HomeMy WebLinkAboutPermit Fence 1992-07-15225 North Fifth Street
Springfield, 0regon 97477
rENCE PERI{IT APPLTCATION
CITY OF SPRINGFIETD
BUILDING SAFETY DIVISION
SPFIilGFIELO
Office:
INSPECTION LINE:
726-3759
726-37 69
CITY OF SPR'A'GFIELD, OFEGO'U
Job Location:
-,\ Assessors Map #, /*nL o-, I 74 Tax Lot #: OS \Ac:
.*1
0vner:
Address , 6 TP /V V Z* Jf Phone *z 7/C *{V97
Zip:Tzrzrcitv: Z--;,/)zt S ta te:C-,r--7--7 ,{'Zaoz,Fence Perrni t is $5.00Va1ue of Fence:
Con t rac t or / Ins tal Ier :4Address:Phone #:
Ci ty:State:zip:.
Construction Contractors Registration *:Exp i res :
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that aII information on
this application/permit is correct and that I vas provided r,rith the Springfield
Development code requirements for fence standards.
'7-t5- t7Z
gna ture
FOR OFFICE USE
2 JoB *:Date of Application:
Receipt #
TotaI Amount CoIlected:<>o
Clrecked for Delinquencies: l/ Checked for Historical. Statrrs:
r9Vlt \ t14
(
=L
Date
Issued By:
Permit No:
Address:
lssued by
ASg /\/, 33 Us-
Date:
1
2
R OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSI BI LITIES
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 38:
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.
A 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
3.8 I 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 certily that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
7 - /i--qz-
n ure of rm Applicant Date
CONSTRUCTION CONTRACTORS BOARD
o24N 8191
3
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
?zo?"
INFOR.,,ATION NOTICE TO PROPERTY C,,NERS
ABOUT CONSTRUCTTON RESPONSTBILITIES
'' I[ yQu'are.acting as your own contractor
existing structure, you can prevent many
of concern
to construct a new home or make a substantial improvernent to an
problems by being aware of the following responsibitities and areas
EM PLOYER RESPONSI BILITIES:
lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the construction or imprwement cif a residential structure, you will, in most instances, bil ruled to be an
"employer" and the people you hire will be "employees". As the employer, you must comply with the following:
Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at
uwillbeiiaoleforthetaxpaymentsevenifyou.don'tactuallywithholdthe
tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390.
Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon EmploymentDivision DHR
at 378-3224. ''
Vorkers' Cornpensation lnsurance: As an employer, you are subject to the Oregon Workers' Compensation
taw, and must obtan workerd compensation insurance for your employees. tt you fail to obtain workers'
compensation insurance, you may be subject to penalties and will be liable for atl claim costs if one of your
employees is injured on the job. For more information, callthe Workers' Compensation Division DIF at g7g-24w.
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.
ymentevenifyoudidn,tactuallywithholdthetax.Formoreinformation,call
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERNi --_u
yqqq tgqplglge: As the permit holder for this project, you are responsible for resolving any failure to meet
.ode requirernents that may be brought to your attention through inspections.
Liability and Property Damage lnsurance: Contact your insurance agent to see if you have adequate insurance
chasfal[ingtools,painto,erspray,waterdamagefiompipepunc.
tures, fire, or work that must be re-done.
Time to Supervise Employees: I\4ake sure you have sufficient time to supervise your employees.
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 offlclals at the appropriate times so they can perform
the required inspections.
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
NOTE lhis..,lnfgrmation Noiice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.05S(S),
pa.ss.ed by"the 1989 Or5lgon Legislature. '
0244J 10t24t89