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Home My WebLink AboutPermit Plumbing 2004-4-5 . Status Issued 225 Firth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspeclion Line SITE ADDRESS: 1917 SCOTI RD ASSESSOR'S PARCEL NO.: 1703253401000 . CITY OF SPRINuHI!,LJJ Building/Combination Permit PERMIT NO: COM2004-00379 ISSUED: 04/05/2004 APPLIED: 04/05/2004 EXPIRES: 10/05/2004 VALUE: Springfield TYPE OF WORK: Plumbing Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Replace approx 70lfsanitary sewer Owner: JACKLYN INGRAM Address: 1917 SCOTT RD SPRINGFIELD OR 97477 Phone Number: 541-736-3780 Contractor Type Plumbing Contractor OWNER # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type 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 I CONTRACTOR INFORMATION I License Expiration Date Phone R-3 BUILDING INFORMATION' # of Stories: Lot SM.Q;,/O\l \0 Height of Structure \"\ 1a.>N 1s<r'F\\Y~8I!1b~iW , Type of Heat: ",.Olago ,"-S~p~~ ~I;lt\ Water TY!l.'\'i"E."'I\O ~OOp,ad '0'/ Sa ~q,!J.t~~f.)O' Range Ty.~\o>N 1\llaS ar.\al. 1\"10 o~.!a~Port Euergy P~~\'iC0.'iO\"\ C O~.OO~~'nfog\Ilt't.-b\ilri"o\"\e -.lO Ojl.~ 95Z.o ~ 0'0\0.'\"\ c ,~(I,~tv\~~i~~'ifp.gn\rea: ,n I .. ",61 - 11-10 . .. . ...'nll \ I D", v "'LUmIEN'I"INFO:RM1\T-I()N '~;ego\"\ U~~'2M4). . ", I ('\f\ 'l::"o .- . ""\:latlUI " '" ~ -" - REQUIRED PARKING '{\U\i\~ _ ~.~,..." Overlay Dist: Total: # Street Trees Rqd: Handicapped: Paved Drive Rqd: Compact: % of Lot Coverage: VN ,t I PUBLIC IMPROVEMENTS I \r "\\\t. 'N~, ~ ~'llk'~'t. ~\"\ \~ ~01\C\WI\"\ ~\\~~~fn~:rQ?- "\\\\~ \l~\\\1.t.Q \} \)?- \~f..'I01'< ~\}\~ ~t.~Ct.\) \It.?-\\)\)' C\)W' 'Q\) \)~ ~1oI'l \ I Valuation Descriotion , $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Total Value of Project Page I of2 . Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Fee Description + 10% Administrative Fee + 7% State Surcharge Sanitary Sewer - 1st 50 Feet Sauitary Sewer Each Addtll 00' Total Amount Paid l..Fees Paid I Amount Paid Date Paid . CITY OF :srKll"\ilJNJ!.L1J Building/Combination Permit PERMIT NO: COM2004-00379 ISSUED: 04/05/2004 APPLIED: 04/05/2004 EXPIRES: 10/05/2004 VALUE: Receipt Number 1200400000000000437 1200400000000000437 1200400000000000437 1200400000000000437 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. $5.90 $4.13 $45.00 $14.00 4/5/04 4/5/04 4/5/04 4/5/04 1 Sanitary Sewer Liue: Prior to filling trench and including required testing. $69.03 I Plan Reviews I I. Relluired In1ne~tiom I By signature, 1 state and agree, that 1 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 ti~~ng :str~tiOOKAru~/ tt" ~,,;" ,.,,,;n\ Paee 2 of2 4-)~~ 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 pennit#:CCJAIlZOa-CX:Y3.7 ~ . Address: I '717 sf! 1'2.J ~(? Date:!{/sjoy Issued by: 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 app.vp.:ate blanks and initial boxes I 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. 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 ft 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. IfI 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 bereby certify tbat tbe above information is correct and tbat I bave read and do understand tbe Information Notice -to Property Owners about Construction Responsibilities on tbe reverse side of tbis form. ( ~t (J{/WAj\~ Lj-r;-tJ Lj i( - -, V'igmiture of Pi mIt applIcant) (Date) U (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.doc 03/11/03 . . Adfinnga~, 1:{ mnrr ([)wnn G~nn~rran C~nn~rra\l:~~rr? 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 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. lEmjpnoyer ReSjpOHllSibnnides 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 imprQvement 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 ID number, call 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 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 503-947-78,15. 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 Resjpolllsibmties ~mdl Areas of COllDcerllDs Code Compliance: As the pennit 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 ypu have the skills to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to I1ptifY 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 03/11/03 225 Fif,th Street ~;pringfield, Oregon 97477 541-726-3759 Phone . Job/Journal Number COM2004-00379 COM2004-00379 COM2004-00379 COM2004-00379 Payments: Type or Payment Check 4/5/2004 RECEIPT #: .~ ~.... ,ay of Springfield Official Receipt .velopment Services Department Public Works Department 1200400000000000437 Date: 04/05/2004 Description Sanitary Sewer - 1st 50 Feet Sanitary Sewer Each Addtl 100' + 7% State Surcharge + 10% Administrative Fee Paid By JACKL YN INGRAM Item Total: Check Number Authorization Received By Batch Number Number How Received djb 8394 In Person Payment Total: Page 1 of I 1:33:46PM Amount Due 45,00 14.00 4,13 5,90 $69.03 Amount Pnld $69,03 $69.03