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Home My WebLink AboutPermit Plumbing 2007-9-6 (2) Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-01356 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: 465 S 47TH ST ASSESSOR'S PARCEL NO.: 1702324306700 Springfield TYPE O~ WORK: Plumbing Only TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Encroachment Permit for connection of private sewer to the public sanitary line. Install sanitary sewer approx 50' Owner: NOWAK DAVID M & CHRISTINA N Address: 465 S 47TH ST SPRINGFIELD OR 97478 I CONTRACTOR INFORMATION I Contractor Type Sewer Contractor SEC CONSTRUCTION BUILDING INFORMATION I License Expiration Date Phone 541-747-6504 # 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 INFORMATWS I IH/. rJet,,- REQUIRED PARKING Overlay Dist: Au 'S Ptl/. Total: # Street Trees Rqd: Co 'HOl/lll '/[,fIr SHA. Handicapped: Paved Drive Rqd: AN 'It1Il1EII/. 'EO UNa il !fftmpact: % of Lot Coverage: Y 180 'CEO Ob 'E'R '/J 'lilt If: DAy '1 IS A ,ilS A rHE PPJ:>'O 8AAl; 'E'I?IIA/~ Wn,>>\ ATTENTlO I PUBLIC IMPROVEMENTS I . U. \l UII/fO ~d~1 NO~ Street Improvements: follow ru'esN~g;:t~~nb;~~6urres YOUtU"I~ Sidewalk Type: ~ Notification C t Th regon I ity Storm Sewer A vailabm:OAR 952- en ere ose rules are set forth Downspoutsillrains: SpecialInstruction: 0090 Vi 001-0010 through OAR 952-001- ". ou may obtain copies of the rules by Notes: calling the center. (Note: the telephone number for the. Oregon Utility Notification f'~n+,f'. .~ 1 !',.,~ o-c: 1. "" >> -~ 1-..0 1I;t",~ ...,......In- Valuatio'n Description I Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: . t~. t:' Description Type of Construction $ Per Sq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Pa2e 1 of2 Status Issued CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2007-01356 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 Fees Paid I Fee Description + 10% Administrative Fee + 5% Technology Fee + 5% Technology Fee + 8% State Surcharge Encroachment Permit Sanitary Sewer - 1st 50 Feet Amount Paid Date Paid Receipt Number $5.00 $2.50 $6.75 $4.00 $135.00 $50.00 9/6/07 9/6/07 9/6/07 9/6/07 9/6/07 9/6/07 3200700000000000603 3200700000000000603 1200700000000001165 3200700000000000603 1200700000000001165 3200700000000000603 Total Amount Paid $203.25 I Plan Reviews I Public Works Review 09/06/2007 09/06/2007 10 EW Take in encroachment permit application and route to Maintenance Division for review 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. ~Reouired Insoections I Sanitary Sewer 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 ~~:t::;;;;::; f,nnt of the p,"perty, and the app,"v; ~ ~:a: will rema;n nn the sile at all v'" ' ( Owner or Contractors Signature Date Pae:e 2 of2 .\:-...: ... Perrnit#: un - l~51O .. Address: 4.o~ s. 4\-\'~..~ . I~~ued by: b\VJ~ ).' Date: 0- 19 ,()( '. Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 ~alem OR 97309-5052 phone: 503-378-4621 Web Address: www.ccb.state.or.us , , Statement: Inf~rmation Notice to.'Property.Owners About Construction ResponsibiUties Note: Oregon Law, ORS 701.055(f) 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. This statement is required for residential building, electrical, mechanical and plumbing permits. 'Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. , , Fill in nriate blanks and initial boxes I and 2, and either box 3A or 3B: ',', . , , ~'L/eslde m, or WIll reSIde m the completed structure, .'" ..' o .2. . I understand,thatI must become licensed as a construction. contractor if the structure is sold or offered for sale before Oton com.,letion. V3A. MY~;S ~~ ~C-.- '50'=1<60 ~. . (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 o 3B. I will be my own general contractor. Iflhire subcontractors, 1 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 theCCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information ~otigj:zn a~J~ponSibilities ontbe reverse s;e ;f(~:O:' IJ (Signature ofpennit app'11cant) " , [(Date) (White copy to issuing agency permit file, pink copy to applicant.) Property _ oWner. doc 06-01-04 - -' > " , , ,'~ \ j\c;ting as Y'ou ./ ; I /, _. , . . I , -, _', -. ,I ,. INFORMATION~ ABOUT, General Contractor?' PROPERTY OWNERS RESPONSIBILITIES ., 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 contractor to construct a new home or make a substantial improvement to an e~isting structure, you can prevent many problems by being aware following responsibilities and concerns. ,Employer You will, in most , be ruled to be. an "employer" and contractors you contract with will be "employees" if you use contractors not hcensed with the Construction Contractors to do labor in constructing or to assist in the construction or of a'residential you c.omply with the followhig: Oregon's employees are Tax Law: As an employer, you must income taxes from' employee wages at the time You will be liable for the tax . even if you don't actually withhold the tax from your call the Department ' at 503-378-4988. on Tax: As an employer, For more are call to ,pay a tax fot unemployment insurance purposes' Employment Department at 503-947-1488. Identification Number To file for a I number for poth Oregon, Withholding and or. w'ww.d6r.state.or.us/fonnsmw.htmll for the \. ,I . , ~" ~ Workers' Insnnmce: As an employer, you are must compensa.1ion insurance your insurance, you could be subject to penalties 'and liable job. For more infonnation, caB the Workers' Services at 503-947-7815. to 'Oregon Workers' Compensation Law, you fail to obtain workers' compensation costs if one of your employees is injured on the at the Department 'of Consumer and Business u.s. Internal Revenue Service: As an employer, you must You will be liable for the tax payment even if you IRS at 1-800-829-4933 or visit their web federal income tax fromeinpldyees' Wages. withhold the tax. For a Federal EIN number, call the As the pennit holder may be brought to your attention you are responsible for resolving any to meet code Code Insurance: such as see 'if you have adequate' insurance water damage from pipe punctures, fire or \ . / \"; I .~ ." ',\ " '.' , I " , , , : , I . time to and finish the skills to act as building officials as to coordinate the work of so they can peifonn the required inspections. If you have additional Box 14140, Construction (503-378-4621) or the agency at PO Property _ owner.doc 06-01-04 22~ Fifth.St~e~t Springfi?ltl, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2007-01356 COM2007-01356 COM2007-01356 COM2007-01356 Payments: Type of Payment Check cReceint I RECEIPT #: Description Sanitary Sewer - 1st 50 Feet + 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 3200700000000000603 Date: 09/06/2007 Item Total: Check Number Authorization Received By Batch Number Number How Received llh 573 In Person Payment Total: Page I of I 11:16:43AM Amount Due 50.00 2.50 4.00 5.00 $61.50 Amount Paid $61.50 $61.50 9/6/2007