HomeMy WebLinkAboutPermit Fence 1993-02-16225 North Fifth StreetSpringfield, Oregon 91477
FENCB PERUTT APPLICATION
CITY OF SPRINGFIELD
BUILDTNG SAFETY DIVISION
SPllIIirGFIELD
0ffice:
INSPECTION LINE:
726-3759
726-3769
C'TY OF SPR'NGF'ELD, OREGON
Job Location:
Assessors M"p #t OZ
A}O .T
Tax Lot #z 0 S 700
Owner:
Address:
Ci ty:
€2d ]l t tt)Phone *:* 13yv
zip:(f S ta te:
Value of Fence:
45oo''
Fence Permit is 95.00
Con t rac tor/f ns tall_er:-fs t {
far",4t
State:
Construction Contractors Registration #:
By signing thisfence has been cthiapplieation
De pmen
re
FOR OFFI
Date of Application:
Receipt #
Total Amount Co1lected:
Zipz
_Expires:
Da te
CE USE
JOB *:
fssued B
Address:
Ci ty:
Phone *:
permit/applica,i?ll_r agree to carl for an inspection once mvonstructed (726-3769) ' "r
"r"" "',","J-irr". "ii"rnfo.rrtion on'i:ili:J:";:';;;'r:l:",:ll"l,ns. provided wi th the springri"ra
Checked f or Delinquene i e.s :Checked f or Hi.s tori ea 1 S ta tus :
r
3Permit No:
Address:
lssued Date
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 from registration
under ORS 701.010(7), need not submit this statement. This statement will be
filed with the permit.
Fill in the licable blanks, and initial boxes 1 and 2, and either box 3A or 38:
lh
1
2
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.
3.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.
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 certify that the above information is correct and that I have read and understand
the form ce to Property Owners about Construction Responsibilities on the
side th form.
m cant Dat
CONSTR
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
o244J 8t91
N CONTRACTORS BOARD
OR
=-----_-__-4-
INFORi,TATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
lf you are acting as your own contractor to construct a new home or make a substantial improvernent to an
existing structure, you can prevent many problems by being aware of the following responsibilities and areas
of concern.
EMPLOYER RESPONSIBI LITIES:
lf you hire persons not registered with the Construction Contractor$ Board to do labor in constructing or assisting
in the conslruction or imprwement 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 comply with the following:
Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at
the time employees are paid. You will be liable for the tax payment$ even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Department of Flevenue at 378-3390.
Unemployment lnsurance Tax: As an employel you are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the 0regon Employment Division DHR
at 378-3224.
Workers' Compensation lnsurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtiiin workers'
compensation insurance, you may be subject to penalties and will be liable for all elaim costs if dne of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at 973-7434.
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from ernployees'wages.
You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
cod e requrre ments 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
coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must be re-done,
Time to Supervise Employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to acl as your own general contractor, to coordinate the work
of rougn-in and finish trades, and to notify building officials 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 97310-0'151
Phone 503-378-4621
v
NOTE: This lnformation Notice to Property Owners About Construction Responsibilities
was developed bylthe Construction Contractors Board in accordance with ORS 701.055(5),
pa$sed by the 't989 Oregon Legislature.
0244J 10/24189