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Home My WebLink AboutPermit Plumbing 2007-6-28 ZZ5 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ~ o o..~ 1 ~ @ U .~ . ....-"..":.,... P.l ~ <C ~. .~ 5 ~ ~ ~. C,). U ......-1 > C) Q ~... o .~ ~ ~. (1.).: > C,) H ~. ~ o r' .1 1.....1 V ",. ...""j u ced. 00 9bS- $ frli;stpf/ City Job Number CO.'V\. '2..6C:;. -7- 00 Job Location cPr; 55' A 3tiEFf Assessors Ma~ l 702-3 LtLf ( Owner ~11r1.l~ f/t//z J...._ Address G!.o/55 J/ ,crtrppj- City S PV/'lJ 11eH, . Tax Lot 07/1 :1 PhoDP D4/- IL/LI-Yj~~ zip97 Jj??I Statp (JR BAcKFLOW PREVENTION DEVICE PERJ.vllT FEE: $55.35 Contractor b~formatiol1 00VN~ Contractor NOTICE: AllIdlSse~P.MIT SHMl-~PI~E IF '!'~~ 'MQlU( AUTHORIZED UNDER THIS PERMIT IS NOT cnpMMENCE~ OR !a ABANDONE~ ~f}R ANY 180 DAY PERIOD. Construction Contractors Registration # Statp A I II:NTlON: Oregon law requ1res you to follow rules aaOpilllo by mill V,eyUII ULilily Notification Center. Those rules are set forth In t')Aa.9Ba~-OO10 tbfOlJgtt OAR A&2.QQ.1- 0090. You may obtain copies of the ",188 by calling the 08""11 (Note: the telephone numoer Tor me \jregon Utiiity Nwogaiil;m Center is 1-800-332-2344). . Expires By signing this pennitlapplication, I agree to call for an inspection once the backflow prevention device has been installed and is visible for inspection (726-3769). I also state that all infonnation on this pennit/application is correct. Signature ~ ,J4,J/Tl/) - 0 For Office Use Date of Application- ~26/o 7 I V DatI" t~ - 2 S' -() '7 Checked for Delinquencipc: Checked for Historical Status ~ Shared Drive (T:)/Building Fonns/Backflow Prevention8-06.doc Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2007-00965 ISSUED: 06/28/2007 APPLIED: 06/28/2007 EXPIRES: 12/28/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 6655 A ST ASSESSOR'S PARCEL NO.: 1702344107113 Springfield TYPE OF WORK: Backflow Device TYPE OF USE: New Residential PROJECT DESCRIPTION: Backflow device Owner: SHAR HEINZ Address: 6655 A ST SPRINGFIELD OR 97478 Phone Number: 541-744-8166 I CONTRACTOR INFORMATION I Contractor Type Landscape Contractor OWNER License Expiration Date Phone BUILDING INFORMATION I # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: # of Stories: Lot Size: R-3 Height of Structure: Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: VB Water Type: Sq Ft Basement: Range Type: Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: NOTl~e: Occupant Load: I. DEVELOPMENT INFORM,J;1bV,ttMII :>ttALL EXPIRE IF THE WORK lII~/ZED UNDER ttti~eLi8fuNp ~HOfG Overlay Dist: ~~~~~Ng~~ OR IS ~Np'ONED FOR # Street Trees Rqd: PERIOD.Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: AlTE RtMF~~g i;' follow rules a Ot Those rules are set tOrtlsidewalk Type: Notification Ceo er. hOAR 852-001- in OAR 952_001-0010thrOug 8 of",e rules bYownspoutslDrains: 0090. You may obtain ~~ the telephone calling the center. (N utility Notlt\C&tlOn number for the Orego~ 1ll1.l1)_2344\ Center is 1-80~ " I Valuation Description' Notes: Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of 2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: cOM2007-00965 ISSUED: 06/28/2007 APPLIED: 06/28/2007 EXPIRES: 12/28/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid $4.50 $2.25 $3.60 $14.00 $31.00 6/28/07 6/28/07 6/28/07 6/28/07 6/28/07 Receipt Number 1200700000000000833 1200700000000000833 1200700000000000833 1200700000000000833 1200700000000000833 Total Amount Paid $55.35 I Plan Reviews I 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. I Reouired Insoections I Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all inforination 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. ~~ C''UMJ2 O~e-r or Contractors Sign~re 0- 2'l.-O '7 Date Page 2 of 2 Construction Contractors Board. 700 Summer St NE Suite 399 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Pennit #: Coo.1l\ 'Z-c::sc::. 7- () a '76 J h6rr. A--')~- -:bd Date: b/z.~ h.f ! I Address: Issued by: Statement: Information Notice to property Owners Ab~ut Construction Responsibilities Note: Oregon Law,ORS 701.055(4) requires residential construction permit applicants whoare not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued,. This stq.tement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), ne(jd not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and. either box 3A.or 3B: ~ 1. I own, reside in, or will reside in the completed structure. ... . ~ 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. . I"" D 3A. My general contra. ctor is . , (Name) (cCB #) P- 1 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 wilChire 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 theCcB ahd will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify thatthe above information is correct and that I have read and do understand the Information Notice to Property Owners ~bout Construction Responsibilities on the reverse side of this form. c!bJl' ,fIvm!), ... /0,-;Z<;5--Cr7 .- . (Signaturt.9fpe~it applicant) - (Date) ~ (Whit~ copy to issuing agency permit file, pink copy" to applicant.) Property _ owner. doc 06~0 1-04 ., ;. \ r. '" \ ',' ictlIfgJ ~s Yoli'r --!,. '..l~ -~. INFORMATION ABOUT Contra.ctor? ',_.~ NOTE: This Information Notice to Property Construction Contractors Board in accordance about Construction Responsibilities was developed by the ORS 701,055(5), passed by the 1989 Oregon Legislature. If you are acti~g as yo~r OwTI ~ontractor to construct a new structure, you can prevent.many problems by being aware . a s~bstaniial improye~ent t~.ari existing responsibilities'and concerns. You will, in most instances, be ruled to be an "employeI:" you use contractp1.'~. n~t: lice:nse9 "Yi~h th~ Constructi?n construction of Ii resigential . . contractors. you contract. with w,ill be "employees" if . do labor in constructing Ot to assist in the you ~nust ~omply with the following: Oregon's Withholding Tax As an employees are paid, You be liable for . tax employees, For more information,.call the Department . I '.' : income taxes from employee wages' at the time even if you don't actually withhold the ~ from your at 503~3784988, Unemployment As an employer; on the wages of an employees. For more information, to:pay a.tax for unemployment insurance purposes>- .. Employment Department at 503-947-1488, ". ~. ~ :," . " '. .' .. .. " , . . \ number f9r. both>, Oregon, Wi~N1Olding au'd\ . or w\vw.doLstate.oLus/formsnav.htmll for the ; " ';; . ~ ,~.. . The Oregon Unemployment appropriate Identification Number To. file for a Workers' and must obtain . r .- ~ .' '. ' , inslira,nce, YOil 'could job. For more Services at to the Oregon Workers' Compensation Law, If you fail to obtain workers' compensation . .if one'~fyo!lr employee~ is1tijured on the at the Department 'of Consumer and Business . Insurance: As an compensation insu~ance . fo penalties can the Workers' Service: As an employer, you must tax payment even or visit their web site -income. tax from employees'.' wages', tax. For a EIN number, call the ,) ll.S. You IRS' at Code the permith01der for . ,t~ you: attention you are . , for resorving any'failure to' meet code ,-.\-, to 'see if you have adequate insurance water damage from pipe punctur~s, fire or \. ;; . f\ ", ~ ~.~ ,.~. . M~ke sure time to your .:. . ,", the. skins to act as your o\.vn building officials as . ., ,- to coordinate the work of rough-in so they can perform inspections. and finis~ trades, (503-378-4621) or the agency at PO If you have Box 14'140, caB the 97309-5052. 06-01-04 225. Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Job/Journal Number COM2007-00965 COM2007-00965 COM2007-00965 COM2007-00965 COM2007 -00965 Payments: Type of Payment Check cReceintl RECEIPT #: 1200700000000000833 Date: 06/28/2007 Description + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Backflow Device Minimum/Adjustment Plumbing Paid By SHAR HEINZ Item Total: Check Number Authorization Received By Batch Number Number How Received djb 502 In Person Payment Total: Page 1 of 1 8:56:23AM Amount Due 2.25 3.60 4.50 14.00 31.00 $55.35 Amount Paid $55.35 $55.35 6/28/2007