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Home My WebLink AboutPermit Fence 1993-07-28PENCE PERI{IT APPLICATION CITY OP SPRINGFIELD BUII.DING SAFETY DIVISION SPRINGFTELO 0ffice: INSPECTION LINE: % 225 North Fifth Street Springfield, 0regon 97477 726-3759 726-3769 CITY OF SPRINGFIELD, OREGO'V Job Location: Assessor Map #:Tax Lot *: Ovner: Address:Phone *: Ci ty S ta te:Zip: Value of Fence:Permit is $5.00 Contractor/Ins taller : Address:Phone *: Cl ty r State:Zipt Construction Contractors Registration +: Expires: 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 this application/permit is correct and that f vas provided r,rith the Springfield Development code requirements for fence standards. 7-rK-?3 S ture Date FOR OFFICE USE Date of App Receipt * Iication:JOB *: Issued By \\b[x _,- $) Total Amount Collected:C\) Checked for Delinqueneies:7 Checked for Historieal Status: ((Idr\t Permit No: Address: lssued Date: R 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 f rom registration underORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the icable blanks, and initial boxes 1 and 2, and either box 3A or 38: )St". 1 I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 7--=L3 -73 2 3.A My general contractor is , Contractor reqistration 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 will be my own general contractor. lf I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. lf 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 inlormation is correct and that I have read and understand the lnlormation Notice to Froperty Owners about Construction Responsibilities on the reverse side of this form. t gnature o rm pp cant Date CONSTRUCTION CONTRACTORS BOARD 0244J Bl91 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT INFORTTIATION NOTICE TO PROPERTY OVI,NERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: - Thip lntormation Notic€ to Property Owners was developed by the Construction Contractors Board passed by the 1989 Oregon Legislature. About Construction Responsibilities in accordance with ORS 701.055(5), .: tf you are acting as your own contractor to construct a new home or make a substantial imfrr(ivement to an existing structure, you can prevent many problems by being aware ol the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: ll you hire persons not registered with the Qonstruction ContraCtofs Board to do labor in constructing or assisting in the construction or iriprovement of a:regide-ntial strlrcture, f,gu will, in most' instancesrie ruled to be an "employer" and the geople.yro.u'hire will be "6mployee-s". As thebmplgyer, you mVS! complywith the following: Oregon's Withholding.Tax Lqw: As,an emptoyeg, you must withhol.d inceme taxes from enployee wages at the time employees'are paid. You will be liable for the tax pay,ments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department gf Flevenue at 3/8-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment i'nsurance purposes on the wages of all eqployees. For more information, call the Oregon Employment Division DHR at 378-3224. Workers' Compensation lnsurance: As an employer, you aresubiect to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers' compensation insurance, you may be subject to penalties and ffFbe hable:for all claim costs if bne of your employees is injured on the job. For more information, call,lhe Workers' Compensation Division DIF a|573-7434. U.S. lnte_rn4EelgnL,q Eglylge, . AS an employer, you must withhold federal incorle tax from employees' wages. You will-b6lEElAloiTn*g ia1 F"v1qS!.gven if you didnlt.TctuAlly withhold.t[e tax. For more information, call the lnternal Revenue Sbrvice at 22i-3960. ,-] oTHERRESPoNSlBlLlTlESANDAREASoFcoNoFRN:,'. Code Compliahcei As the permit holder for this projec{; }rou are responsible,for resolving any failure to meet code requirements that may be brought to your attention ttuough inspectlcns ? -. ,! Liabili{y andPrb@y Damage:fnsurance: Contact your insurance agent to see if.you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water darnage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Em ployees: ,Make sure you have sufficient time to supervise your em$oyees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. ;; . i lf you have additional questions, write to: Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-Cl/8-4621 0244J10t24189 s-