HomeMy WebLinkAboutPermit Fence 1994-7-22
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FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: 07tfl( 8C~lle_
Assessors'Map#: \~Oc9~
Owner: S (t::-t1€rU . ~(3kc;,veel
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Value of Fence:.'j(, :2 zta:?"-
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.Tax Lot #:
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Address:
. 'Phone #:
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Zip: 97 <(t r
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State:
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Fence Permit is $5.00
Confractor/Installer:
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Address: .
Phone #:
City:
State:
Zip:
Construction Contractors Registration #:
Expires:
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Dy signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that all information on
this application/permit is correct and that I was provided with the Springfield
Development code requirements for fence standards.~
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Date
FOR OFFICE USE
Date of Application:. '1- A.A Cf4 JOBr.: q4\\~
Receipt. \4tAt ri) Issued By: rJ\~.-J .
To tal Amoun t con-ec ted: Q '.
Checked for Delinquencies:
. Checked for Historical Status:
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Issued by: r\~ Date:~!J1:-=+-
Permit #:
Statement: Information Notice" to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered 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 registration 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: j I. I own, reside ill, or will reside in the completed structure.
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2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
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3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
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OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general.contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this b.uilding 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
Notice to Pr;:}fv O~ners ab~nst~ion Responsib.ilities on the reverse side of this form.
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V (Signatureofpermit applicant) (Date) ,
(White copy to issuing agency permit file,
pink copy to applicant)
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. Information- Notice to . Property Owners
About Constructi~r R.e.sponsibilities
No~e: T~!s),!formation Notice. to.Pr;perty Owners,:about Construction Responsibiliizes,:
was'developed by the Construction Contractors BoardYn accordance with ORS 701.055,/5).. '
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prev.:n~ ~y proble~~'by being aware of the fo;llowing resp?nsi~ilitit(s .andareas of c~p_cem. .
. I:MPLOYER BESPONSISILlTIE'S:
If you hire persons not register~9 with the Construction ,Contra9tors Board -to -do labor. in constructing or assisting in the
construction or irrip~~vym~n( o(il r~sidentiafstructure, you wiU; in, most instances,. bl:':, ru.led. to be an employer and the people
you hire will be employees. As'the employer, you must. comply with t.he following: :' . ,
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Oregon's withhc)lding ta~ law: As an employer, yoil must withhold income taxes from employee wages at the time employees
are paid. You will be liab!e for the tax payme.nts even if yoli don't actu~ly withhold the tax froni:your ,employees. For more
information, call the Oregon Dept. Of Revenue ,at 94.5-8091: ": :
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 infoimation,callthe-Oregon Employment Division at the Department of Human Resources
at 378-3524.
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Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workt(r,s' compeQsation insurance for your e!TIployees: If you fail to obtain workers' compens.ation insurance, you may
be subject to penalties and will be liable for all ciaim costs if one of your employees is injures:J on th~ job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
u.s. Internal Revenue Service: As an employer, you must withholdfederal.income tax from employees' wages. You will be
liable for the taX payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040. '", - '.'
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
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 inspections.
Lia~ility and property damage insurance: Contact your insurance agent to se'e if you have a.dequat~ insurance coverage for
acci,dents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done" . . ';(
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
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Expertise': Makesu(e you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish
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trades, and to notify'building officials at the appropriate times' so: they can perform the required inspections.
. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer S1. NE Suite 300, in'Salein.
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