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Home My WebLink AboutPermit Plumbing 2003-5-30 "i City of Springfield Plumbing Permit Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ...... PLM2003-00034 ') -<,~ .' '.-.-- 5/30/2003 5/3012003 11/3012003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 1412 I ST 1703362203400 Underfloor drain replacement for 3 drains Springfield TYPE OF WORK: TYPE OF USE: Repair Residential OWNER/APPLICANT: PLUMBING CONTRACTOR: SPECIALTY PLUMBING CO 2650 COUNTRY LANE ~~UGENE OR 97401 ~<(. ~\j~\)\ ~~<(. ~~\ ~~~CCB# 102974 , ~~ ,Co ~~ ~f\) ~ ,,\t>..\-"" '\..~\- ~\S\ Descrintion ~. -< c~ou!Jt PaiJl~ Date Paid ~'y' ~,- ~\.)'" ~:Q' + 10% Administrative Fe~tf:)\"\ <:?~~~~\) \) \)~ {o AQ 05/30/2003 + 7% State Surcharge \~S ~~ ~~\) r.r.,~ W5 05/30/2003 Fixture ~\'0 ~~ ~ ~ 42.00 05/30/2003 Minimum/Adiustment Plumbi&~~~~ <o~ \) 3.00 05/30/2003 u\:; ~:~-.J... \ JUANITA SIDWELL 1412 I ST SPRINGFIELD OR 97477 541-747-9906 541-686-4191 EXPIRES 111211200~ Receint Number 1200200000000001379 1200200000000001379 1200200000000001379 1200200000000001379 _.).'to , ,~eS ~~ \\~,\\j . To Request an inspection call the 24 hour recording at 726-3769, All inspectioq~~u~~d 'b'eAO\~('?':OO a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the fgUQJwi'ifg~~@'klh~l~~ Se ~OQ'\ .., I~ \ "'~ _\0'0 _ n~?,; '^' "UP' :\~v e\\J'-Op..~- ~e'::)-- Reauired InsDections: ;:\\t:.:~ \ ~eS '3-0.0'9 ~ .,\'f\OS.rov.Q;'f\ ~ \'f\e ~v. O",e ~ N ~\,). r e'(\W ",0 \'{\\ . eS 0 \e'9"{'1. . 0'" 1 Rough Plumbing: Prior to cover and inc\~iji~g ~{\QilJirettfj.!iiDg.. '" Co'Q' . \'f\e \e 'i-..\~\c'3-\'I. 2 Final Plumbing: When all plumbing WOflij~~<;S~Il1~?e.~ '3-\j O'O\:~. \~O\~\\\\\\j ~~~l' ''l'\ O~ ....fOV. '(<\ ('e"'~ nO'" 0~?..?> By Signature, I state and agree, that I have carefully.G~ttmi!ie( l~-e' comP'!eteifl ~ePli(iation and do hereby certify that all information hereon is true and correct, and I furth~~ cecytyqj '~\@n~rn%aH~brk performed shall be done in accordance with the Ordinances of the City of Springfield and the laws 0~~l}:e~1a~f8tf0}~gon pertaining to the work described herein. I further certify that only contractors and employees who are in compliance with ORS 701.055 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, and that the approved set of plans, if applicable, will remain on the site at all times during construction. ~~~~ 0 h__ff <z)iner or ContractoPs"Signature 6-- 30 - Zl3 Date 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 Address: Permit #:pLfl1 ZC .-J' 000 :s L{ I Y 12- r ~+- Issued by: _ ~~ Date: ~73?~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: ~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 that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. A OR 3B. I will be my own general contractor. If I 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 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. Q~ {/I ~ O. ~#"./~ 6--.3t::J-D,g (Signa~ of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant.) Property_owner. doc 03/11/03 ll,' . . :.. , . . Acting as :Y o:ur,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,ContractorsB?ard in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your o\-vn contractor to constmct a new .home or make a substantial improvement to an existing stmcture, you can prevent many problems by being aware of the following responsibilities and concerns. :Employer. Responsibilities You will, in most instances, be mled to be an "employer" and the contractors you contract with will be '''employees'' if you use contractors not licensed -witl::t the Construction Contr~ctors Board to do labor in constructing or to assist in the , , construction or improvement ofa residentia~ structure. As th~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 Hable for' the tax payments even if you don't actually withhoid the tax from your , employees. For a State Business ID number, cail the 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 infoimation,caIl 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' cOIppensation 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 Service~ at.~03-947..7815. , " ; ~ . U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You wiII be liable for the tax payment even if you didn't actuaUy 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, )rou'are'responsible for resolving any failure to meet code requirements that may'1::)e brought to youtattention 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, waterdamagefrom'pipe punctures, fire. or work that must be redone. Time: Make.sure you have sufficient time to supervise your employees. . ~ -.. - . . . Expertise: Make sure you ha~e the skills to act a~ 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 can the Construction Contractors Board (503,-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property;..,owner.doc 03/11/03 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield , Development Services Department Public Works Department' Official Receipt' Receipt #: 1200200000000001379 Date: 05/30/2003 Job/Journal Number PLM2003-00034 PLM2003-00034 PLM2003-00034 PLM2003-00034 Description Fixture Minimurn/ Adjustment Plumbing + 10% Administrative Fee + 7% State Surcharge Amount Paid Item Total: 42.00 3.00 4.50 3,15 $52.65 Payments: 'Type of Payment Check Paid By JUANITA SIDWELL Received By djb Check !'lumber Confirm No How Received In Person Payment Total: Amount Paid 52.65 $52.65 5/30/2003 1O:02:41AM Page 1 of 1 cRcccipt.rpt