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Home My WebLink AboutPermit Plumbing 2004-6-8 . . CITY OF ~rtul~uFIELD Building/Combination Permit PERMIT NO: cOM2004-00667 ISSUED: 06/08/2004 APPLIED: 06/08/2004 EXPIRES: 12/08/2004 VALUE: ~ Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 1405 OLYMPIC ST ASSESSOR'S PARCEL NO.: 1703253210800 Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: Repair Residential PROJECT DESCRIPTION: Replace approx 50lfsanitary sewer line Owner: ROBINSON KATHRYN A Address: 1405 OLYMPIC ST SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I Contractor Type Plumbing Contractor GARY ALAN MUSTIN License 129990 Expiration Date 06/24/2004 Phone 541-463-7568 BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: VN # of Stories: Lot Size: Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: Water Type: TTENTION: Ore on law~~Ftl!W;~' Range Type?> g sli (jar ,arport Energy Pa~h1I,~ow rules adopted by t~ reM. I SprinkledtBuildiiif,on Centelt/lhose M~IMll8ttfl1Jci':rth in nL\~ ",J;?_nn1_nn1 n thrn"nh i'fA~ "'5?-OO1o , DEVELOPMEN11IINFORMI\1I1IONl1lin copies of the rules bV """"1!,! "'''IJ''t.l",,- (Note: the tel~OJRED PARKING O I D. number for the Oregon Utility Notificat lion ver ay 1st: C '1 800-332 2344\1'0 a : # Street Trees Rqd: enter IS - - 'Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: R-3 Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I PUBLIC IMPROVEMENTS I Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: NOTICE: Down~~utslDrains: THIS PERMIT SHALL l:XPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ..IV 1 on n^V o~tllnn I Valuation Descrintion I Notes: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page I of2 . . U 1 i/ OF ~rlUl'i\.JFIELD . Building/Combination Permit PERMIT NO: COM2004-00667 ISSUED: 06/08/2004 APPLIED: 06/08/2004 EXPIRES: 12/08/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I F~~s PlIirl.l Fee Description + 10% Administrative Fee + 7% State Surcharge Sanitary Sewer - 1st 50 Feet Amount Paid Date Paid $4.50 $3.15 $45.00 6/8/04 6/8/04 6/8/04 Receipt Number 2200400000000000720 2200400000000000720 2200400000000000720 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. l..R~nuirl'rl Insn~ctinn'iJ I Sanitary Sewer Line: Prior to filling trench 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 will be made ofany 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 sUe at all times during construction. c;Y12~~ 6 - ~-OLj Owner or Contractors Signature Date Page 2 00 -. , . \ .: ", ," " .' , " . . · 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~ ~ -ClOG:, b 7 Address: /40S- O(YVV\P:c S~ , Issued by: b!3 Date: V 8;/Ol{ 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 requiredfor 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: ~1. .-Et 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. ~ 3A. My general contractor is frA (LV AI Ad J1Il u 'S,. TI rif I (Name) 127770 (ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR o 38. 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 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. C/<(~ b-f-04 (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) :"_r..;),_owner,doc 03/11/03 I. . A.~ttnnng ~~ 1!(Q)unrr (Q)wnn Gennell"~n C(Q)nnttll"ad(Q)ll"? I, INFORIIIlATION 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 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. lEmployer Respol1ls!bmties il 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 impl,ovement of a residential structure. As the employer, you must comply with the following: I 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 a State Business ID number, call the Business Tnfonnation 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 infonnation, call the Oregon Employment Department at 503-947-]488. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain wotkers' compensation insurance for your employees. If you fail to obtain workers' cV"'I'~..sation 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 infonnation, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947~78]5. U.S. Internal Reve'nue Service: As an employer, you must 'withhold federal income tax from employees' wages. You will be liable f6r 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 80]-620-7] 15. I I' ,I I Code Compliance: II As the pennit holder for this project, you are responsible for resolving any failure to meet code requirements that m~y be brought to your attention through inspections. ' Other RespoBllsibilities, ~mdl Areas oJ!' COBllcenns 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 YIlU 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 perfonn the required inspections. ]fyou have addition*l questions call the Construction Contractors Board (503-378-462]) or write the agency at PO Box ]4140, Salem, 0R 97309-5052. I I I Property _ owner.doc 0311 1/03 225 Fiftb Street . Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00667 COM2004-00667 COM2004-00667 Payments: Type of Payment CreditCard 6/812004 . RECEIPT #: Description + 7% State Surcharge + 10% Administrative Fee Sanitary Sewer - 1 st 50 Feet Paid By KATHRYN ROBINSON ~ ~ ~~J -, ,~ of Springfield Official Receipt veIopment Services Department Public Works Department 2200400000000000720 Received By djb Page 1 of I Date: 06/08/2004 Item Total: Check Number Authorization Batch Number Number How Received 000404 673058 In Person Payment Total: 9:18:38AM Amount Due 3.15 4.50 45.00 $52,65 Amount Paid $52.65 $52,65