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HomeMy WebLinkAboutPermit Plumbing 2006-9-15 225 FIITI-I STREET. SFRINGFIELD, OR 97477 . FI-I:(541)726.3753 · FAX: (541)726-3689 5 City Job Numb.. COW\ ~ <:> ,- 0 II " · zj Job Location 8cB .5 5 +~ S T_ ed U .~ ,..---4 ~ Owner IfZA"i'~ ~ ~ Address BOI? City Sf?R',t-l~Fiel...D ~ .~ a (j) P"-1 (j) () .~ > (j) a ~ o .~ ~ ~ (j) > (j) ~ ~ ~ o f'~ ~ U cd en S!?~ 2::;1 E i'6 C3; f1= r: {~~~L, K:' Assessors MaY' 17023"""3>r7... Ols3l( . Tax Lot CO"r'- c, c; -ll1 Phonf' 541- 74b - 7't78 .S:/: . Stat/" OK Zip q7478 BACKFLOW PREVENTION DEVICE PERc1\tIIT FEE: $55.35 Contractor Information 100\0 . "~c. \ ......! ~\ '\\ --' ~_'\\\\\-J I ~e-.'- ,n\\ oJ." .",.:n \'(3.\1\ - ,.r...-.I '.'0\ . rr','""')'\\ .\..C (.~\~';'-', -.. s~\. \ rJ;.,. f"'. . ,.' ".' ,~ _ <;;' \~ .DBenf" rl',"". 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'7 Jr ;, (.",:, I I .. /' Checked for Historical Status ~ /' Date of Application Checked for Delinquencie~ ~ Shared Drive (T:)/Building Fonns/Backnow Prevenlion8.06.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 54 I - 726-3676 Fax 541-726-3769 Inspection Line -=ITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01196 ISSUED: 09/15/2006 APPLIED: 09/15/2006 EXPIRES: 03/15/2007 VALUE: Springfield TYPE OF WORK: Backtlow Device SITE ADDRESS: 808 55TH ST ASSESSOR'S PARCEL NO.: 1702331201534 PROJECT DESCRIPTION: Backtlow device Owner: TRA VIS COX Address: 808 55TH ST SPRINGFIELD OR 97478 Contractor Type Plumbing Contractor OWNER # of Units: Primary Occupancy Group: R-3 Secondary Occupancy Group: Primary Construction Type VN 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: Notes: Description Type of Construction TYPE OF USE: New Residential Phone Number: 541-746-7478 I CONTRACTOR INFORMATION I '\eS ,/01..1. ,? \a\N ~eC\\6cen.s'e\\\\\" ftxpiration Date Phone . o~e90f\ \Ie o~e9~' set 'O~'(\ . ~....\('\N. . _rI 0\/ '( , _" ~~e _ ,.,IY\- P.\I" byifumNG:i&FORMAl:~O~f.?-lj':)c\o~ '0'/ 'o\..~ 'of\ \.JV" 0,\0 '\.' II ~ - oi ~(\e ~\J ~ e x'\Ca\\ (\'\ -0 ?\8S \ ?,\\Of\ ~o \ ~ ~\9'f.'S'foties6\~\f\ CO . t(\8 \e e,. '2t\\Ow-ot Size: \f\ O~ ~Jg.Jft;;~f%&"et~t~f,~\~\\\\\" \'-\O\\,\C Sq Ft 1st Floor: 0090. -!~~'Pfq.f~D~e90f\ '2._'2.?i\A). Sq Ft 2nd Floor: C'2t\\~t\eruTYP~;s \_t)00-3'2> Sq Ft Basement: f\\J~an~€Ky.pe:\ Sq Ft Garage/Carport Energy Path: Sq Ft Other: Sprinkled Building: n/a Occupant Load: I DEVELOPMENT INFORMATION I REQUIRED PARKING Total: Handicapped: Compact: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: I PUBLIC IMPROVEMENTS I ~CJ~~ Sidewalk Type: \~ \'0X:. \S ~CJ\ DownspoutS/Draitf~'!Y\~\X:.~\1\~ ~CJ~ ~\\\;y;~~\\ ~~~~~ \~~~\)\)~~ \\ \\\S ~~ ~\1t.\) CJ~ \S ~ "\ \\\\~,C%\;I(.\), Oy~\\)'0, "\J~\\'l'- \w'\' I Valuation Description I \) ~~'{ \ 'Q\J $ Per Sq Ft or multiplier Square Footage or Bid Amoqnt '. Value Date Calculated Paee I of2 Status Issued .CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-01196 ISSUED: 09/15/2006 APPLIED: 09/15/2006 EXPIRES: 03/1512007 VALUE: 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 54]-726-3676 Fax 54] -726-3769 Inspection Line Total Value of Project Fees Paid I Fee Description + ]0% Administrative Fee + 5% Technology Fee + 8% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 $2.25 $3.60 $14.00 $31.00 9/15/06 9/15/06 9/15/06 9/15/06 9/15/06 220060000000000]298 220060000000000]298 2200600000000001298 2200600000000001298 2200600000000001298 Total Amount Paid $55.35 I Plan Reviews, To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Reouired Insoections I Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further ceJ'tify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. ~$; ~ - / Owner or Contractors Signature q/'5hb Date Pa2e 2 of2 y Address: <go 8' ~ .Jh ell 9.6 , S S +-l-. s+- Date: , /r /oro I I 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 #: C OVVl ~~. Issued by: Statement: Information Notice to Property Owners About Construction Responsibilities Nott Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not lice~sed 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. Thi~ statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: lfl. g2. 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! hire subcontractors, I will hire 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 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. .~~ .. t;/ 9/l~/e;c.. (Signatllre of permit applicant) , (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 06-01-04 ll_ . ~ .~ Acting 'as ~ our Own General Contractor? . ~ ~ -. INFORMATION. NOTICE' TO PROPERTY OWNE~S ABOllT CONSTRUCTION RESPONSIBILITIES r.:. , '. 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 construc't 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 ~oncerns. Employer Responsibilities . ,. .' You will, in most instances,. be ruled to be an "emploJ:er~"an~ the contractors you contract with will be "employees" if you USIe contractors.not licensed with the Constructi~n Contract~rs Board i<;> do labor in constructing or to assist in the construction OI." impr~vement of a residential structure. As the employ~r, you must comply with the following: . ., Oregon's Withholding 'fax 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 purpose's'.. ' 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 compined number for b{)th Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503~945-8091 or www.dor.state.or.us/formsnav.html1 for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and mustob~a.inworkers'. compensation insurance for your employ~es. If you fail to obtain workers' cVUlpensation insurance, yoil could be subject to penaltIes and be liable for all claim costs if one OfyOuT 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' wage~>< 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 1-800-829-4933 or visit their web site at www.1rs;gov. Other 'RespoQsjbiliti~s and Areas Qf Concer,!s ' 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 employee~) <, ; 1 .'~ . Expertise: Make sure you' have the skin~ .to act asyoui own generahOrttractor~ tOc6ordirtate' 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 Sprii\gfieJdY, Oregon 97477 541-726-3759 Phone (" <)f Springfield Official Receipt 1. Jopment Services Department Public Works Department Job/Journal Number COM2006-0 1 196 COM2006-0 1 196 COM2006-0] 196 COM2006-0 I 196 COM2006-0 I 196 Payments: Type of Payment CreditCard cRcccint 1 RECEIPT #: 2200600000000001298 Date: 09/15/2006 Description + 5% Technology Fee + 8% State Surcharge + ] 0% Administrative Fee Backtlow Device Minimum/Adjustment Plumbing Paid By TRAVIS COX Item Total: Check Number Authorization Received By Batch Number Number How Rl~ceived 018 0]5586 In Person Payment Total: Page] of I 9:51:l1AM Amount Due 2.25 3.60 4.50 14.00 31.00 $55.35 Amount Paid $55.35 $55.35 9115/2006