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HomeMy WebLinkAboutPermit Fence 1994-9-26 FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 North Fifth Street Springfield, Oregon 97477 Office: INSPECTION LINE: 726-3759 726-3769 Job Location: (.oJ-l ~as('_ aAC2 Df""v-€. ' Assessors Map #: /'i 0 2 . S.,) 3 3 Owner: ,-')enV\\~\ t-\~:(obGr'1 HOrd(~'S Address: ~?27 C_uSCOr&e TJ("v-t City, S?.r\ ()lir-ed . State, () 17 '" if Value of Fence: (~OD Tax Lot #: 6.32.00 Pq.one #: /44/9/0S Zip: C)j Lf7 !' Fence Permit is $5.00 .Contractor/Installer: fDher +~f rrra /ts Address:_!;If}J~, ~ t+Pyj uf /t:)tAJ~o, ) ~ ,,/ Phone #: ... " City: State: Zip: Construction Contractors Registration #: Expires: (: By signing this permit/application, I a~ree 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. . do JYlJJ& Df) Iv [flam' S~gnaturel , , '~JY}f Jto /Y9c; Data' FOR OFFICE USE Date of Application: Receipt # 1l1tb&~ 1/24- ~9f Issued By: Checiked for De1inquencies: < ,8"0' , ~ JOB .~ 9f/f1!>f. 1~ , Total Amount Collected: Checked for Histortcal Status: Permit#: 9~/ ~~ <(.. Address: ~21 ~O"h)i!:-.{J~ Issued by: /e L Date:. 'J/~/Jf 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 b.efore 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. I own, reside in, or will reside in the completed structure. l><1=- 2. I understand that I must ~egister as a construction contr~ctor if the structure is sold 'or offered for sale ( before or upon completIOn. . . . ~ 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, OR ~ 3~. 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 Property Owners about Construction Responsibilities on the reverse side of this form. ()~I2L . timetiJJL / (Signature of permit applicant) SJ; d 2(0 /9yv I (Date) (White copy to issuing agency permit file, pink copy to applicant) _~ -4 "'- ':'.. '\.. '. ,"..., " \... , , -:," "\ ,\~" .... . ~ '." . . Informatio'n Notice to Property Owners ,- (~>~~. < ,About Constructi~ro..lR~$ponsibmties -.'~ _..."j "" ' -..- __. '.._ +__ "..." _ ._ ,~"~ '._' _ " ~4" .~~., ..~,. _ ;..~-t. '.:\_ "" ',..' 'Nate: This Information N~tice to 'p1;9perty Owners q-bout Construction Responsibilities :'. ~ ~ .,\,' -;.. ''',',..' "'. ~...\ - -'~' ...... - ..-' ,'~ '.. . , ." was developed by the Construction Contractors Board in accordance with ORS 701.055(5L . 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~mt.lTI,al}.y proplems by.beipg aware of th~ following wsponsi.bilities and ar~as ?f concern. , . - ,'. EMPLOYER RESPONSIBILITIES: ' If you hire persons not registered with the Constru,ction. CoI1tractors ,Board to doJabor in constructing or assisting in the construction or improvement of a resi,dential structure, you wili,in m. ostinst~rices,be ruled to be ~ employer and the people you hire will be el11Iiloyees. As the employer, you must comply' with the ,foIIoWmg;.' ' .... ." .' . .' t .\ '. . . Oregon's withholding tax law: As an empl()yer, you musrwitbhold income taxts fto~ en,lployee wages at the time employees are paid. You will be liable forthe tax payments even if you don't actua!ly withhold the tax from your'employees. For more information, call the Oregon Dept.ofRevenue at 945-8091. - 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 information,' call the Oregon Employment Division at the Department of Human Resources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and'must obtain workers' compensation insurance for your empl()yees. If you fail to obtain workers' compensation insurance, yourpay be subject to penalties and will be liable for all claim costs if one of yoUr empioyees is injured on the job. For more informatiob, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. u.s. Internal Revenue ~ervice: 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 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. ".. ".'>". r Liability, and'propecty d!mlagc'insurance: ,Contact your insurance ag\;nt to see if you have adequ<l.te insura,nce coverage for accid.en!s and omissiQns sue-has falling tools, paint overspray, water damage from pipe puncture.s, fire, orwork that must be re-done. - 'i . Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expern~e: Make ,sure you have the~ expertis'e:to act asyour own genetafcol!tr~ctor, t.o coordinate the work of rough-in and fmisb trades, and to notify'building officials at the appropriate'times so they' can perform the required inspections. If you have adrlitional q~esti~ns, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. . prop.own.pm4 1/94 '. '.1 . . . . .,~ 1t~