HomeMy WebLinkAboutPermit Plumbing 2007-9-6
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2007-01357
ISSUED: 09/06/2007
APPLIED: 09/06/2007
EXPIRES: 03/06/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 461 S 47th St
ASSESSOR'S PARCEL NO.: 1702324306700
Springfield
TYPE OF WORK: Plumbing Only
TYPE OF USE: Addition
Residential
PROJECT DESCRIPTION: Water Line approx 180'line
Owner: NOWAK DAVID M & CHRISTINA N
Address: 465 S 47TH ST
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION'
Contractor Type
Sewer
Contractor
SEC CONSTRUCTION
License
150980
Expiration Date
04/04/2008
Phone
541-747-6504
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure:
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street ImprovemenAi . elmON' Ore ,
afpll . gon aw requires you to
Storm Sewer AvaWll1 ~w r~"es adopted by the Oregon Utility
Special InstructioDi~~~atlon Center. Those rules are set forth
00 952-001-001~through OAR 952-001.
Notes: cec:il Youhmay obtam Copies of the rules by
a n~ ~_e center. (Note: the teleohonA
~at ...MIII" Jll;UUlI -~l'fo;, ,:
C t. ~ ..r. ''''CUIV/I
en er IS 100800-3 ~f.l~ . D .
~ IOn eSCfl
Sidewalk Type:
DownspoutslDrains:
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
A~THORIZ~D U~DER THIS PERMIT IS NOT
r eMMEf~eLj) \}n I\) Al;)ANUUNtU ,"UR
NY 180 DAY PERIOD.
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-01357
ISSUED: 09/06/2007
APPLIED: 09/06/2007
EXPIRES: 03/06/2008
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
LFees Paid I
Fee Description
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
Water Line - 1st 50 Feet
Water Line - Each Addtll00'
Amount Paid Date Paid Receipt Number
$6.60 9/6/07 2200700000000001402
$3.30 9/6/07 2200700000000001402
$5.28 9/6/07 2200700000000001402
$50.00 9/6/07 2200700000000001402
$16.00 9/6/07 2200700000000001402
Total Amount Paid
$81.18
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
L Reouired Insoections I
Water Line: Prior to filling trench and including required testing.
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
ltime~in~~.ct~~~ 1; W 01
Owner or Contractors Signature Date
Paee 2 of2
,-
, .
Construction Contractors Board
700 SummerBt NESuite 300
PO Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.us
Permit #: ,Q/l -{ ~ 5- {
'Address:' '44f \ _ 'S -~\~
Issued by: l!\ (lj'Dl' ) ,Date: q - /p - or
"
Statement: Information Notice to' Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS701.055(4) requires residential construction permit applicants whoare not
licensed with the Construction Contractors Board to sign the following statement before'a building
. permit can be issued. 1Jzis 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.
Fillin the appropriate blanks and initial boxes land 2, and either box 3A or 3B:
~ L ~ide in, or will reside in the completed structure,. '.' .' "
o 2.. I understand that I must become licensed as a construction: contractor if the structure is sold or
,. ,.of~ere~ncomPletion._ "
.0 3A. MY~~'.laicontractorls 56G
, (Name)
\ ~L)C{ Y;()
(CCB #)
. .I will instruct my general contractor that all subcontr3;ctors who work on.the structure must be
licensed with the Construction Contractors Board.
OR
o 3B. 1 will be my own general contractor.
IfI hire subcontr~ctors, I will hire only subcontractors licensed with the Construction Contractors
, Board. IfIchange 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 hereb certify that the above information is correct, and that Ihave read and do understand the Information
;iC to., ro:~wnif;:ruCtion Responsibjijti~ on tbe reverse~i:e~~:~ form,
"\ .. (Signature ~fpetmit applicant) f v. .(Date)
(White' copy to issuing agency permit file; pink copy to applicant.)
Property _ owner. doc 06-01-04
<,
'....
'\
\__u __:; '"", '
~cting as (Your' ontractor?,. . '1
, ./ : I f -f-::',. J', '';' . ' . ...'
I .f INFORMJ\Tldr4 ;NOTICE TO PROPERTY OW'NERS
AsdUTCOI\ISTRUCTION .RESPONSIBILlTIES
... ..; I . ' .
. . ,'!I.. ~" ~'
"-
\
)
~,\
'J"
"
. }' ;"~'"
NOTE: This Information Notice to Properly Owners about Construction Responsibilities was dewit/oped by the
Contractors Board in accordance with 701.055(5), passed by the 1989 Oregon Legislature.
If you are your own contractor to construct a ..new
structure, you can prevent many probh.uns'by
or make a substantial improvement to an existing
fonowing'responsibilities'andconcerns.
Employer
. . . " ,,~. "~', :, ~ ...
You wiU,.
you use
instances,; beruledtp be an
not hcense~ \vlth the,Constr:uctio,n
or of a residential . As
Oregon's
employees are You will be liable for
employees. For more call th~'
::h -; ';.
. . r~ ',-':"- ....~ 01 ,,,:.~. .~.
to pay"u tax for uriemploym:e:rit.insurance'purpos~s
Employment Department at 503-947-1488. '
As an employer, you are
For more information,
on the wages of
. ,
-
.-:' ,"
compe:qsatio!l insurance, for
you could subject to penaJties
job. more information, can the Workers'
Services at 503*947-7815.
Identification Number (BIN) is a
Tax. To file for a BIN, can
,nl,UTIber. forjJ~oth., Orego~" )Vit4holding, and
or w\vw.dor.state.G1'.us/formsnav.htmll for the
" , i .,} j ", ~ .
. j J
....
; -:- -~ -. ~, >>0..
Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law,
If you fail to obtain workers' compensation
, - , . if9n~ of your errtployee:s is injured on the
at the Departnient 'ofConsumef' arid Business
Revenne Service: As an employer, you must
You for the tax payment even if you didn't
at 1-800-829-4933 or visit their web siteatw\\/\v,irS;'Q(W.
federal income' tax frdin' :employees' wages. ..
the tax. For a EIN number, ca 11 the
Code
holder for
. t? your attenti~~
Insurance:
slich as
you are
for resOlving
failure to meet code
" , ,.
agent to :see if you have'adequate insurance' .
,l . , .
waterj damage f:rom pipe punctures, !ire or
Time: Make sure
"
sufficient time to
~\ . .
~n; ,. \Ji~ ,~ '"
'.-- \'1....,.../ -.j. \
,".. , l' '
~'. ..!'.JrJ*/' :
, '
"1,1,' "
your
.... ~ . .... "'.
# ..... . .
suie\ne skins to' ~ct as
to notify building officials as
'co~t~~c'tor~ to cootdihale the \york of rough';in
so can required inspections.
(503-378-4621) or
the agency at PO
,/
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-0 1357
COM2007-0 1357
COM2007-01357
COM2007-01357
COM2007-0]357
Payments:
Type of Payment
Check
cReceint I
RECEIPT #:
Description
Water Line - 1st 50 Feet
Water Line - Each Addtl 100'
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
DA VID NOWAK
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200700000000001402
Date: 09/06/2007
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
IIh
574
In Person
Payment Total:
Page 1 of 1
11:56:49AM
Amount Due
50.00
]6.00
3.30
5.28
6.60
$81.18
Amount Paid
$81.18
$81.18
9/6/2007