HomeMy WebLinkAboutPermit Building 2003-11-6
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-37691nspection Line
SITE ADDRESS: 1461 DELROSE AVE
ASSESSOR'S PARCEL NO.: 1703243304900
PROJECT DESCRIPTION: Dryrot
.
. Ul t OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01126
ISSUED: 11106/2003
APPLIED: 11106/2003
EXPIRES: 05/06/2004
VALUE: $ 500.00
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE:
Repair
Residential
Owner: JAMES CHORLTON
Address: 1461 DELROSE AVE SPRINGFIELD OR 97477
Contractor Type
General
Contractor
OWNER
.
# of Buildings:
Primary Occupancy Group: R-3
Secondary Occupancy Group:
Primary Construction Type VN
Secondary Construction Type:
# of Bedrooms:
SETBACKS
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
Bid Amount Use Bid Amount
Phone Number: 360-319-3475
I CONTRACTOR INFORMATION I
.\Ov .~~i
....,,, ,'~ f; E . t' D Ph
,~<<J3ICenS!\O xplra Ion ate one
o..-V 0" 0' $:)0
,0 .",($,,<:i .n' ,
I BUILDING INFeRM;\ 1-ION:'" ~J ~J-0~0 .
C\<,0q,- 0 'Q~ s0 ,- ~ 'oJ ~ '$'0 ~~O ~O~ .
# ~,t.St.o,!;teS:"~~,,,<,o~~ 0'" 0 ,~0 ~,v0' Lot Size:
~Belghtlof ~tructure O<:!:~ '$'0 ~O Sq Ft 1st Floor:
^<v~ T-ype:-;'t;'Heaf:'\:,~ ~,o\.~'...~~ n.t>.~' Sq Ft 2nd Floor:
~ ' ." v ,.- ~<7 ,'(" v' .~"
~ O~ \".:!ter~ypeo'Q ,." O~ ~'lJ Sq Ft Basement:
'~'1i.,C:R~fe'}rpe: 0~,0 ,rq($ rJY'"5 Sq Ft Garage/Carport
.:;.O~ t~ner!lY PatH: 0 0 v~ Sq Ft Other:
0' .... ~, ..:s' \c. .
.s- 0.0' .~Q, 'O~ or' ImpervIOus Surface Area:
_C'\.-.J .,\."\ (, ,..
I DEVELOeMENTINFORMATlON I
REQUIRED PARKING
Overlay Dist:. . R'-~ Total:
# Street Trees Rqd:. &:. ~\:l S),\Handicapped:
Paved Drive RqiI: Ii- '\~ ,S ~ Compact:
% of Lot Coverage: . ~~,<(.~~<(.~~ y.~<(.
-. .~.~\.':.... '\~,\,~~~~ .
I PUBLIC !lm~R6V~M~i ,S ~'Qf"
\~'~~~<(.~~~\) \~~~dewalk Type:
~\\~~\~ \)~ DownspoutslDrains: .
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I Valuation Descrintion I
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
500.00
Value
Date Calculated
Total Value of Project
Paee 1 of2
$500.00
$500.00
ll/0612003
.
. U 1 t OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-01126
ISSUED: 11106/2003
APPLIED: 11106/2003
EXPIRES: 05/06/2004
VALUE: $ 500.00
.
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
, F~~. Paid.l
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Building Permit
Amount Paid
Date Paid
Receipt Number
$4.50
$3,15
$45.00
ll/6/03
ll/6/03
ll/6/03
1200200000000002432
1200200000000002432
1200200000000002432
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.
~ Re/luired In.nection. I
1 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
2 Final Building: After all required inspections have been requested and approved and the building is complete.
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 ofthe Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will he used on this project.
I further agree to ensure all required inspections are requested at the proper time, that each address is readable from the
street, that the ermit a iI is cated at the front of the property, and the approved set of plans will remain on the site at all
\:: onstru io .
Wov
b
Qc?o~
d\s or Contra~rs Signature
Date
Paee 2 of2
(f).
. .
\'" .../
" "
. .
.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 #:
c.ovwwt3 _Otlz..b
Issued by:
iLl6/
~L<
be/ros c:
Date: 1/or03
Address:
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:
--2f1.
~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 00 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
~ 38. I will be my own general contractor.
If I 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 certi. if t at the ab information is correct and that I have read and do understand the Information
Notice t Pr p Ow s about Construction Responsibilities on the reverse side of this form,
\0" WnJ t:, - :;loo~
~ (Signature of permit applicant) (Date) .
\J (White copy to issuing agency permit file, pink copy to applicant.)
Property_owner.doc 03/11103
. . .
Acting as Your Own General Contractor?
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners about Construction Responsibifities was developed by the
Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legis/ature.
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 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 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 a State Business ill number, call the Business Information Center at 503-986-2200.
Unemployment Insurauce 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.
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 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, 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' 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 Areas 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 employees.
Expertise: Make sure you have the skills to act as your own general contractor, to coordinate the work ofrough-in
and finish trades, and to notit'y 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 03/11103
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01126
COM2003-01126
COM2003-01126
Payments:
Type of Payment
Check
8i
Receipt #: 1200200000000002432
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Building Pennit
Paid By
JAMES CHORLTON
Received By
djb
l:heck Number
Batch Number Authorization Number
City of Springfield Officiar Receipt
Development Services Department
Public Works DepartmeQt
Date: 11/06/2003 2:23:56PM ·
Amount Paid
Item Total:
3.15
4.50
45.00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65
.
.