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Home My WebLink AboutPermit Fence 1995-7-13 , sp," '-,''''''''''JoFIELD < FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 North F1fth Street Springf1eld, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: 33;? 5 c/;goK e-e \ ~ (Yl.rlot. \ P Sc/;/'adc/' Address S 3';<.) cAcY/'ol< Q!2. City. SPr/h c;F,(zc cI V DI Assessors Map #. Owner: .scoff Tax Lot #. 0 lw) State: 0(' Or?-<.- Phone #: 77"'1 -3/57' Zlp: '17'17 J? Value of Fence: 3cm ~ov- Fence Perm1t 1S $5 00 Con trac tor/Installer, Sc off Address 332.~ elZ e-/'O,e~ C1ty <;0/ /)1 0f",.'Cc.c/ State. '-" ~/a/e/ Phone #: 7Y,/ - Y 07 Od<.s<- Zlp: '17'/75 Construction Contractors Reg1strat1on # Exp1res: By slgn1ng th1S perm1t/appl1cation, I agree to call for an fence has been constructed (726-3769). I also stated that th1S appl1cation/permit is correct ~nd that I was provided "'L"d' ;""")1':;' "",de<d' inspection once my all information on with the Spr1ngf1eld Slgnature 7-/3 - 7:;-- Dat~ FOR OFFICE USE Date of Appl1cat1on. ~~.q~ ~OB #: C\tJ\\l~ Rece1pt # \<1) ~:\ Issued By: ~ Total Amount Collected: ~.()l) - Checked for Del1nqu(>nci es: Checked for H1storical Status. Penmt # ' C\~\ \1')'6 ,~0'lS rnQXD~~_ 0V ~C10GU Date ~ \~ QS , Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701055(4), requires resldentzal constructIOn pernut appll, 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 resldentzal bUilding, electrical, mechamcal, and plumbing permits Licensed architect and engineer appllcants, exempt from registratIOn under ORS 701 010(7), need not submit this statement This statement Will be filed With the permit ~ '~ :::~:::1,:, ::'::,:,:',:, ~~:p:::d,::::::"' 3A "' 3B , W \ 2 I understand that I must regtster as a constructIOn contractor 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 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 Inllnedlately notIfy the office IS~UIng thIS bUIldIng perrmt of the name of the contractor I hereby certify that the above mformatlon IS correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsiblhtles on the reverse SIde of thIS form. \ ~\ L.d /? ~cA ,_~ 7-/3- 9s- "" ~ (Signature of penmt applIcant) (Date) (White copy to ISSUing agency permit fzle, pink copy to appllcant) w Inform~tion Notice to Property Owners About- Construction Responsibilities Note TillS [nformatlOn NOllce to Property Owners about ConstructIOn RespOllSlblhtles was developed by the ConstructIOn Contractors Board m accordance wtth ORS 70] 055(5) If you are actmg as your own contractor to construct a new home or make a substantial Improvement to an eXlstmg structure, you can prevent many problems by bemg aware of the followmg responslbl/tnes and areas of concern EMPLOYER RESPONSIBILITIES: If you hire persons not registered With the ConstructIOn Contractors Board to do labor m constructmg or asslstmg m the constructIOn or Improvement of a reSidential structure, you Will, m most Imtances, be ruled to be an employer and the people you hire Will be employees As the employer, you must comply With the followmg Oregon's WIthholdmg tax law. As an employer, you mu~t Withhold Income taxes from employee wage~ at the nme employees are paId You Will be /table for the tax paymento even If you don't actually Withhold the tax from your employees For more informatIOn, call the Oregon Dept of Revenue at 945,8091 Unemployment msurance tax As an employer, you are reqUired to pay a tax for unemployment msurance purposes on the wages of all employees For more mfonnanon, call the Oregon Employment DlvlSlon at the Department of Human Resources at 378,3524 Workers' compensatJon msurance. As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must obtam workers' compensatIOn msurance for your employees If you fall to obtam workers' compensatIOn msurance, you may be subject to penalties and Will be /table for all claim cost~ If one of your employees IS mJured on the Job For more mfonnatlOn, call the Workers' Compensation D,VISIOn at the Department of Comumer and Busmess Services at 945,7888 US. Internal Revenue Service' As an employer, you must Withhold federal mcome tax from employees' wages You Will be /table for the tax payment even If you didn't actually Withhold the tax For more mfonnatlon, call the Internal Revenue Service at 1,800,829,1040 OTHER RESPONSIBILITIES AND AREAS OF CONCERN Code comphance: As the permit holder for th" project, you are respon"ble for resolVing any faIlure to meet code reqUirements that may be brought to your attentIOn through mspectlons Liability and property damage msurance: Contact your m~urance agent to see If you have adequate msurance coverage for aCCidents and omiSSIOns such as fallmg tools, pamt overspray, water damage from pipe punctures, fire, or work that must be re-done Tune to superVise employees: Make sure you have suffiCient time to supervise your employees Expertise. Make sure you have the expertise to act as your own general contractor, tocoordmate the work ofrough-m and fint~h trades, .lnd to nOllfy butldmiofficlals at the approprIate limes so they can perfonn the reqUired inspectIOn. I 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 St NE SUite 300, in Salem prop.own pm4 1/94