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Home My WebLink AboutPermit Plumbing 2004-6-21 . . CITY OF SPRINGN~LD Building/Combination Permit PERMIT NO: COM2004-00735 ISSUED: 06/21/2004 APPLIED: 06/21/2004 EXPIRES: 12/24/2004 VALUE: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2695 NOVA ST ASSESSOR'S PARCEL NO.: 1703224404200 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Install effiuent pump. Owncr: MOIR STEVEN W & L YNETT A H Address: 868 S 38TH ST SPRINGFIELD OR 97478 _...~ I CON TRAC~'''''''''''.o.1'';ftMATION I .,." \. , \fJ"I'- ~",~-~ Contra~!w\O. ~~ ~ 'l13\~O ~~ C,1Q ~~~cense EA~~l~.d~\'IfJGIU ~O~""'~.~770 OWffll;R~ ~..~~:'.n\\\tOIl.~~ n'I~~~,,~ ~o\\~~.ij'JY'.af".,,~LG.IN~kM~io~ , \1\0 l). -:~~~ tf u\.tM, 1\1\). # of Units: ~ !\\1\g ~ e Q'ill/lJ'S\'0~ist-Z3 ' Primary Occupancy Group: cSRi'dQI \ot ~"" ~rof Structure Sccondary Occupancy Group: (\\ll" (jS1I"'" Type of Heat: Primary Construction Type VN Water Type: Secondary Construction Typc: Range Type: # of Bedrooms: Energy Path: Sprinkled Building: Contractor Type Electrical Plumbing Expiration Date 10/04/2005 Phone 541-915-9828 Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: nla I DEVELOPMENT INFORMATION I REQUIRED PARKING Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Sctback: Solar Sctbacks: Strect Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: p,~Compact: % of Lot Coverage: P,t It 1r1t 'l-JO 01 ~01\C~~..rf Srl~\.'-: t::\~ PtP,tJll\l~ ~ I PUBLI~.;~I~~;~j\~w~Wgt ~~~~\)ON\:U IS COtJItJIt~I.j\:~ ~~P,IO\). Sidewalk Type: ~~'{ "aO \)~ DownspoutslDrains: Notes: I Valuation DescriDtion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of2 . . Lll i' VI' :srKll~t.FIELD Building/Combination Permit PERMIT NO: COM2004-00735 ISSUED: 06121/2004 APPLIED: 06/21/2004 EXPIRES: 12/2412004 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.....P:aW Fee Description + 10% Administrative Fee + 7% State Surcharge Fixture Minimum/Adjustment Plumbing + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Minimum/Adjustment Electrical Amount Paid Date Paid $4.50 $3.15 $14.00 $31.00 $4.50 $3.15 $43.00 $2.00 6/21/04 6/21/04 6/21/04 6/21/04 6/24/04 6/24/04 6/24/04 6/24/04 Receipt Number 1200400000000000948 1200400000000000948 1200400000000000948 1200400000000000948 2200400000000000848 2200400000000000848 2200400000000000848 2200400000000000848 Total Amount Paid $105.30 I Plan Reviews I 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. L.~frI)JJir..~ Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. Rough Electric: Prior to Cover Final Electric: When all electrical work is complete. By signature, 1 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 thc Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work descrihed herein, and that NO OCCUPANCY will be made of any structure without permission ofthe 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 furthcr agree to ensure that all required inspections are requested at the proper time, that each address is readable from the strect, 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. Owncr or Contractors Signature Date Paee 2 of2 -w;r- . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-00735 ISSUED: 06/21/2004 APPLIED: 06/21/2004 EXPIRES: 12/21/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2695 NOVA ST ASSESSOR'S PARCEL NO.: 1703224404200 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Alteration Residential PROJECT DESCRIPTION: Install effluent pump. Owner: MOIR STEVEN W & LYNETTA H Address: 868 S 38TH ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I ,ff~ _~ ,-5:) -i: ,,~-l '<BUILDING INFORMATION I ~ ~ <.i..- ..s> # of Units: # ($" ,t;> # of Stories: &' ~~ i:.S'lt't Size: Primary Occupancy Group: <If ~~~N<::5 Height of Structure ,g;~;; ~o s5S!Q.Jlt 1st Floor: Secondary Occupancy Groul1"- ~ -# Type of Heat: ~ # q,<O 1D'1I ,~ ~ 2nd Floor: Primary Construction Type~ ~ ,,\iN Water Type: #cJ <Ii g;.Oj ~#t.!fSsement: Secondary Construction ~e:~ ~ <5>' Range Type: ,J ~q, ~II 0"(' ~ ,~;!'JiGarage/Carport # of Bedrooms: {j;$ i$> "> <::5 ~ Energy Path: If' 'Q':'" q, ~ ~ ~~t ~ther: . ~_ Q.~~~....$ ~ <:{ Sprinkled Buil~~~~ ~o~~~_~o,~ ~~'cf!pant Load: ..... . .. "<;;,,,,~~~'-i:'~-~~<:::." 'DEVELOPMENT.oo'O~a:ib~~6'~'#. ~ ,,-v , "" ~ N' OJ , <::5 ~ ~.... ril(f ..;' ~. !-,. r5f s:I G~ ~~~~~~~ Front yard Setback: ~ Overl ~ io::,o If}I ~ (J>~ q,0 ...: Side I Setback: # Streer~~:c3> ~ f' ~~ Side 2 Setback: Paved Di'I~ : ~ if: ,0 # '.-s>."1::' !-, 0 Rearyard Setback: % of Lot ~r!S"':~ ~0 0 Solar Setbacks: <:s u;:,~ <:' Contractor Type Plumbing Contractor OWNER License Expiration Date Phone REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: DownspoutsIDrains: Notes: I Valuation DescriDtion I Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Paee 1 of2 _~s~~~~.,~ .; \- - . .,. . . _. . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2004-0073S ISSUED: 06/21/2004 APPLIED: 06/21/2004 EXPIRES: 12121/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fp.p.~ tlWLI Fee Description + 10% Administrative Fee + 7% State Surcharge Fixture Minimum/Adjustment Plumbing Amount Paid Date Paid $4.50 $3.15 $14.00 $31.00 6/21/04 6/21/04 6/21/04 6/21/04 Receipt Number 1200400000000000948 1200400000000000948 1200400000000000948 1200400000000000948 Total Amount Paid $52.65 I Plan Reviews I 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. e Rough Plumbing: Prior to cover and including required testing. Final Plumbing: When all plumbing work is complete. 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 will be made of any structure without permission of the 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 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 t front of the property, and the approved set of plans will remain on the site at all times during constr . t 4//01 Owner or Contractors Signature Date Paee 2 of2 -. . . \" ../ '. ,.' . 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 Permit #: CO~ tlo 4-- DC) I. 3. S- Address: --z.. 6 ~ S- Mo \\ f:>.. '2:>1:: . Issued by: J t-i\? Date:Db~'Z.l~C t\- 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 1 and 2, and either box 3A or 3B: ~1. D 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. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl 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 of this form. ~J:ofCant) ~/~1~tf (White copy to issuing agency permit file, pink copy to applicant.) Property_owner.doc 03/11103 . Actnnng ~~ !1lIlIr (Dwnn GenneIr~n C~nntIr~d~Ir? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES i NOTE: This Information Notice to Properly 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. Employer lResponsibm~ies 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 Withholdiug 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 a State Business ill number, call the Business Information Center at 503-986-2200. 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. 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 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 866-816-2065 or fax them at 801-620-7115. Other Responsibilities and Areas of Concerns 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 surc 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 03111103 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . Job/Journal Number COM2004-00735 COM2004-00735 COM2004-00735 COM2004-00735 Payments: Type of Payment Check 6/21/2004 . ...A1N......... .Ii ~.t'. RECEIPT #: 1200400000000000948 Description Minimum! Adjustment Plumbing Fixture + 7% State Surcharge + 10% Administrative Fee Paid By Received By MOlR CONSTRUCTION INe. jmp Page I of I JIlty of Springfield Official Receipt .elopment Services Department Public Works Department Date: 06/21/2004 2:S4:13PM Amount Due 31.00 14.00 3.15 4.50 $52,65 Item Total: Check Number Authorization "Ratch Number Number How Received Amount Paid 4436 In Person Payment Total: S52.65 $52.65