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Home My WebLink AboutPermit Fence 1994-8-2 SPRINGFIELD 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, 3y! W. (Ef/J*/J~I Assessors Map #: Il'{ D~ 'l-7 L./,L Tax Lot #: owner~Lf1-:? !-'U J-Z Address: S4tf~.l, ~r/?+Enn; IlL ~g f\:0 I'IT/\ ~,. Value of Fence :t./0U tvvV'\JUV o C) I ()1J Phone #:'747-/47/ , q7L(77 Zip: City: State: n1L Fence Permit is $5.00 Contractor/Installer: Address: Phone #: City: State: ,Zip: Construction Contractors Registration #: Expires: ~y 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., ~ Od,.l'') tfre d v~ t-,(;) - / l( Date ' FOR OFFICE USE Date of Application: , S2 ...- 35->11 Receipt # Issued By: f'B #: t{J.1^-,,- ~4U Rl) Total Amount Collected: Checked for Delinquencies: ~ Checked for HistoriCClJ Status: t..-- "''} ',- '" ''\...,. ,- / ,I / I / I / I ! .,.~. . ,'t,' , .... Ci'i./ of ], r~q'~" 'J. (.,;: j., f.; ''''''\1::' ;""'4\" r'i..r:.th ~:~ i.. r'Q(:.; '!; :!. .::~. .~~; j' D~\' 9 [".q. (' i ,:: !.~. D :':i;; '7 ;:~ ':':'f 'M. :J .? ~5 ~j i !';Jn~:::~'j::''i,..;.cln !'~i.i!\:i:J{~~r' Gt/r.i.:::.;f:j !;~I U D r .~ ~:~ 'i~ 0 ~::: '/ i 9 ~.,; i\. J. ;; :i. ."j ?i"'~ F\~c.~cP:i. \.i c'd f f" Ofil ~ "1,., .".... ,-';;"jl".,i,t:. \:",.... .~.) J 1':1 Cun1'''';JC'i; / U!l!n " ?,ddl"'e:~:'.;; ;:;"1';:; Hfi;;';'::::,~:;nf::);r'iI(li.. City: SPRINGFIELD St= OR ll~: 374:; \ " ..~ jj{j 1 .i. () :i, f\ 9-- .. " \<: :~ ~\I J ob ~; :91,. .t,.i. <3+ D I':, ;,,~ c: 1" :i, p 'i; :l 0 f\ . F(.:~ncI2 {:l:II'!.: To-t.=Jl : ~j :. ;4; 1,.,: -. . . i'( ;',:, ~::. ~:: :J. \., fr (} ~ :5 r: CJC 1....:.:1;:.:./., " Th~:lnk .YDU ~1 )/ Vr r. ~ ~:,"i::.:' :::J..UU ,.1 ,. \, a L(t! yL( I' I '"319 W c~~/) ~ i ()~ Date: ,&~3~<j Permit #: Address: Issued by: 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, I own, reside in, or will reside io the completed structure, ~ 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. I, 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 I)1J 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 Property Owners about Construction Responsibilities on the reverse side of this form. . ~ A 1 ; ~ ,'-<Iu ~ <t~ ;;;(-'7 tf . U- (Signatuk-of Permit a&cant) (Dale) (White copy to issuing agency permit file, pink copy to applicant) " _ t , -- - lnformatoon Notice"U{Property Owners n"_ _ _ . Abo~~ CO~~_~If'~ctio~ ~esponsibmties " 'I', . Note: ThisJnformation Notice to Property. QWn.f:?TS about Construction Responsibilities' ., ,', was developed bjiihe Constructic/n tont-"~dors B~ard in 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 preventmany'proble~s by being a\Yilfe~fthe following responsibilitiesancl ar~as of concern. "" . \'. . , .~ ~ )_' ". '. - I " . I " ': . ~'EMP-LOYERRESPONSIBILltIES:' If you hire per~on$ nqt registe!ed with the Con~tr,uction.Contra,ctors Board to ,do,-labor,in constructing 9r assisting in the construction or imp'ro.vement'of a residential structure, you will, in most instances,. be ruled to be an, employer and the people , I ',~ _...' ~ . -, _ '.. ' :. ~ . . ..... you hire will be employees. As the employer, y<?u must c.omply with thefollowing':- " , ..~..'.~'. ..:.'.....,_, ._~. ..-1.., '."~..' '_', .-<-.\. Oregon's withhoh:ling tax law: As an employer, you must withhold incoitIe' fixes from employee wages 'at the time employees are paid. You will be iiable for the tax payments even'if yo~ donY actually~withhold the tax from your employees. For more information, call the Oregon Depf of Revenue.at 945~:809L .' , " 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 DepartmentofHuman Resources at 378-3524. . ' Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compens~tiop insurance for your employees. ,If you fail to obtain workers' compensation insurance, you may be subject to penalties 'and will be liable for all claim costs if one of yo~r'employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. us; Internal Revenue Service: As an employer, you mustwithhold federal income tax from-employees' wages. You will be liable for the tax payment even if you didn't actually withhoid 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. ' ./ Liflbility and property damage insuranc.,e: Contact your insurance age,nt tO$ee if. you have adequate insl,1rance coverage for accideflts and omissions such as falling tools, paint overspray" waterdawage from pipe puncture,s, fire, or work that must be re-done. '" " , , Time to supervise employees: Make sure you have sufficient time to supervise your emp]oye~s. Expertise: Make s~re' you have the expeitise,'to ~~t'as your ow'ngeneral ~(jntr~cto~, to, coordinate the workofrough-in;md (rnish trades, and to notify building officials at the'appropriate times so they can perform the required inspection's. ' ." ~ '\ 'r.. t . }I"' If you have~dditiomii"questions, write or call the Construction Contract~f.s'Boar~'(P6 Box~141~O; Sal~In:OR97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300t ih Salem. . . ' .. prop-own.pm4 1/94 '. .," , "