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Home My WebLink AboutPermit Plumbing 2006-2-24 225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 =J OJ .~~.~ t,_t Job Location '"1... :2- ~ ~ Assessors Mar .,)~q r-----1~ ~\ Ii' Owner ~\ 1"',..,Jil ~~ ~4 .i J~_5 .'~,' .(-.4 ;-- ~ ...",..,. ~ ~; _.,~ ~\ r;....,Ll~ ~) ~) ."~1 ~, (4j),~ di ~J ~) ..., .,)~~ I~_b ~'l ~1 ~ ~... ~f\'~ ~ ~4 ~\-.H ~ 0; r;,r:~J~ 1,--1, ~;l 'r~,Jq ~) ~? ~l ~i ~ ,I CITY OF SPRINGFIELD, OREGON Sa:oIJ:llDli\'l<<:ilIFOa;lL.1O> ' -~ ..~~~ City Job Number CO..."" ~.......-6 - 0-0 2l r s \" ~ C'1 ':' L~~. '{\~ /7032..710 q---R ~~ C"'Y~\ ~~~, \~. oC> ~O ( Tax Lot ~~o,C\.~~ \-.,.., ~< '(' r if" ,.." , ~ .. -- Address .:.'2..:2 q g c; \i\ = A '( \ C1- ~i"" ? "c."" City S~~, ~~ ~"u'> \c\ Phon/" ('1/ "2- ?7 ..2. 9:2- Zip 4' :;z... ~/-? 7- Stat!' t"'! ~ , .- AllEN IIUN: UI~!:lUd Ii:lW It:LjUIIt:;:, yuu .u BACKFLOW PERMIT IS $53.10 (includes ~ORi~~~SU:l':tmlil%Bwdrt\~HYstrative Fee) Notification Center. Those ruFes are set forth in OAR 952-001-0010 through OAR 952.001- 0090. You maylobtain;copies at th~.rj)Jes,by-- calling the center. (Not~...the-rerepho~e number for the'O..reg~Utility Notification ~ - - - - ~ ~\ CeAter IS l-tlUU.,j,,~.~J"t"tI' , ~, Phon!' /' // / Construction Contractors Registration # Contractor Information Contractor o \N' t'l P C" Addres':' City Statf" Zip Expires By signing this permit/application, I agree to call for an inspection once the backflow prevention devise has been installed and is visible for inspection (726-3769). I also state that all info~on this permit/application is correct. N01\CE~ t\ll E~~\f\E \f 1\-\ S NO\ , 1H\S PERM\~ ~~OER 1H\S PERM\\\~ '\ \ ~ll\HOR\IE \~ M~f\N~NiP (/ / Signaturf' 1\1\ 0 -'~A ~ \ ~ 0 ~ CA ~ r tffMMr.t-\CEO OR ,~tfP /' ~ L 0 (':) AN'I180 01\'1 \'t.~ . I I For Office Use Date of Application 7fr~b ~ Checked for Historical Status ..---- Checked for Delinquencie~ Shared Drive (T:)/Building Fonns/Baekflow Preventionl-06,doc ~"".zG'~ iii, . .,~ :. WI1L ,ae;,' , . 'aU" ! . ".- -~--~- -----"- ..- .-.- -. \ ) CITY OF SPRING~lEL]} Building/Combination Permif PERMIT NO: COM2006-00218 ISSUED: 02/24/2006 APPLIED: 02/24/2006 EXPIRES: 08/24/2006 VALUE: Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 2298 SHADYLANE DR ASSESSOR'S PARCEL NO.: 1703271000801 Springfield TYPE OF Backflow Device PROJECT DESCRIPTION: Install backflow device TYPE OF USE: New Residential Owner: Address: MARGARITO GARCIA , oe. 't:Ql 2298 SHADYLANE DR \N re~uwes '1 \J:'."~'L'; SPRINGFIELD OR 97477\ON', oregon \a t\le ore90n.:"8~ '0"r~(\\ --1~\\.'1' - >",r\ '0\1 ,_ ",rP. ;;l _,' r-( - u\eS auul"- ..hOSe IU\~;:.,,\~ <;:;2::(..-'-'- ' ., 'o\~~W ~\on C~6NJl~-AwrQR IN,EORMATION . NO''i.I'lca t') 0 -uC, OOI\::P ~' '.-, ~ . (.\boP-.95&-- obtaIn c , ,t\,e \e\e~>-.,,_ ContractOr -ioU rna'l (Note" Not\b::Llcense OWNEll090:",,'J ,,\Ie cen\~r:Otion \J\\\I\~n A/\\. ~~~ber 'i~e;1NFOiMATIONI Ce # of Stories: Height of Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Contractor Type Plumbing # of Units: Primary Occupancy Group: Secondary Occupancy P'rimary Construction Type Secondary Construction # of Bedrooms: R-3 VN I DEVELOPMENT INFORMATION. , Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Storm Sewer Available: Special Instruction: Phone Number: 541-912-7292 Expiration Date Phone n/a 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: .. Downs pouts/Drains Notes: I Valuation Description I Description $PerSqFt or multiplier Square Footage or Bid Amount Tvpe of Construction 1 of 2 Value Date Calculated ~$,P,"A, ING,,'F.','liE, U) iii",',.,,',',' ""(.,"'. LAt.1 \ --.::-. : Status: Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00218 ISSUED: 02/24/2006 APPLIED: 02/24/2006 EXPIRES: 08/24/2006 VALUE: Total Value of Project L Fees Paid I ,. Fee Description + 10% Administrative Fee + 8% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid Receipt Number $4.50 2/24/06 1200600000000000198 $3.60 2/24/06 1200600000000000198 $14.00 2/24/06 1200600000000000198 $31.00 2/24/06 1200600000000000198 Total Amount $53.10 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. 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 wiD 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 wiD remain on the site . at all times during construction. Owner or Contractors Signature Date kn.~o~~~~ r:;:",c~~ '2/ :L ~ ~-6 2 of 2 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 pennit#:COIMZ.O'E~;G- C> OZI r Address: ~Z- '1 <F <;;.hA-d(,f~e-~tL ~ Date: C;/Z<( 10 b / - I Issued by: St~tement: Info. mation 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 ORS701.010(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: ~1. ~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 thatall subcontractors who work on the structure must be licensed with the Construction Contractors Board. ' OR V 3B. I will be my own general contractor. If I 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. "" "" ~ "\ N '" ':. \,., . S; ,<" ;., z /~ If ft r;, (Signature of permit applicant) , I (Dat91 (White copy to issu~ng agency permit file, pink copy to applicant.) Property- owner. doc 06-01-04 ....: Acting as:'~~ol!'t. Own General Contractor?' . . " 'INFORMATION' 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. Employer Responsibili~es . You will, in most instances, be ruled to be an '-'employer" and the co~tractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructipg.or to assist in the ._' construction or improvement of a residential structure. As the employer, y~)U must comply with the following: . ,.' . ~. , " ' , - ' 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 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 purposes-, on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. " ''t-- The Oregon Business Identification Number (BIN) is a combined npmber for both Oregon Withholding and; Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htm11 for the appropriate forms. 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 obtai~ wor~ers', CVH1pensation insurance, you could be subject to penalties arid 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' wag~ 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 w\vw.irs.l!ov. Other ResponsibilitIes 'and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resoiving 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 redo!1~', ~ '~ ./- Time: Make sure you have sufficient time to supervise' your employees. . ~.. ,"' . "~- . . . ! Expertise: Make sure yoilhave the skills to act as your oWn' general cohtractor, 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 06-01-04 225 Fifth Street S~ringfield, Oregon 97477 541-126-3759 Phone 1tIr6',"[j~:$;~.,.' t , .. "~ ;--'A!f ~ " ~/", ~ ".~~,_jL.".",.,._ ,,~, .:,~ "'~~__~ >,_.,~~1 rity of Springfield Official Receipt ~velopment Services Department Public Works Department "., Job/Journal Number COM2006-00218 COM2006-00218 COM2006-00218 COM2006-00218 Payments: tyPe of Payment Cash Change ::..'} Ji~/Journal Number CpM2006-00218 CbM2006-00218 COM2006-00218 COM2006-00218 Payments: Type of Payment Cash Change I~ } : :'j '7 .~~ .~' :~ :t' ,1 , J , . ~~ ,I ':1 :y~ (~' ,\ 2/24/2006 RECEIPT #: 1200600000000000198 Date: 02/24/2006 Description + 8% State Surcharge + 10% Administrative Fee Backflow Device Minimum! Adjustment Plumbing Paid By MARARITO GARCIA MAGARITO GARCIA Item Total: Check Number Authorization Received By Batch Number Number How Received djb In Person djb In Person Payment Total: Description + 8% State Surcharge + 10% Administrative Fee Backflow Device Minimum! Adjustment Plumbing Paid By MARARITO GARCIA MAGARITO GARCIA Item Total: Check Number Authorization Received By Batch Number Number How Received djb In Person djb In Person Payment Total: I of I 9:21:39AM Amount Due 3.60 4.50 14.00 31.00 $53.10 Amount Paid $60.00 , ($6.90) $53.10 Amount Due 3.60 4.50 14.00 . 31.00 $53.10 Amount Paid $60.00 ($6.90) $53.10