HomeMy WebLinkAboutPermit Fence 1995-01-04225 North Fifth Street
Springfield, Oregon 97477
FENCB PERHIT APPLICATION
CITY OF SPRINGFIBLD
BUILDING SAFETY DIVISION
SPRINGFIELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
CITY OF OREGO'U
Job Location:b+q +b5? alb
Assessors Map #:03 523 Tax Lot *:Cltao
Phone #:ar'7-/s/g
zip:?- l:
Phone *:
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Owner:
Address:
Ci ty:
Value of Fence:
Con trac tor/Ins taller :
Address: t'
State:
Fence Permit is $5.00
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Ci ty:Zi p:
Construction Contractors Registration #:lres:
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
lr
State:
(r-
this application/permi
Development code requi
t is ct and that I vas provided with the Sprlngfieldr fence standards.
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fo
/*q-7sgnatuDate
FOR OFFICE USE
Date of Appricati ;", /-n-*S JOB *:o0c)
Receipt #Issued By:
Totar Amount corlected , 65 tD
I 5
Checked for Delinqueneies:l-/ Checked for Historical Status(--
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Permit #:
Issued
S
Statement: lnformation Notice to Property Owners
About Gonstruction Responsibilities
Note: Oregon l-aw, 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, exemptfrom 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 I andz,and either box 34 or 38
fi lown, reside in, or will reside in the completed structure.
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2. 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.. 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 ContractorsBoard. If I change my mind and hire a general contractor, I will contract with a contractor who isregistered with the CCB and will immediately notify the office issuing this building permit of thename of the contractor.
Ihereby certify thatthe above information ls that I have read and do understand the Information
on the reyerse side of this form.
#,
W-
/-+-
applicant)
(White copy to agency perrnitfile,
Notice to Property
(Signature
pink copy to applicant)
(Date)
75
Information Notice to Property Owners
About Constrdction Responsi bi I ities
, ..f .
Note':7.hisInJornlationNoticetoProper4,.ownersaboutC'llnstruc:tionResponsibiliries
was t{e:veloperl bt' the Construt'tion Controctors Bctard in accordance with ORS 701.055(&'",
If yor_r are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can preyeqtrygy,,pqoltem^1&r.ttrS a8tr9.{the folloqilB t*PqryeF.lrftfl$areas S.*uqp,;l5i'rrl-
-t' i::,.Iifitr;pgSyER RESrc)NSlBiLlTlEB:, ii. il.in;'r'
If you hire person$.not registered.with.the construction contracto{s p3ard to do.labor in const5gctr4gor assisting in the
construction or ir4prgemJnt of i residential structure, you wil[, in most iT?qr":t, be ruled tq be an employer and the people
you hire will be "qploy""..
As the employer, you must comply with the following: .
d incbme taxes from employee *ages at ttre time employeesoregon's withhotding 14x lar-v; As an empl<iver' vou must withhoti:ffi;:rffiiilt:,..
from your errritoyees. For more
are faid. You will tie liable forthe tax payments even if you don\
information, call the Oregon Dept. of Revenue at 945-8091'
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information, cali the oregon Emptoyment Division at the Departnent sf HurEn Resources
at378-3524
.! -:- ---^-^^. A. ^- l-u*;ma#JWorkers, compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation
obtain workers, compensation insurance^for your employees. If you fail to obtain workers' compelsation insurarrce, you-may
be subject to penalties and will be liable for ail claim cost.s if one of your employees i1 injured ol ti" jtl -f]Iry"* informationl
call the Workers, Compensation Division at the Department of Consumer and Business Services at 945-7888'
u.s. Internal Revenue service: As an employer, you must withhold federal income tax from employeeS'wdges' You will be
li"dti;;;hei* puy*"nr even if you dicln't acrually withhold the tax. For more information, call the Internal Revenue service
'a
at i-800-829-1040.'
oTHER RESPoNSIBILITIES AND AREAS oF GoNCERN:
code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirerne$q
that may be brought to your attention through inspections. ;i 'l ' ' l:'- J
Liahility and property d*mage insurance3 Contact your insuranc€ agent to see if you havea@uate insEdnee coverage for
accidents and omissions such as falling tools, paint overspray, water Jarnage from pipq trmc&rcs, fite, of work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees'
)rdipate-thQ ]9rf . oirgu$tr.j' and frn ish.;
hkilaitise: Make sure fou have" the expgrtise.to act a.s your own general contractor' to coc
rrades, and to notify building officials at rhe appropriate times s;.th.eY cai, p".rot* the req\ireii't*pectionsl'
\ t ' \_\
If you have addkional questions, wrire or call the C"r,1r1r!1"1C.irtJi"^t"Jt tltfu 1Polol^ iAiaO, S'?rlem' G' 97309-5052'
5031378-4621). The Board is located at 700 Summer st),NE suitc 30o; in salem"
prop-own.Pm4
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