HomeMy WebLinkAboutPermit Fence 1996-03-20SPRINGFIELD, OREGO'VCITY OF
225 North Fifth Street
Springfield, 0regon 97477
FENCE PBRI{IT APPLICATION
CITY OP SPRINGFIBLD
BTIIIJING SAFETY DIVISION
SPRINGFIELD
0ffice:
INSPECTION LINE:
726-37s9
726-3769
Job Location:46a /t/, 35 /4 5/
AssessorsHap#:11 OL Zl 2a
ovner: Ooo, l,*-s * tse-TFv B/ocb
rax Lot *: i 13@
Address:5 rt sf phone #, V/6 ' ? 2 ?/
State: Oe zipr 77/78Ci ty:
ilsnValue of Fencel Fence Permit is $5.00
Contractor/Instal1"r, Dr., q E Lcl clD
trd T
Address:Phone #:
Ci ty:State:zipz 77,/78
Construction Contractors Registration *:lres:
By signing this permit/application, I agree to caII for an inspection once my
fence has been constructed (726-3769). I also stated that aII information onthis applieation/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
-?,'\z-..J 76
S ture
FOR OFFICE USE
Date of Application:3->o-ftz
Receipt * U>A75a
Total Amount Collected:
JoB *: Qtr| 3ZA
rssued svrD - fnAC- qdo
Checked for Delinqueneies:
S.6D \
Checked for Historieal Status:
(
-s'T'
Permit #:
sfruz+
Issued by
Address
Date:
4bo n. .3saa-
Statement: lnformation Notice to Property owners
About Construction Responsibilities
Note: Oregon Law, 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, exempt from 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 r and2, and either box 34 or 38
tr 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
(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.
38. 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
Owners about Construction Responsibilities on the reyerse side of this form.
(Signature of permit applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
OR
x
Notice to
,3- >D-?L
3/zu,/za
(o{te)
- \ :' i -/
irrfonrnationltJtice to Property Owners
rt ( r-\ About ponslryction Responsibilities
-,i.. .
lNote: Titis Owners cbout Construt'tion Re
wa.., r[et'el,tperl vors board in accorclance with
If you are lcting as _v(i! ri crryrr contra,:lot to cunstruct a nrlw horne or make a substantial improvement to an existing structllre,
you cel prc:1Ent l-I1giri. ppobierrrs b;
?_?T,
*ri of tt.e loiforving responsibrFo:t
"r{
areas of PTylo' ..., .a -r
.: ";- .FMPI$YER RESFONSfEILITIEE:' ' , I '
If yo1 hire persqp; not registr:red lvith tlre Construction Contractors Boar$ to do labor in constructing or assisting in the
constructton or tmprovcnicnt ol a resiclential structuie, ;,ou will, iri most instances, bc ruled to be an employer and the people
r! ^ { . | -. 1 i
you hire wril beoempi"y;t;.' Ar,h6 employei. you *u.iiomply with the follbwinq: . ;: .
Oregon,s withholding tax larv: As un eniployer, you rnust wrthhold incorne qi: f*T employee u'a8es-,atth,1 time employees
*" poia. you willbe iiable for the tix payments evbh if yori dor't actualTy *itlihold rh€ tax frortr your ernployees. For more
information, call the Oregon Dept:tf'Revenue at 945'8091': r' r'1 \'7r1
Unemployment insurance tilx; As an eraployer, yor! ue required to pay a tax for uncmployment insurance purposcs on the
*0g". of ull employ,e,:s. Ft';r n;cre information; call the Oregpr-l Employ.mentDivision at the Depiu{mentPfHElqen'BBsgrffi9$
at378-3521 ..-
i
Workers, compensation ini;urance: As an ernpioyer, yor, *r" duU.lect to the o..gon Workers'Compensati[n I-u*, unatrffil
obtain workers. courperrsatic:r insurancc fol yoLrr employees. tf you tail to obtain workcrs'conrpensation in;uraqce, yoq#ay
#*[:;t,,*il;r;1 ,;;;;;';,i b;ii;il;;;i""x .rri* J;.'" irone of your employees is inlqrpd on tie job' For niijre informitioni
call the Workers' Ctrnrpen:;irrion l)ivision at the Departmeint of Consumer-and Busihesdrser{'ices it q+S-f g8t.
US.Internal Reverue Service: ,,{s an employer, you must withhold federat income tax from employees: wages. You wilibd
liabfefoithetaxpaymentevi'i1 ifyouditln'taciuallywithhold'thetax. Forrnoreinformation,callthelntemalRevenueseivied
at l-800:829-1040. '! t' ' ': '
J spon.;tbilities
{}R,-\ "iat.055(5)."
STI{EH HESPONSIBILTTIES AND AREAS OF CONCERN:
that tnav be l-'rought 10 ):l)L'i ,.rit*,ltioli through inspreclitltts. 't.
Liabitity and propcrty damage iru;urancc: Contact your insurance ageilt to see if you have adequate insurance coverage ior
accidents anii onrissiu.:l:. such a,s falling tools, paint overspray, water damage ltom pipe punctures, fire, or work that must he
re-Jone.
Timc to supervtsr l:rnpkrtr*t,:; Make rure yoi: have sulllcient ti{nc io }Llpet'visu vOtrr employees.
fixpertise: Makesureyouhrvelheexpertisetoactasyourowngeneralcontractor,tocoordinatetheworkofrough-inandfini,sh
trades, ancl to notify building officials at the appropriate times so they can perform the required inspections. ':':
If you have iditional questir.rns, rvnrt'. or ca!! thc Construction Cbntractors Board (PO Box -l4l4O Salem, OR 97309-5052,
5A3n78-4621). The Board is located at 700 Surnmer St. NE Suite 300, in Sahm.
prop<rwn.pm4
ll94