HomeMy WebLinkAboutPermit Fence 1994-2-13
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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:
i~t{~ Ch.~~cJ
Assessors Map #: ,I 7'" 3
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Owner: S-e"'etU..~O c.AQ,.DO~c
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Address: IA~5 W. {)L'It-{PI(..
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Ci ty: ~rp_\~&~I'2'-~
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Tax Lot #:
/ /400
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State:
06'L
Phone # :t-t/ I J 'Il f
Zip: Cf14f1-
Value of Fence:
4, {Of)
Fence Permit is $5.00
Contractor/Installer:
~/A)4_2O?_
Address:
Phone #:
Ci ty:
State:
, ,Zip:
Construction Contractors Registration #:
Expires:
By signing this permit/application, I agree to call for an inspection once my
fence has been construct€d (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
~^Jo~
Z-/~-q4
Date
FOR OFFICE USE
Date of Application: ,
2//4/P<i
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Receipt #
;/t-? ~<
Issued By:
JOB #: C}4z:;/73
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/F /"VI
Total Amount Collected:
,5"' ()D
Checked for Delinquencies:
~"" Checked for Historical Status:
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q4tJI7 "X
Address: /?~r- ~V/4 ,d4ll.
Issued by: ~~ Date: ~//f1f
Permit No:
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
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
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1. I ~ I own, reside in, or will reside in the completed structure.
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2 ..J.-><:" I 'I understand that I must register asa 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. r r:><:!.1 wi II 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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Signature of Permit Applicant
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Date
t 'Y-C4
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CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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, , INFORMATIO~NOT~CE TO' PRbpERty.O~ER~'"
"~BOUTCONSTFl.UCTION RESPONSIBILITIES
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NOTE,: ::' ,~~. Thi$':.lrifprtTt~i9n NotiGe:to.F?roperty Owners About Consiructibn R~sponsieilitJes .
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. :was developed by th,e Consfn,ictioh Contractors'Board, in accordaQce with ORS '70:1 :055(~)1~:'.
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! .:;.,;.'~,;~".3-,",' ",j'ilassed~;by,1t1e..~1989::C)tego!1 Legislature~ ; " ' . ' . '.,,;, ':', :-~~<";"j~7{:; .,' '\ j.':' '.
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,1 . If.y'ou' are\c!lctirigas yoU(owh 'contractor ~o consfruct :a ne~ home cjr.makea:.substantial<irnprgv~ment!to' an
: existing structufe, you.c.~n, pie.vent many problems by' be'ing aware of thE} followingre~p()nsibiliites~and 'areas -
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',EMPLOYER RESPON'SIBILlTIES: "
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If.,y()u 'hire'pers9,ns .r1ot regist~r~d with thl? Con~truction Contf~qtors Board to d9.!aoor in cOJ:1structing or assisting
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in the co~~tru.~~iorr ()~' improy~r:n.~.nt -of. ~ r~~ld~rjt,i~~:,stt~ctu~$),,:Y.ou' will',' ,!,n ,n:io~t .i,rsta!1t~~, qe. ruled to be, an
"employ~r" ~ndt8~;R~op!eyothir~.Y':!!I:'?~';"~fDPII~Y;r,'~S";.~s ,tti~~mp'b~~r! ~y~,u, m,~~~ fbm~p'ly vYith, the following: ,
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Oregon,s Wlthhol.djng.,Tax. La:N:' As all empl0.yer, yoi,.qi)ust withhold income ta~es from:el1lployee wages at,
'the timeei]1ploy~es,ar(3. P?iQ.. You' w"(~,~.Ji~ble.f.or,:the.~~~' p~~me~ts"eveo"if;y6u.don,t~c!~:?II:y withhold the
tax from youre~ployees. For more infor'matip,n~! call the O~e,gon DepaPtment pt- R~yen~~'la!,378~~399'
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Unemployment Insl,lranceTax: As ane~ployer, you are r~quire<:j; tCfpay a tax fOLtmerilploymentiilsurance
'purpose~ori the wag~s'of aILelJlpl~y~e~k,Fdr,..mor~.,;iQ~ofm~tion,.caJI tbe 9r~g0n;E.rnploime.f1r[3~yi~ion DHR. '
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Workers" Compensqtion Insurance; As a'n,empI0yer;,.you are subject.to"the Ore@on WorkEi'rs'Compensati.on'
. Law, and must- obtain wor~ers' compensation insurance rpr your enip19yees. If you f~il ~o ~Qbtain work~rs'
,., compensation.irsurance, .you maybe subject to. p,enaJties'an-d will.be';liabJe forj'all daim,cost~ i(one of your
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employ~es is injured on the job: For more information, call the Workers'-CompelJsation',[~ivi,~ion DIF at 373-7434. .
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U.S.inJ~mal B.ev~e.flue ?e.:rYi.c.e.~:~,~n..,~l11plpy'~rj. ~ou ~;!Jst: 'Xirl~,hOld J~de~ClI i~9ome~ t~X.f~ol1!~mployee~' wages,
You wi I l''Qe liable lor" tn~ tax.PClYrtlerifeven irypu ,did'ri'.ta(m;l~c:lIly'witl:1h()W ttjetta~. For more information, call '
, the Intenlal Revenue'Service 'at- 221'-:3960: .'" ' '.' '- .," ", . """'" " ".... " ,
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'OT~IER.flESP<?NS~BILrrIES AND AREAS.oF CONG>IE~,~': .~. ,:,:,.:,,'c'F' .,.i,.') ,:" ;;-:';' '-; ,~~,~j.-r:.,Ci' ..;.~.
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'Gode:Co,rr.ipl.ia'lice: 'As,thepermit, b(j)ldet~for.t'tlis P(ojec:::.t, 'Y()'lFar;e<resp.o~Sible'for'~re$oi"'lng any failure to meet.'
code.requirementsthat may,be brougfJt,to'ryour attention through ',ii1SfD'e'GtiC;n$'~;;",'< 'r'., .
'~;'l:',t~.''': . ~ ." ":,;l. "{.,:~'~:'~ .ft -"~~'Sl(' .,<: .' > ',.., . ~,.'.:.. ":';':~'~: J !.' ..... -...... ." .
u'ability ~nd Property: Damagelnsura'nce::: CdAtact' you(insurahCEdigemHd see !ftry6u~'have adequateinsurar)ce '
cove'rage for accidents and omiss~onssuch asJalling tools, paint dversp'r:~y;::Wate-(:d1image from pipe' pu'nc-
'tures, fire, orwork that must be re'~dbl1e." ','.'.,' ' . . ' " '
"r"'.i>""I - '..>:i U'~' . : '< " . . :~: / ~.;: ;~~".H.S ;::: ,:~:>. ':, r~.\t;;;'t~ ;~~,' .~:<~ .. \;'f; -;~. -. ~ :" > ~f ~ ~ ~ !., ~;:.~ \':_~i~ ~:"'" ,
Time~;to' $uper,visedEmploYees: .Make. sure Y0,U b'ave ;sl:S:ffici'el)t'ol~irr,"e: to~supel\ise'voiJr'empJoyees:.,
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'. Expertise: Make sure yoiJ have the expertise to act as your own' generai contractor, to coqrdinate :th~ work
of rOLi@h~iri and ".finish trades" and to notify builping officials~,t ,th~ appropri~te tim~s '.~o' th~y' caD per!cmn ."
thej~9uired in'spectiorts: 1,. :J-: ~~. '. ' : "'>'- "---',~" '"::~f0-}.J::;r.;.s~C _ '; .;,;:( ',~' ):' i'1/~;I. ;".;" ",'
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, I If you.haveaddition'sl questi'on,s, write to:
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.u'0244J'10/24i8941P;,)'i',:,,:s, ,,)' ,,':,'~3,j , >
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Construction Contractors Board
.,,' 700 Summer 81. 'NE;: Suite ;300, ,
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Salem.. OR 97310:0151 " '. '. ,'.> ,
, Phone 503-378-4621'
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