HomeMy WebLinkAboutPermit Fence 1993-9-7
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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:: ZZ4Q
Assessors Map #:~r 20
Owner: ~e WILSo-J
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fuuul(::: ~ c:::QF0{) oQ_ Ql'\-ll
AllcdE F..M~Tax Lot #:
Address: 7.2-4C\
Ci ty: -S~.-vO
Phone #:
/47~~q ~
Zip: 'T14l'l
State: OR
Value of Fence: 1jLtC(x)
Fence Permit is $5.00
Contractor/Installer: ~~
. Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration #:
Expires:
By 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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Signature
or(l/f1 S
Date
FOR OFFICE USE
, Receipt #
Issued By:
JOB #: 9 3/ 3 ,77
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Date of Application:
<9-7
J/)/~o
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Checked for Delinquencies:
5PO
V--
Checked for Historical Status:
Total Amount Collected:
Permit No:
93/37?
~24) 4,A-'AJ/&- ~
4/~ Date: c9-7-,J
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Address:
Issued by:
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701,055(4}, requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment 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
fi led with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1. L;><J
2.1~~1
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A.I
I My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B.)--><-ll will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I 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 understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
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Sfg1lalure of Permit Applicant
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Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COpy TO APPLICANT
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, . INFORMATION NOTICE Tb,.PROPE8TYOW,NI;RS, ,:
- '.A~9~:r~GQN~j~RLJ~T!9N'RESPONSIBIL:~:tIES:: . "
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NOTt;; \~/f~ts Inf9rm~io~ NQti~.tofF?ropeqy Owhers~About Cpnstruction Respo'n,sibilities' ,
, was dev~loRed by tt:le Qpnstruction,Contractors Board in accordance with ORS 7Qf.05q(5r,' >
',\,.:' passecEpy 'tJ1e .1~89..'Oregon:Legislature: I'. " ,., .-..' ":' .<- -'-, .
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;lfYQU ar~~ actin{{ as YOltr oWn conihlctor to const-rucf-ia new home or make a substantIal, i.mpr~ye'r.nEihYto an' .
existing structure, yougpn:preyel1t ma,ny, problems by~being:aware of the following responSiQiHties,al)d areas
'of:cOricerrl: . ',;'" "";~' -.I.i'.,.... ',.'.-- ...... -,' -',.. " :.,... '~I~<: .' ,
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EMPLOYER RESPONSIBllITiE'S':~:':!' f.. :
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If you hire personS not registered with 'the Construction Co'htrpctors Board to do labor in con'structi(lg or assisting
. .,' . -.. .- ,',:'.., "~,~:'l:';,t:-.-, ~4",' ," , ~'r~'.',-' . -,~ ' ':'\", '_' "0 "f. I~:'",' .~. ',~t, " "",__,,~,.,.",,~_.; '''''',i,. '. .
in the constructiQ~' 6r'ii]1pr<?vem~nt ~t a r~'1?i9.~ntial ~t~.4.ct,ur~, 'yqlj :~iJ~,,:ir most iri~ta~c~s,-b_erUled to be an
"employer" andJt:i~:people'you hire '~i11l:le"~riiploye<es"':A!:)-the empipye,f,you I1id~t'~Qmply with the following:
.: '~'_'''7'~~':':'''' "'~"'''':';'-)1-''":-~~'~,,,- ~~":~"~:'~'~:'~";::'~':;:":'<'>';~:\I':::'C'::"':'~;,.,':.~,.,'"~ :::';: ;;'~:;: . ", 0 0
':: Oregon's Withholding Tax Law:-As anemp.loy,~r, y'bu.~mLJstwi(l;1h.old'rIlCometaxesfrom employee wages at
'" ,_".~ .'. . ~F . " '. ,.'. .,;''''_'_;~ t.'. .,,',"., "-'I ',<:,".. .~{,,,"-..~,, ','~,' _ ,'._.' ,,'j, 1 ,',~.;... '~', ,','
the;tirre er:np.l~y~e_s,:are.p~i.d:- VQu will l;)e,J!~bl:e:,fpr t!1~ f?'5~pqymt3nt~e~~!1:.ityoy dg~~t<ayty,allY withhold the 0
taxfrorri your:~mployees: ,For more information, call the Oregon Depar.ttJ;lent M Hev,enu.e-;at 378-3390. '
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UQemploymeritlnsurance Tax: As ahe~ploy'er, you are, reqJliredto pay a tax for unE.:r:hploymentinsurance.
purpose~,on' the wages of. aIJ4~mployees;-: If:Qf.:D:!oreinfor:IlJ;~tib~i; ,9C\1I th~ Oregon I;mployr!"Lenl-.EHvision DH R
at:37e-3224. .~,' . ". _,'. ;',' " ,'1. ,.,-.., '...- ',,-<';' ......
.): ' .,.{i) :-~..:id '.'1 ~,~ .:~ ~::~~: ";', ~ '~., ,0 '~""i"=;.;}t<.,: ~f~' ~:'~""':', ~~ ,..~ ~-..:.: - : ,~d ,:i:;:;?~'It~{ ~ }f~:: ;',' 'l~-": ,-;,,~,: .< :, ),....~.J:.f "", .
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Workers'Compensation h'1Surance: As an e:mp'~oyer; you are'subject-t!li,the Orego,n:Workers' Compensation
. Law,: ~nd mus~ :bbtc;iir worker~' compen,$a!ioninsurance for your. employees. If you,: faJI)9 obtain- workers'
compeRsah0Rf:insuraRce, you -may be'$l;Jbject-to per.Jalties and will be' li,able f0r:all daim' costs! Wori~,c5f your '
employees is injured oothe job.. For more'information,callthe Workers' Compen'sation Division DiF at 373-7434.' .
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U.S.lriterfl?LR.~venp~SerYi9e.; '~,.ar)~mp!oy~r, Y9Y"'tDl,l.$t yYJt~hold ted,er?1 in~ome' ta,x.I~omeni~loyees" wages, .
':'ou ~m beliaDhffoqtfetaxpaym~nt.'ey~~~H;Y9~"~Jdh~t,~~c!b,aIlY ~yi~:6:I1?I.Q ,!~e,tt:i,(, ':~9{inor~inf()rm~tion, call'
the Interna} R~venue Service a(221:3960. t .. v'- ", ...- ,', ", .>" "
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'::' OTHER .RESPONsial.Ll'raES::AND ~A~AS- OF"CO~9F~~~:.A!:':"'" . .>;.,,.. :fr.;' ..,"" ,.:;,,::,:':'.:. "
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CodeCQmplicfrlge; :,As',the 'Perr,n.ili m&I~~r jor:.t~is,p~oj,ect, :you are'{~spor)sU1.I~.far':re~olving any failure to meet '
code lequirements.tnarmay be br6'l!jgmi,it6;:your,att~l}ltiom~'thfough';inspectio'ns~~ :'-.:';,1>,' . .
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Liability, an(,'f PrEip~rty: Dan1ag~'J~sufijA~~:6 0(;)fitaOFYQdf'i:n$Cf;'iinte:age~ftbs'ee;W'y6u: have ad~q uate ,insu ranee
coverage forac~idtmtsahdorni~sioris such as fallfn@;.tools: paintoverspray;V?tlfer'da:mag~frompipe punc~.
tures: fire, orwork,that mustbe re-qone. . .. ,'. '..' ' '.
i~i,~";,.~~rf;.. :;-"",::' :~'::~""'., .:'~ifr::, ":., !;~,"> "\,t.::t , .::.~~. ~ .,"~ ,~:;. .~.:~~~.., ~
. Time':to' SupervisefEri:lplqyees~. Make'sure}yG>u~tlave':~~lficienttirrl~, tb;superviseyol)r emr:>loyees."
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Expertise:' Make sur~ YOl-!hav~the eXQertiseto'act as your'own generalc16'ntr,actor,to'coQrdinate the.work..
. of, rough-in<aridfinj~~,:.~f~Cje~, ;ifnd JO notify buildh1g officfalsa! t~e,aJ;ujr9pria.te. ti~~~ ~o th.eY can perfo~m:.
the required:inspections:' ,;,',,: ' ' .. ' , .~', ".. ,t~, ...;.>:':.'
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. ConStruction ~ontractb'rs Board.,
700 Summer St. NE', Suite 30,0, . ,...: .:.
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Salem,"OR'9.7310-0151 "'., ~-,;' ".:
,P~~ne' 503;.378-4:621 '
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If you 'have additional questions,write to: '
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0244J ~?/24l89 . T\.~.;.,;)Uc;qA dT'Jqi.)~) )jylFt
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