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Home My WebLink AboutPermit Building 2006-7-27 Status Issued 225 Fifth Street, Springfield, OR 54]-726-3753 Phone 541- 726-3676 Fax 541-726-3769 Inspection Line , CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00775 ISSUED: 07/27/2006 APPLIED: 06/23/2006 EXPIRES: 01127/2007 VALUE: $ 438,521.00 SITE ADDRESS: 6446 FOREST RIDGE DR ASSESSOR'S PARCEL NO.: MOUNTAIN GATE PH 3 SPRINGFIETYPE OF WORK: Single Family Residence TYPE OF USE: New Residential PROJECT DESCRIPTION: Single family residence - Mt Gate lot 94 Owner: Address: CAS LEY JEFFREY 923 S 55TH PL SPRINGFIELD OR 97478 Contractor Type General Electrical Plumbing Afr '- . Phone Number: 541-954-6564 EN / 'u, tOl/ow rUI v. Urf:)9Uflla Not;,;"",. liS adol2.ta.... w reOJJJlD~ In OA D 111:, r lJenter -, Lyme Ore ..' j vu to I CONTRACTOR I~_~e'tto\liOl-ooi~hose rUles B~on Utility caw '" may Obt~. thrOUgh ~R e Set fom nu ~'tmt!tfltttante {6~YJH~~S2J.lJwte rn er for the 0 r. Note: the t rUles b, 15!f91f.r;s 1~:gon d/liRPl;y.ptJ~~hon$}n -998- 7187 65065 OO".l3aM1JJl,.flfICBticiril-342-3765 BUILDING INFORMATION. Contractor OWNER BA TEMAN ELECTRIC INC STEVE R JOHNSON # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: 45.00 10.00 12.00 88.00 50.00 1 R-3 U VN # of Stories: 2 Lot Size: Height of Structure 32.00 Sq Ft 1st Floor: Type of "~~C" Forced Air Gas Sq Ft 2nd Floor: Water T9\M:11 C E : Gas Sq Ft Basement: Range TyPl~S PERMIT SHALIGD~PIRScjfFlIlH!~rport Energy lkU'rHORIZEO UNO~lfthrHIS fS~ffIt1W~srNOT Sprinklee~wt~tEO OR 1~/~BAND~~5ar6~oad: I DEVELOPMEN1FINFciRMATIimfLf. 988 422 22,720 1,903 2,002 4 Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of Lot Coverage: REQUIRED PARKING Total: 2 Handicapped: Compact: Hillside 3 Yes 25.60 Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: I PUBLIC IMPROVEMENTS. Fully Improved Sidewalk Type: Curbside 5' Yes Downspouts/Drains: To Storm Sewer Storm water and sanitary sewer connections at NW corner of lot via private system Notes: No hookup to City infrastructure until Public Improvements are accepted by the City; storm drainage piped to storm sewer via private system 07/03/06 CJS Pa2e 1 of5 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Description Type of Construction AC - Residential Deck V Wood Frame Gara2e Gara2e A.C. - Residen Deck/Balcony Dwellin2s Gara2e Garae:e Fee Description Plan Review Residential + 10% Administrative Fee + 8% State Surcharge 3 Baths One & Two Family Addressing Assignment Appliance Vent Building Permit Curbcut Permit Dryer Vent Exhaust Hoods Fire SF Fee - Residential Furnace - more than 100,000 Gas Outlets 1-4 Gas Outlets 4+ Mountaingate Impervious Area Plan Review Major - Planning PW Disc - 2nd Permit (Street) Sanitary Sewer - Improvement Sanitary Sewer - Reimbursement SDC MWMC Administration SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC Transpo Reimbursement Sidewalk Permit Storm Sewer Each Addtll00' Temp Power 200 amps or less Vent Fan Willamalane Single Family I Valuation Description I $ Per Sq Ft or multiplier $4.00 $18.00 $99.00 $26.00 $26.00 Square Footage or Bid Amount 3,827.00 496.00 3,827.00 988.00 374.00 Total Value of Project ~ Amount Paid $1,096.49 $238.22 $169.31 $306.00 $31.00 $6.00 $1,667.40 $80.00 $6.00 $9.00 $265.75 $15.00 $4.00 $1.00 $1,883.57 $198.00 $-30.00 $762.80 $1,002.80 $10.00 $865.31 $82.03 $220.13 $59.62 $805.70 $182.69 $80.00 $28.00 $50.00 $24.00 $1,000.00 Date Paid 6/23/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 7/27/06 Pa2e 2 of5 CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2006-00775 ISSUED: 07/27/2006 APPLIED: 06/23/2006 EXPIRES: 01127/2007 VALUE: $ 438,521.00 Value Date Calculated $15,308.00 $8,928.00 $378,873.00 $25,688.00 $9,724.00 $438,521.00 07/19/2006 07/19/2006 06/23/2006 06/23/2006 07/19/2006 Receipt Number 1200600000000000938 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 1200600000000001148 CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2006-00775 ISSUED: 07/27/2006 APPLIED: 06/23/2006 EXPIRES: 01127/2007 VALUE: $ 438,521.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Amount Paid $11,119.82 I Plan Reviews I Initial Review Plan Review Comments 06/23/2006 LLH DLM 06/23/2006 07/19/2006 APP 10 Planninl! Review 06/23/2006 07/19/2006 APP TAJ Public Works Review 06/23/2006 CJS 07/03/2006 APP Structural Review 06/23/2006 DLM 07/21/2006 APP Talked to owner about BONUS ROOM above garage. It is accessed from, and is part of the garage environment & cannot be heated above 55 degrees or used for habitation. Therefore, it does not require insulation to residential standards. However it does require fire separation from the attic area of the dwelling. Either place construction fencing to the driplines of the trees to be preserved or fence off the back portion of the lot. Follow the tree preservation guidelines in the attached Hillside Development handout. Choose street trees from the list of Hillside trees in the street tree handout. No hookup to City infrastructure until Public Improvements are accepted by the City; storm drainage piped to storm sewer 07/03/06 CJS Called engineer for clarification of steel requirement in garage pier footings. 7/18/06 dim Engineer returned call verifying the steel shown on the drawings & requesting a note to be added to retaining wall detail onpg.47. 7/21/06 dim. 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. ~e{]uireCUnsnections I Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete. Pal!e 3 of 5 CITY OF SPRINGFIELD Building/Combination Permit Status Issued PERMIT NO: COM2006-00775 ISSUED: 07/27/2006 APPLIED: 06/23/2006 EXPIRES: 01127/2007 VALUE: $ 438,521.00 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to floor insulation or decking. Floor Insulation: Prior to decking. Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Final Building: After all required inspections have been requested and approved and the building is complete. Underfloor Plumbing: Prior to insulation or decking. Underfloor Drain: Prior to cover or placement of concrete. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Underfloor Mechanical. Prior to insulation or decking and including required testing. Underfloor Gas: After line is installed and required testing and capped if not attached to an appliance. Rough Gas: After line is installed and required testing and capped if not attached to an appliance. Gas Service: After line is installed and line has been connected to a minimum of one appliance including required testing. Presure test done at this point. Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Final Mechanical: When all mechanical work is complete. Temporary Electric: Approval required prior to Utility Company energizing pole. Pa!!e 4 of 5 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: COM2006-00775 ISSUED: 07/27/2006 APPLIED: 06/23/2006 EXPIRES: 01127/2007 VALUE: $ 438,521.00 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. :!!!. c~ Signa'"" Paj!e 5 of5 7/:J-7/~G Date CITY OF sf~NGFIELD SYSTEMS DEVELOPME~"'ORKSHEET JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS 1. STORM DRAINAG~ DIRECT RUNOFF TO CITY STORM SYSTEM 1 IMPERVIOUS S.F. x COST PER S.F. II CHARGE I 5831.50 $0.323 = 1 $1.883.57 . RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS S.F. I x COSTPERS.F. 'I x 1 DISCOUNTRATE I _ 1 0.00 I $0.323 I ' 50% - 1 ITEM 1 TOTAL - STORM DRAINAGE SDC '$1,883.57 I C0M2006-00775 Casley , 6446 Forest Ridge Dr. Mt. Gate Lot 94 SINGLE FAMILY RESIDENCE 1 BUILDING SIZE (SF: 5215 LOT SIZE (SF): 22720 rfJ ~ Cl o U ~ ~ E-< rfJ >-< Id ~ DISCOUNT $0.00 $1,883.57 /1070 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: NUMBER OF DFU's x COST PER DFU 40 $25.07 $1,002.80 1091 B. IMPROvEMENT COST: 'I NUMBER OF DFU's x 1 40 $]9.07 $762.80 1'1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC =1 $1,765.60 3. TRANSPORTATION A. REIMBURSEMENT COST: ADTTRlP RATE x NUMBER OF UN]TS x 1 COST PER TRIP x 1 NEW TRIP FACTOR 9.57 ] 1 $]9.09 I 1.00 ' $182.69 1093 B. IMPROVEMENT COST: I ADT TRIP RATE x NUMBER OF UNITS x 1 COST PER TRIP x NEW TRIP F ACTORI . 1 9.57 ] I $84.19 1.00 , $805.70 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = I $988.39 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU's x ICOST PER FEU 1 I $82.03 = $82.03 1054 B. IMPROVEMENT COST: INUMBER OF FEU's x ICOST PER FEU 1 1 I $865.31 = $865.31 I 1055 MWM~ CREDIT IF APPLICABLE (SEE REVERSE) , $0.00 1054 MWMC ADMINISTRATIVE FEE $10.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC =, $957.34 . SUBTOTA~ (ADD ITEMS], 2, 3, & 4) = 1 $5,594.90 5. ADM]NISTRATIVE FEE: ' I SUBTOTAL x I ADM. FEE RATE CHARGE I $5,594.90 I 5% $279.75 TOTAL SANITARY ADMINISTRATION FEE: , 220.13 ' 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: I, $59.62 1078 Carol Stineman 7/3/2006 TOTAL SDC CHARGES =1 $5,874.65 PREPARED BY DATE DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (N01E: FOR REMODELS, CALCULA 1E ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUNALENT UNITS IBATIlTUB 2 0 3 = 6 I DRINKING FOUNTAIN 0 0 1 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0 IINTERCEPTORS FOR SAND / AUTO WASH / ETC. 0 0 6 = 0 ILAUNDRY TUB 1 0 2 = 2 ICLOTHESWASHER/MOP SINK 1 0 3 = 3 ICLOTHESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRIG / WATER STATION / ETC. 0 0 1 = 0 I RECEPTOR FOR COM. SINK / DISHWASHER / ETC. 1 0 3 = 3 SHOWER, SINGLE STALL 2 0 2 = 4 SHOWER, GANG (NUMBER OF HEADS) 0 0 2 = 0 SINK: COMMERCIAL/RESIDENTIAL KITCHEN 1 0 3 = 3 SINK: COMMERCIAL BAR 0 0 2 = 0 SINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 SINK: SINGLE LAVATORY/RESIDENTIAL BAR 5 0 1 = 5 URINAL, STALL / WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRIVATE INSTALLATION 4 0 3 = 12 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 40 *EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFD's) set at ]67 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE YEAR ANNEXED BEFORE ]979 ]979 ]980 ]98] ]982 ]983 ]984 ]985 ]986 ]987 ]988 ]989 ]990 ]99] ]992 ]993 1994 1995 1996 1997 ]998 1999 2000 2001 CREDIT RATE/$l,OOO ASSESSED VALUE $5.29 $5,29 $5.19 $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $0.09 $0.05 ]S LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter] for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR 2 2 ]979 CREDIT FOR LAND (IF APPLICABLE) VALUE / 1000 CREDIT RATE $0.00 x $5.29 = I $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE $0.00 x $5.29 o TOTAL MWMC CREDIT $0.00 = ,," , '. ' ", " " ' , , - ' :: ,: ,'" .,,:: ", '. CITY: OR, RINGFIELD: OREGON.; >:',: : -,~ ': ".~'.,.... 't,~'~~'~-, .fJ.,. ,.\,,'~..."'-~ ~ ~:..'-~,.,<~.' -),':;/.., ",..>':_{~ t< SPRliMCi"Ifi!:LD: _ '_ i :;;::~~~~==::::~~ :'(S4I)n~7S3 .FAX'(S41)~ <-~ . City Job Number CO"""" zc>c:sG-0077 S Date ' ""'u ,";' 2 \ ~ ~ f'J' '^' 3. COMPW1.~FEE SCHEDULE BELOW 1. ,LOCATION OF INSTALLATION . bl{t.{b F~ ~-ael-- DIt / ',' LEGAL DESCRIPTION JOB DESCRIPTION . ,~t> ?~j &t. Penn its are non-transferable and expire if work is not started within 180 days ofissuance or if work-is . Suspended for 180 days. 2. ; CONTRAt:1UR INSTALLATION ONLY - _. . - . - - Electrical Contractor Address City Phone Supervisor License Number ~ ~/ / Exph-ation Dote ,\ t,~ Constr. Contr. Numbert~/ Expiration Date I S. fS' {, EI .. Ignature 0 upervlsmg ectriclan Owners Name Lfd~f uJ ~M. \~ Address q t; ~. 65th PL. City ,~~l\.~t:,J Phone '16"1-105 W .-. U OWNER INSTALLATION The installation is being made on properly I own which is not intended for sale, lease or rent. Owners Signature: :PI- '1: 1./ Inspection Request: 726-3769 A. New Residential- Single or Multi-Family per'dwelling unit. . . Service Included 1000 sq. ft. or less Each additional 500 sq: ft. or portioQ thereof ' Each Manufact'd Home or Modular Dwelling Service or Feeder ! ~~r-:~,~Tt0~~' On'~aon law requires you to B. ServiJ:~ 9r,r~~fs~~~~~lati9Jl.' AltefationSo on .Ralocation: k '~'n rd."" C,~,ul-,Ic;a.Dy lne UI\j\:jUII uTHny , 200 AIriP~:~~~I~;s,ion Center. Those r~leS~~rp.~~~ for~h 201 Ai;; (~:\:-40" "0:'5..'2-001-0010 till UU~'I 0 -GO I:' mps LV nmps b' . < . C" 1_.. 401 A nO(?t:'l'60Vc,o'Amay 0 tam vUI-',e;;:, v. e rooe" ..11 mps o. ps (".." t 25. _ C8.lIlon the center. I\lULt:1. lite; e e[?nonv 60] Am~~J?l1lg00~' ~W~e Oregoft-t}:ility-M:Wfl89ticn Over lOw Amp olts . 1 80n 'J0t') t')0~i\75.00 ' Reconnect Only enter IS - \:r;:rv'~ ~~ $'51.>.00 $106.00 $ 19.00 . $50.00 c. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less / 201 Amps to 400 Amps 40 I Amps to,,600 Amps qver 600 Amps or 1000 Volts see "B" above. D. Branch Circuits .- . . , ' if, ~ : New AlteratioJi or'Extension Per Panel One Circuit~IS PERivill SHALL EXPIRE If .iBtoo WORK Each Additlbli81 OCEncillJ lOr ~ib) E R T HIS PER IVI TIS I~ 0 T Service or'Peetfer.iPermito OR IS A n A .lnOI$E1L,)O'On VV!V'iIVlLI~VL nunl~u 1\1 r I ,-' f',';" ,,,-,,. ,\;';\1 D!=B10n E. l\fiscellaneous (Servi(Je/reooer Dot included) -Each Installation .. ~- ~ $ 50.00 $ 69.00 $100.00 50 , , 't' Pump or irrigatioii $ 50.00 .~ Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Pennit Inspection Fee is $45.00 + Surcharges 4. 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HI~.U~ ;';:J..ln::!>;J. <l1 (#h'!f!~,',e}<JH'D' OJ) iHi~.;. \,) MI:{;gl).,;.3i.l"1,lif3 "tJZ: f?1t )S;l,\"7tQH~) 22~ Fifth Street Springfield, Oregon 97477 541-726-3759 Phone r' 'of Springfield Official Receipt A.. _ lelopment Services Department Public Works Department Job/Journal Number COM2006-00775 COM2006-00775 COM2006-00775 ' COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006~00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 COM2006-00775 Payments: Type of Payment Check cReceint I RECEIPT #: 1200600000000001148 Date: 07/27/2006 Description Addressing Assignment Willamalane Single Family Temp Power 200 amps or less Fire SF Fee - Residential Sidewalk Permit Curbcut Permit PW Disc - 2nd Permit (Street) Mountaingate Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/Storm Admin SDC Transpo Admin 3 Baths One & Two Family Storm Sewer Each Addtl 100' Furnace - more than 100,000 Vent Fan Appliance Vent Exhaust Hoods' Dryer Vent Gas Outlets 1-4 Gas Outlets 4+ Plan Review Major ~'Planning Building Permit + 8% State Surcharge + 10% Administrative Fee Paid By JEFF CAS LEY Item Total: Check Number Authorization Received By Batch Number Number How Received njm 5290 In Person Payment Total: Page 1 of 1 9:04:27 AM Amount Due 31.00 1,000.00 50.00 265.75 80.00 80.00 (30.00) 1,883.57 1,002.80 762.80 182.69 805.70 82.03 865.31 10.00 220.13 59.62 306.00 28.00 15.00 24.00 6.00 9.00 6.00 4.00 1.00 198.00 1,667.40 169.31 238.22 $10,023.33 Amount Paid $10,023.33 $10,023.33 7/27/2006 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 /1 , Permit #:(by;;;'f0\t;:V~-OO 775 ' '~~ , Address:_(; ..<;-<<& /DhL6/~. .1~uedbY' 1n11./'( Dat< -r/;;'/~ ~ U 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 Boardto sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical and plumbingpermits. 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: ~ 1. . I own, reside in, or will reside in the completed structure. . ~2. D 3A. My general contractor is I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. IV/A (Nalne) /?:/-/f (CCB #) I. will instruct my general contractor that all subcolltractors who work on the structure must be licensed with the Construction Contractors Board. ~ OR ' , ~ ,3B. I will be my own general contractor. In hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. In 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 of the contractor. I hereby certify that the above information is correct and that 1 have ,read and do understand the Information Notice to Property Owners about Construction Resp~J.lsibilities on the reverse sideofthis form. . ~~ P/,/n(; t/ - (Signature of pernlit applicant) , ~e) (White copy to issuin,g agency permit file, pink copy to applicant.), PropertLowner.doc 06-01-04 Acting as lour 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 contiactqr to construct a ,new home or make' a substantial improvement to an existing structure, you can preventtnany problems by being aware of the following responsibilities and concerns. ,\' Employer Respons~bilities . . . ~ .... . . You will, in mqst instances, be ruled to be a:n "employer'"and t~e,.contradqrs you contract with will be "eII!-ployees" if you use cQntractors p.ot licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction of improve~ent ofa residential structure. As the employeJ:, you must comply with the following: , . , -' ' Oregon's Withholding Tax Law:' As an' employer, you must 'withhold income taxes fro'm 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. , ' , . J. .... '. _.. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call ~03-~4~-8091 or WV\'W.dor.state.or.us/formspav.html1 for the app~ up' ;ate forms'. ' Workers' Compensation Insurance: As an employer, 'you are subject to the Oregon Workers' Compensation Law, , and must obtain ~ork~rs' compensation insurance fQr 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 inforInation, call the Workers' Compensation Division at the Department of Consurrierand' 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 1-800-829-493301' visit their web site at www.irs.Rov. , Other Responsibilities a~,d .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 i!lspections. J . LiabiUtyand Property Damage Insurance: Contact your insUrance' agent to see' if you have adequate'insimince coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redQne. ' . Time: Make sure you have sufficient time to supervise your employees. '\, .' . , - .... " . r.", '.. , Expertise: Make sure you have the skills to act as yoUr . oWn general contractor, 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. ~: . '., -"i \..~. PropertLowner.doc 06-01-04