HomeMy WebLinkAboutPermit Fence 1995-02-24SP,tINGFIELE,
CITY OF OREGON
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FBNCE PBRHIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North Fifth Street
Springfield, Oregon 97477
0ffice:
INSPECTION LINE:
726-3759
726-37 69
5 ,J 3Job Location:
Assessors Map *:o a/3
Owner:
Address:(1/
State, 0/'{
Tax Lot *:o3
Phone #:'1V'/- 076 (,
,q7qTrZipCi ty:
varue of Fence , if?*Fence Permit is $5.00
Address:Phone *:
Ci tv: State:Zipt
Construction Contractors Registration f :Expires:
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gnature Da
FOR OFFICE USE
t'
By signing this permit/application, I agree to call for an inspection once my
fence has been c|nstruct"i (ZZO-S7'69). I also stated that all information on
this application/permit is correct and that I vas provided with the Springfield
nevelopment code iequirements for fence standards'
JOB #:Date of Applicati on
Receipt t
Total Amount Collected:
Issued
--Yyl-
Checked for Delinqueneies:
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Checked for Historical Stattts:
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o/u q/a
Permit #:
Issued
Address:C03f /V 3L{I'h >7-
L-24
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon law, ORS 701.055(4), requires residenti.al 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 and2, and either box 3A 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
3A. My general contractor is
ame)Contractor regis. #
I will instruct my general contractor that subcontractors who work on the structure must be
registered with the Construction Contractors Board.
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 that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
2,Y q
(White copy to issuing agency pennitfile,
pink copy to applicant)
OR
(Date)
B
4,kL K, olL*.^^q#
l3ignature of permit a$plicant)
Information Notice to Property Owners, About Construction Responsibilities
Note:
_'t'his lnfortnq-rio4 Notice to Propcrty Ov,ners' abottt C'onstut'ti.on Responsibilit:ies .: o
v'as devr:lr;perl bv tlte Con.structio'n Contractors Board in accr.srt{ant:a *,tth ORS 701.055(S).
I1'yor,r are acting as )i out r)wn con{ractor to constntct a ne w home or ma}ie a substantial improvement to an exisring slructure,
you can prevent many problems by beirg aware of the following responsibilities and eueas of concem.
EM PL&YER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvenrent of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must cornply with the following:
Oregon's withholding tax law: As an employer, you must withhold income taxes fronr ernployec wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information, callthe Oregon Dept. of Reventrc at 94-5-8091.
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, call the OregonEmployment Division at the Departurent of !trumanResouirpsat378-3524 *,.-4
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, *d6od
obtain yorkers'compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you-mfiy
besubjicttopenaltiesandwillb^eliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformdtis-n;
call the Workers'Compensation Division at the Department of Consumer.and Business Services at 945-7888.
.i.-. .
U.S. Internal Revenue Service: As an employer, you mustwitlfiold federal income tax from employees' wages. You will.*i
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue ServiE
at l-80G829-1040.
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 requirements
that may be brought to your attention through inspections.
Liability and property damage insuranee: Contact your insurance agent to see if you have adequate 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 employees: Make sure you have sufficient time to supcrvise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and frnish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
5031378-4621). The Board is located at 700 Summer St. NE Suite 300, iir Satem
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