lllpr the Oregon Utlllt\' r'~'.'I. !:~~p'act: % of Lot 'e'enter is 1-800-332-23' ~I. I PUBLIC IMPROVEMENTS I Fully Improved Yes Sidewalk Type: DownspoutslDrains: Curbside 5' Curb and Gutter Notes: Storm drainage piped to existing to curb face 6/20/1005 CAS Description I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Value Date Calculated Pae:e I of3 '-Wlr&~R'~GPllILD' .- 'J .. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Dwellines V Wood Frame Fee Description Plan Review Residential -Mechanical Issuance Fee-- + 10% Administrative Fee + 7% State Surcharge Building Permit Dryer Vent Fixture Furnace - up to 100,000 btu Miulmum/Adjustment Mechanical Minimum/Adjustment Plumbing Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Vent Fan Total Amount Paid . . CITY OF SPRII~uJ:<l~LJJ Building/Combination Permit PERMIT NO: COM2005-00722 ISSUED: 06/28/2005 APPLIED: 06/13/2005 EXPIRES: 12/28/2005 VALUE: $ 57,888.00 $96.00 603.00 Total Value of Project $57,888.00 $57,888.00 06/13/2005 Fpp< ~ Amount Paid Date Paid Receipt Number 1200500000000000829 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 3200500000000000397 $261.20 $10.00 $49.19 $34.43 $401.85 $6.00 $42.00 $12.00 $21.00 $3.00 $127.96 $168.28 $14.81 $6.00 6/13/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 6/28/05 $1,157.72 I Plan Reviews I Initial Review 06/16/2005 06/16/2005 APP SKG Plan nine Review 06/16/2005 06/21/2005 APP TAJ No Planning review required. Property is solar exempt Public Works Review 06/16/2005 06/20/2005 APP CAS Storm drainage piped into existing to curb face 6/20/2005 CAS Structural Review 06/16/2005 06/16/2005 10 JB Forwarded to Jason Bush for review Structural Review 06/16/2005 06/20/2005 APP JB Approved as noted on plans 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. RpnniriPIl Tn~ne('tions I Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Paee 2 of3 -Wt:.~~':~"-I~ , .' . . ' '.' . . CITY OF SPRlNGFl~LU Building/Combination Permit PERMIT NO: COM2005-00722 ISSUED: 06/28/2005 APPLIED: 06/13/2005 EXPIRES: 12/28/2005 VALUE: $ 57,888.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspeclion Line Framing Inspection: Prior to cover and after all rough in inspections have been approved. Walllnsulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Final Building: After all required inspections have been requested and approved and the building is complete. UnderOoor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. UnderOoor Mechanical. Prior to insulation or decking and including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. 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 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 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. b/;U/Oo fo fO I (YID6e3, Ptl$b Date Page 3 of3 CITY OF StiNG FIELD SYST~MS DEVELOPME~ORKSHEET JOURNAL OR JOB NUMBER: com2005-00722 NAME OR COMPANY: Bilt Randell LOCATION: 6801 Moses Pass TAX LOT NUMBER: 1702341107300 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS 0 BUILDING SIZE (SF: 588 LOT SIZE (SF): 1. STORM DRAINAGE 6545 I'" I[{J 10 18 ..: !:: <Jl 6 ~ DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x I COST PER S.F. CHARGE I 0.00 I $0.310 I = I $0.00 I RUNOFF ROUTED TO DRY WELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I '0.00 I $0.310 I 50% ITEM I TOTAL-STORMDRAINAGESDC '$0.00 \ 2, SANITARY SEWER - CITY DISCOUNT $0.00 $0.00 1070 A. REIMBURSEMENT COST: I NUMBER7 OF DFU's I x B. IMPROVEMENT COST: I NUMBER70F DFU's I ' x 518.28 ITEM 2 TOTAL - CITY SANITARY SEWER SDC COST PER DFU 524.04 $168.28 11091 I 11092 I $127.96 = , $296.24 3. TRANSPOIiTATION A. REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRIP FACTORI 9.57 I I 0 I $18.30 I 1.00 B. IMPROVEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x I NEW TRIP FACTORI 9.57 I I 0 I 580.72 I 1.00 I ITEM 3 TOTAL - TRANSPORTATION SDC = I $0.00 $0.00 I t 093 I 50.00 11094 4, SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER OF FEU's I x I 0 I ICOST PER FEU I 582.03 SUBTOTAL (ADD ITEMS I, 2, 3, & 4) ~ , 5 ADMINISTRATtVE FElt I SUBTOTAL x I ADM. FEE RATE 1= I 5296.24 I 5% I TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: = $0.00 I 1054 I = $0.00 I 1055 50.00 I 1054 $0.00 11056 $0.00 J 5296.24 CHARGE 514.81 14.81 11079 50.00 1078 TOTAL SDC CHARGES =, $311.05 B. IMPROVEMENT COST: INUMBER OF FEU's I x I 0 I ICOST PER FEU I 5865.31 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I Cheryl Slaymaker PREPARED BY 6/20/2005 DATE . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS -I (NOTE: FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT F]XTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS !BATHTUB 1 0 3 = 3 I I DRINKING FOUNTAIN 0 0 1 = 0 I I FLOOR DRAIN 0 0 3 = 0 I I INTERCEPTORS FOR GREASE 1 OIL 1 SOLIDS 1 ETC. 0 0 3 = 0 I I INTERCEPTORS FOR SAND 1 AUTO WASH 1 ETC. 0 0 6 = 0 I I LAUNDRY TUB 0 0 2 = 0 I ICLOTHESW ASHER 1 MOP S]NK 0 0 3 = 0 I ICLOTHESWASHER - 3 OR MORE (EAl 0 0 6 = 0 I IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRlG 1 WATER STATION 1 ETC. 0 0 1 = 0 ! IRECEPTOR FOR COM. SINK 1 DISHWASHER 1 ETC. 0 0 3 = 0 I SHOWER. SINGLE STALL 0 0 2 = 0 I SHOWER. GANG {l'!UMBER OF HEADS\. 0 0 2 = 0 I SINK: COMMERC]AL/RESIDENTIAL KITCHEN 0 0 3 = 0 IS INK: COMMERCIAL BAR 0 0 2 = 0 I SINK: WASH BASINIDOUBLE LA V A TOR Y 0 0 2 = 0 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 1 0 1 = 1 IURINAL. STALL 1 WALL 0 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 ITOILET. PRIVATE INSTALLAT]ON 1 0 3 = 3 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 7 .EDU (Equivalent DwellinA Unit) is a discharge equivalent to a sinwe family dwelling unit (20 DFUs) set at 167 gallons per day MWMC CREDIT CALCULA TION TABLE: BASED ON COUNTY ASSESSED VALUE 'I YEAR CREDIT RATE/$],OOO ANNEXED ASSESSED VALUE IS LAND ELGlBLE FOR ANNEXATION CREDIT? 2 I BEFORE 1979 $5.29 (Enter I for Yes, 2 for No) I 1979 $5.29 IS ]MPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 2 I 1980 $5.19 (Enter] for Yes, 2 for No) I 1981 $5.12 BASE YEAR ]979 I 1982 $4.98 I 1983 $4.80 CREDIT FOR LAND (IF APPLICABLE) 1984 $4.63 VALUE 1 ]000 CREDIT RATE 1985 $4.40 $0,00 x $5.29 ~ , $0.00 1986 $4.07 1987 $3.67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) 1988 $3.22 VALUE 11000 CREDIT RATE 1989 $2.73 $0,00 x $5.29 0 1990 $2.25 1991 $1.80 1992 $1.59 TOTAL MWMC CREDIT = $0.00 1993 $1.45 1994 $1.25 1995 $1.09 19% $0.92 1991 $0.72 1998 $0.48 1999 $0.28 2000 $0.09 2001 $0.05 -. . . \ .: ", ." '. ." . .' , . Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Pbone: 503-378-4621 Web Address: www.ccb.state.or.us Permit#: (5 - 0_;;1,.;1... Address: logO I Mct:e& PaS?: Sp;1~A clol Issued by: ~ Date: ItJptlOs Statement: Information Notice to Property Owners About Construction Responsibilities Note; Oregon Law, ORS 701.055(4) requires residential constrnction 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 a",uu",:ate blanks and initial boxes I and 2, and either box 3A or 3B: ~1. ~ 2. lawn, 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 c!,mpletion. 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. ]x[ 3B. OR I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If! 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 bereby certify tbat tbe above information is correct and tbat I bave read and do understand the Information Notice to Property Owners about Construction Responsibilities on tbe reverse side of tbis form. (\ .. ! U (P /rP-f J OS- (Signat~fpermit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 06-01-04 . .. Adnnn~ ~~ II (lJ)IDiJr 1))WIID GtennteJr~n CC((1)IIDltJr~(Clt((1)Jr? Il\;lFORMATIOi\J NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION 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 Legisleture. If you are acting as your own contractor 10 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. lEmployer lRe~pmn~nbftllntfte~ You will, in most instances, be ruled 10 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 tbe employer, you must comply witb tbe foDowing: Oregon's Witbbolding 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/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' Cvu'y"usation 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 ]-800-829-4933 or visit their web site at www.irs.l!ov. OtllnteJr JRte~]]llOIl1lsli!bilillW.es 2lmJl AJrte21S of CmncteJrIl1ls 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 Sjl'ringfiel,d,. Oregon 97477 . 541-726-3759 Phone . .~" ~ ~ity of Springfield Official Receipt .velopment Services Department Public Works Department Job/Journal Number COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 COM2005-00722 Payments: Type of Payment Check { :i ! ~I .. , 6/28/2005 RECEIPT #: 3200500000000000397 Date: 06/28/2005 Description Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixture Minimum/Adjustment Plumbing Furnace - up to 100,000 btu Vent Fan Dryer Vent Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Paid By , JEANETIE C. JACOBSON Item Total: Check Number Authorization Batch Number Number How Received Received By ddk 3539 In Person Payment Total: Page I of I 11:59:11AM Amount Due 168.28 127.96 14.81 401.85 42.00 3.00 12.00 6.00 6.00 21.00 10.00 34.43 49.19 $896.52 Amount Paid $896.52 $896.52