HomeMy WebLinkAboutPermit Fence 1995-03-27SPFTNGFIELC'
rENCE PERI{IT APPLICATION
CITY OP SPRINGFIEI.,D
BUILDING SAFETY DIVISION
225 North Fifth Street
Springfield, Oregon 97477
0ffice:
INSPECTION LINE:
726-3759
726-3769
CITY OF OREGorv
Job Lo cat ion: 88 O -so
Assessors HaP #,l (o>C5 t>Tax Lot *:taz
Ovner:E pG" cu
Address:88o s o.+s Tlr LE Phone t: ,/- g-o3-72l*s?{
Ci ty:I
Val ue of Fence, 3 O o' oO
_9
Fence Permit is $5.00
Phone *:
State:OK zip:
Zip:q 7q{
Expires:
Con trac tor/Ins taller :
Address , K(J S t/ S=tL
Ci ty t./)
Construction Cdntiactors Reglstration #:
ture
State:OL
By signing this permit/appllcation, I agree to call for an inspection once my
fence has been clnstructii (ZZO-3769). I also stated that aII information on
this applicatlon/permit ls correct and that I vas provlded vith the Springfield
Development code requirements for fence standards.
3 2'/Qg
Date
FOR OFFICE USE
Date of Applieati on, 3 - n-(7 5 JoB *: qsc aq C
Receipt #Clu "t 1 Issued By:
TotaI Amount Coflected:ll 5 'oD t
Checked for Delinqueneies:7-Check.ed for Historieal Status:
a
I ilAttr I
.)
q 471
Permit #:
Address ffib s +=#.
_^ I
tssuea u$Date: '.3-4s
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 buitding, 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 ft.ledwith the permit.
Fill the appropriate blanks and initial boxes I and2, and eitherbox 3A or 3B,:
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction conftactor if the structure is sold or offered forsale
before or upon completion.
3A. 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.
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 huilding permit of the
name of the contractor.
I hereby certify thatthe above information is correctand thatl have read and dounderstand the Information
Responsibilities on the reverse side of this form.
3-L7-4{
applicant)
(White copy to issuing agency permitfile,
pink copy to applicant)
Notice to Owners about
(Date)
Information
-Xotice'
to Property Owners
, About Sonstruction,Responsibil ities
Nrlre.' I?rrs lnfbrmation Notice to Prrsperty {}vvne rs ahout {$rrstru{:ti{}ft.
was developerl bt the cons*uition Contractctrs Board in accordanr:e with oR.s v0l
trf you are acting as y*ur *wn c*ntractoil to corlsti'lle * a **w hilme or maka a substan{iai im:prr:verne*i t* an r:xisling structurc,
you can prevent tnarry problems by treing aware of the {ollowing responsibilities and areas of concern. ,
, ,..,.
trf you hir* persons not registered with the Constructio* Contraclors Board to da labor in constructing or assisting ir: the
consfruclio* or inrprovement of a residential structilrs, you will, in most instances, be mled ti: be an **pioy*, ancl the people
3,ou hire will he emplcyees. As the ernployer, you musl comply with the following:
()regcn's withholding tax !aw: As an employer, you must withholel incorne taxes frorn employee wagf;s at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax fiom your employees" I,br more
information, call the Oreg*n Dept. of Revenue at g4S-8091.
Unemployment insurance tax: As an employer, yclu are required to pay a tax for unemployment insurance purposes on the
wages of all ernployees. Far more information, call the0regon Employntent Division at tlre Departrnent of Humqn Rbsoursp$
at378-3524
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and must
9!dl*qtkqls' cornpensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformation,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888"
U.S.Internal Revenue Service: As an employer, you n+ust withhold federal income tax from employees'*ages. You will be
liable for,the tax payment even if you didn't actually withhold the tax. For more information, cali the Intemal Revenue Sedice
ar l-800-8291040.
OTHHR RESPONSIBILITIES AND AREAS OF CONCEHN:
Cde compliance: As the permit holder for this project, you are responsibie for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
I-iability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage f'or
accidents and omissions such as falling tools, paint oyerspray, water damage from pipe punctures, fire, or work that rnust tre
re-done.
Time tc snpervise exrployees: Make sure you have sutficient time to supervise ymrr emplcyees.
Expertise: Make sure you have the expe$ise to act as your own general contractor, io coordinate the work of rough-in and finish
trades, and to notify huilding 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 L4ll},Salem, OR 9?309-5052,
543/378-462t). The Board is located ar 700 summer st. NE suite 300, in salem.
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