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Home My WebLink AboutPermit Plumbing 2007-6-26 Status Issued CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: cOM2007-00949 ISSUED: 06/26/2007 APPLIED: 06/26/2007 EXPIRES: 12/26/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 4449 IVY ST ASSESSOR'S PARCEL NO.: 1802052401700 Springfield TYPE OF WORK: Backflow Device PROJECT DESCRIPTION: Backflow device TYPE OF USE: New Residential Owner: J DAVID SCHIFFER Address: 4449 IVY ST SPRINGFIELD OR 97478 Contractor Type Landscape I CONTRACTOR INFORMATION' Contractor OWNER License BUILDING INFORMATION I # of Units: # of Stories: -\\-\E \NO\\~ Primary Occupancy Group: ~;3 H~~\1lf~ruc~n~~O\ Secondary Occupancy Grouq~01\C . \\ s\-\~\..\.ryrhq!fItij)~\ \\ Primary Constructio? Type 1\-\\S \,~\I\ D~.mEWaft}~'t~~~tD \,-0 Secondary Construction Type: :\Wj\\\lED \\ \~lf\l;g~"Ype: # of Bedrooms: ~D \\~H~CED a Ft~ergy Path: ca\'J\l'l\ "D~\{ \'tBS(}rmkled Building: n/a "l" -I S\U 1-\\'6' I DEVELOPMENT INFORMATION I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description Overlay Dist: # Street Trees Rqd: Paved Drive R~d;.o % of"'tdff€b~~l\age" \a\N \t';\4' II UtI ."J \..,-,(\N'. O'(ego~ \-"1\1 t\le o~e~~Po set \o~\~ p.,\~~ ~~\e5 ac\~Lf{;imre~~it,~.v.BMi~T~ , \0\\ . II cell' '\Ol\\I~ ,,-no::; ,- NO,\\\\Ca\\OS'2._00'\ ..00 . II CO~)\es 0 \e\e?\lO~e \11 Op.,B ~ u \ila)' o'o\a\ \..NO\e'. ~~\e NO\\\\Ca\\OIl 0090. . 0 \\le celltec Oil \Jt\\\t)' 44). ca\\\1I9 \\le o~eg 0..?/2:>'2. .'2.3 IIIJ\iI'oe~ ~~II\e~ \s '\ ..BO Phone Number: 541-746-6708 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: , Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: Handicapped: Compact: Sidewalk Type: Downspouts/Drains: I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Pa2:e 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00949 ISSUED: 06/26/2007 APPLIED: 06/26/2007 EXPIRES: 12/26/2007 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project l Fees Paid I .. Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 6/26/07 1200700000000000824 $2.25 6/26/07 1200700000000000824 $3.60 6/26/07 1200700000000000824 $14.00 6/26/07 1200700000000000824 $31.00 6/26/07 1200700000000000824 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 Re{]uired Insnections 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 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 a the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of a structure without permission of the Community Services Division, Building Safety. I further certify that only contractors an employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all requi spectl~ are requested at the proper time, that each address is readable from the street, that the permit card is locat d at he front of the property, and the approved set of plans will remain on the site at all tim(eS~durin~.o , CtiOOOIl._. .' ~ '\.. . 1,,1 _H to~Z0 'D+ '-.. l.-/' . ~natu~ L/ Owner or Contractors Si ~ Date Pa2:e 2 of 2 ~ o . ,.....( ~ ro u . ,...q , l."......':l t""""I , t..... J."j ~ W . .,.....( s ~ CI.) ~ C) U · ,..-4 >- Cl.) o o o .~ ~ ~ OJ > (j) ~ ~ ~ o ,. ...1 1'.1 V 1'- """i U cd m . . 225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 City Job Number Cc.)....v'\ '7 ,...., 0 7-~~ 'lit , 5+ Job Location L{4 L{ '7 18cJZ . Tax Lot Of7C6 -L- v' Y 05Z~ Assessors Mar I~ . ~J - . \ .--. <.....Ch-\rr;;.= f\ Owner ~ l./A\J~ ~-~c..tit:..L c) \,,-t<.... clc{.., Q 1 u L- ~. 'T~F["':- T Address \. . I . ( '---> e"" City uPiLll'-\.~~ teLO 1-c[0 ~0~8 Zip q -::;-'-/ -qg . Phone . Statp' oR BACKFLOW PREVENTION DEVICE PERMIT FEE: $55.35 \ ,. .' Contractor b~rormatiol1 \~ '. " ,: , , Contractor , ' ._' ", :b,w-N2t:tft \. . \ '" \ ' \ " ,\ " ,...\' . .,...' .'./ -" ,. . Phonf' ...--:> \.\ Addres~ . State Zip City - Construction Contract~eg{stration # . Expires -. '<.:" ~ \:~ .,;~\ X' \..J \:_''''\,' !'l{,.~. !'-'" ",' \/" >,,' By signin.g this penni~app.li~ation, I. agree ~o cal_~~r an 5nspection g~~~~~~~~p:eventio~ device has been mstalled and IS vIsIble for mspe9-l101rc, 26-376~also~~a!~5t~'&U-.:nlJ~n:B.0tlon on thIS pennit/applicatioll is \;Ouect. /! .. t;::-'.[!.r..;'~$/,g' (.)~f.;<;'_(';?'r.~:;;~ -........., ~~ ror,,:f? .'<:l' r)r6 (!l o~ d--G'..',~U' ~.. ' ~ >,fj-' tj' ') '\:.1 ~.~ .,...\. . --... I' - '" .,.r..J ,r o:V rC.J n". ~., _'- .<." ~ . . \,/j v...-tJ,\.J \. ~ (,,) ".~& ", ,,-," ,- .:-..., '"""',,~ ~"" i."" >. ("> ~ r-:;<< .... .~~ .~, \ . ~v f^\'''' ~,-:};_,...J C; - ~,(Z,. ."....) r. Signatur~ . ;A..; -0. \ /" ~ ,{' ,:" :i' ."GRJ1~ ,,~, 2 ~~ 7 ~ ...0-, ( J(~-;;S-- ~I _'>:- ,,:)'U ~ ~ (~I/ , ~. " ~ ,\\~. ~ cj.: 0' ,,;>). /? ~;'.) \",'.6" .,:\0(', (.~\ .r.'. .r?.i''''r"..; ,~'-. rz~ (-.'/ ""r.,.l Q'" f" co...... \~:;' .<::.~.J', C;.i.J "'~~ n,(j~,""e V _ ~: ..; ",.. ....' _<0 ~~... ..,,::. '\."" For om.~,.UlS~ . ,.9) ,\O'~g;' " "J ..", ;:", (" ,;'. (/.' ~oJ v' :J~" ,"" Date of Application b-Z~-67 Checked for Delinquencif'~ L----- Checked for Historical Status ~-- Shared Drive (T:}/Building Fomls/Backflow Prevention8-06.doc , ' 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 #: COV1l\ (:..0 C 7- 0 C c; l( 7 Address: l!t.{I.f9 Ivy )~ '~~ I Date: bh'~7 I f Issued by: Statement: Information Notice to Property Owners About 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 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: <ltl. ~2. I own, reside in, or will reside in the completed structure. I understand that I must become licensed as a construction contractor ifthe structure is sold or offered for sale before or on completion. 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. OR ~ 3B. I will be my own general contractor. If! 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 ce ify that the abov nfor ation ~rrect and that I have read and do understand the Information Notice to rope Owners a out C nstructioD Responsibilities on the reverse side of this form, (f1 ) \. ~ture ~ 1 ~ ~llte co ',,- (0-- ZG - D:{- (Date) ssuing agency permit file, pink copy to applicant.) Property _ owner. doc 06-01-04 ,"',i_,J ..r.~~j ~'.. ",...., 'f .~,:. Acting -as..YC?t1l'r': ~- . -.,. \ j '.. .'. '.. " " INFORMATION-NOTICE OWNERS . ABOUJ::~pNSTRUCTION RESPONSIBILITIES ,- " Contractor? . : ;, \: :+ \ r- ;. NOTE: Information Notice to Property Owners about ConstructiortResponsibiiities was developed by the Construction Contractors Board in accordance with ORS 701.055(5J, passed by the 1989 Oregon Legislature. If you are as your own contractor to construct a new home or make a sub~tantial improvement t~ an existing structure, you can prevent many problems by . the following responsibilities and concerns, be ruled to be an "~mployer" licensed vvith; the Construction }mp~ovemept o~ a,. resi~ential.struct~e" As an will be,liable for the tax more in:formation~ call the Department contractors y~)U contract with will be "employees" if . to d~ labor: in constrricting or 'tp' assist in the yo~ ~ust ~omply with the following: . You you use '. . ,.... l. .' withhold"income'faxes trom employee wages at the time even you don't actually withhold the tax from your at 503~378-4988.. .":', As an employer, more information, to pay a tax. for unemployment insurance purposesi'-~ Employment Department at 503-947-1488, Unemployment on wages an ....-'-..... -;:..# ~..1 -~f-;. . -~... Identification Number To file for a number:' for b.oth QregoIl Wit!tl101ding an'd or w\:vw.dor.state.or.us/fonnsnav.htmll for the The Unemployment Insurance: As an employer, are workers' comp~n~ation insurance for y~ur subject fopenalties and can the Workers' to the Oregon Workers' Compensation Law, If you fai! to obtai~."Yorkers' ,compensation costs if 'one of your employees is injured on the at the"Department of Consumer and Business As an employer, you must the tax payment even if you or. visit their web sitea.t federal income tax the tax. For a .employees' wages~ EIN number, call the . of Concerns . . Code the permit holder for bro,:ght to your attention you are responsiole-.;fQf .:csolving any failure to meet code ~ }r' " " . . . . Insurance: such as \', ~ to 'see-ify<;nihave' adequate -insurance water 'damage froril'p~pe pu.nctures,nre.or /, must'be redone. .-. -;- C. \ - \ \ \. - " , .'. ': ...J ..'V ~ ],.' sure you sufficient time to your r~-... -.... "0 , / '>.,\ / \: <J ...... \..\ ' , -'",-' .'\. . .' '. '" "'. . contfa~t~,~)o coordinate :the work of rough-in so can perfonn the required inspections. ... '-. . . the skills to building officials as questions call the Construction 97309-5052. (503-378-4621) or Vlrite the agency at PO 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 COM2007-00949 COM2007-00949 COM2007-00949 COM2007-00949 COM2007-00949 Payments: Type of Payment Check cReceint I RECEIPT #: 1200700000000000824 Date: 06/26/2007 Description + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Backflow Device Minimum/Adjustment Plumbing Paid By J DAVID SCHIFFFER Item Total: Check Number Authorization Received By Batch Number Number How Received djb 5676 In Person Payment Total: Page 1 of 1 10:01 :54AM Amount Due 2.25 3.60 4.50 14.00 31.00 $55.35 Amount Paid $55.35 $55.35 6/26/2007