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Home My WebLink AboutPermit Plumbing 2003-9-22 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: COM2003-00946 ISSUED: 09/22/2003 APPLIED: 09/22/2003 EXPIRES: 03/22/2004 VALUE: SITE ADDRESS: 6015 MICA ST ASSESSOR'S PARCEL NO.: 1802033400135 TYPE OF WORK: Backflow Device PROJECT DESCRIPTION: Install backflow device TYPE OF USE: Owner: MARK LEMLEY Address: 6015 MICA ST SPRINGFIELD OR 97478 Contractor Type Plumbing 'I CONTRACTOR INFORMATION' Contractor OWNER License BUILDING INFORMATION' # of Buildings: # of Stories: Primary Occupancy Group: R-3 Height of Structure Secondary Occupancy Group: Type of Heat: Primary Construction Type VN Water l);p'e:'lreS yOU to \~~,!...I",4\.A 'rw Secondary Construction Type: :nON:oregR,an~et l~Jte,:(egon UtI I [ # of Bedrooms: 'A.1iEN, adoptE.En'etg;rPath:s are set 10rt to\\oW rules oter. ihose rule AR 952-00' ,..._~~innCe .~A""~nllnhO ._.... \ l~uO.;R 952.FDEYEL~~~ENq'':IN~OiMA.~i-i!i>N . 0090. :oUt~;~enter:~~l~I~.i\;~~ Not(ncation calling tor the C(i);y,(trJay ~~~':2344). nurnber ter is#\Sfr:'e~f:rrees Rqd: cen Paved Drive Rqd: SETBACKS Front yard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: % of Lot Coverage: New Residential Phone Number: 541-343-2010 Expiration Date Phone Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Impervious Surface Area: REQUIRED PARKING Total: Handicapped: Compact: I PUBLIC IMPROVEMENTS' NOTICE: s~eHE\fJOReK THIS PERMIT SHALL EXPIRErl~J!W~Wfains: AUTHORIZED UNDER THIS PE 1tvtt r COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. I Valuation Description I $ Per Sq Ft or multiplier Square Footage or Bid Amount Description Tvpe of Construction Total Value of Project Paee 1 of 2 Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2003-00946 ISSUED: 09/22/2003 APPLIED: 09/22/2003 EXPIRES: 03/22/2004 VALUE: 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Backflow Device Minimum/Adjustment Plumbing Amount Paid Date Paid $4.50 $3.15 $14.00 $31.00 9/22/03 9/22/03 9/22/03 9/22/03 Receipt Number 1200200000000002185 1200200000000002185 1200200000000002185 1200200000000002185 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. I Reouired Insoections I 1 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 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. ~/J~A<: 9-22~DS . I/'~ Owner or Contractors Signature Date Paee 2 of 2 Address: 6o/~ ":b~ -'09'1b /NIl w4- So, 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 ~Wz.aO_ Issued by: Date: '7 .- z.z -0.3 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 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: k1. ~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 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 ofthe name ofthe 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. ~J7L4Lq~ (Signature of permif'apP1icant) 9-,')2 -0 S (Date) (White copy to issuing agency permit file; pink copy to applicant.) Property _ owner. doc 03/11/03 Acting as Your: Own General Contractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CdNSTRUCTION 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 foHowing responsibilities and concerns. Employer Responsibilities 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 improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withbolding 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 ill number, callthe Business Information 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 aU employees. For more infonnation,call the Oregon Employment Department at 503-947-1488. \Vorkers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' CVlllpensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation 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 information, can 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 [W111 employees' wages. 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 866-816-2065 or fax them at 801-620-7115. - . . Other Responsibilities and Ar~as of Concerns 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 ~mpIoyees. Expertise: Make sure you have the skills to act as your o\.vn general co~tractor, to coordinate the work of rough-in and finish trades, and to notifY building offici<ils as the appropriate times so they can perform the required inspections. If you have additional questions can the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. PropertLowner.doc 03/11/03 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00946 COM2003-00946 COM2003-00946 COM2003-00946 Payments: Type of Payment CreditCard Receipt #: 1200200000000002185 Description + 7% State Surcharge + 10% Administrative Fee Backflow Device Minimum! Adjustment Plumbing Received By djb Check Number Batch Number Authorization Number Paid By MARK LEMLEY 000175 620418 City of ~llringfield Official Receipt Devel' . .~s Department. llepartment Date: 0' "1:15PM ~ 3.15 4.50 14.00 31.00 $52.65 Item Total: How Received In Person Payment Total: Amount Paid $52.65 $52.65