HomeMy WebLinkAboutPermit Fence 1995-03-01,r
225 North Fifth Street
Springfield, 0regon 97477
FENCE PERI{IT APPLICATION
CITY OF SPRINGFIBLD
BUILDING SAFETY DIVISION
SPFItvGFIELD
0ffice:
INSPECTION LINE:
726-3759
726-3769
CITY OF OREGON
Job Location:3tcL-
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Assessors Map
Ovner:
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Address:f,Phone #: 7'll -18 ?)
Ci ty:S ta te:Zip:TLlv
Value of Fence , {O 69 Fence Permit is $5.00
Con t rac tor/Ins taller :
Address:Phone #:
Ci ty:State:zip:
Construction Contractors Registration #:lres:
By signing this permit/application, r agree to caII for an inspection once myfence has been constructed (726-3769). I also stated that all information onthis application/permit is correct and that r vas provided vith the SpringfieldDevelopment code requirements for fence standards.
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FOR OFFICE USE
Date of Application:l nrt e{-d*qs
Receipt *5
Tota1 Amount Collectedi $S
JOB *
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Checked for Delinqueneies:
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Checked for Historical Statns z L----
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Permit #:
Address:3so)/z N n+l^sT
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Date
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon l-aw, ORS 701.055(4), requires residential construction permit appli-
cants wha 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 3,A, or 38:
1. I own, reside in, or will reside in 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.
3,A.. My general contractor is
I will instruct my general
(Name) Contractor regis. #
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 immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and thatl have read and do understand the Information
Notice to Property Owners about Responsibilities on the reverse side of this form.
(Signature of permit applicant)
(White copy to issuing agency perrnit file,
pink copy to applicant)
(Date)
?-t-q{
Information Notice to Property Owners
About Construction Responsibilities
: -. ?r_*
Note: 'l'his Infctnnation Notice to Property Owners about Construction Res^ponsibilities
was developed b"y the Construt'tictn Coriractors Boerd in act:ordanr:e yyith ORS 70 t .055(5).
lf you arc acting as your own contractor to construct a nrrw home or make a substantial improvement to an existing structure,
you can prevent marny problems by being aware of the following responsibilities and iueas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not,registered with the Construction Contractors Board tp d9 labor in constructing or assisting in the
construction or irpprovernent of a residqntial structure, you willnin most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply w.ith t\ following:
Oregon's withhotdirig tax law: As an employer, you must withhold income taxes from employee wages at the time employees
are paid. You will be liable forthe tax payments even if you dont actually withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091
Unemployment insurance tax: As an ernployer, you are required to pay a tax for unemployment insurance purposes on tle
wages of all employees. For more informatiotr, call *re Oregon Employment Division at the Department of Human Resourcds
at378-3524.
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and must
obtain workers' compensation 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 your 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.
U.S.Internal Revenue Service: As an employer, fou must withhold federal income tax from employees' wages. You will be
liabl'e forthe tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at l-800-829-1040: l
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 requiremenls
that may be brought to your attention through inspections. '
Liability and property.damage insurance: Contact your insurance agent to see if you haveadequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise ernployees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as yourown general contractor, to coordinate the work of rough-in and finish
trades, ancl to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional quesrions, write or call the Construction Contractors Board @O Box l4lilO,Salem, OR 97309-5052,
5031378-4621). The Board is located at 700 Summer st. NE suite 300, in salem.
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