HomeMy WebLinkAboutPermit Fence 1992-02-24P'l!NGFIE LDs
%
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISiON
?25 Fitth Street
Springfie'ld, Oregon 97 477
Offi ce:
INSPECTION LINE:
726-3759
726-3769
Job Location:*7 <\), tt'^)
Assessors Map #:
Owner:
Addresst \ .}
city: /t..v',ma&. U
Tax Lot #:_ pI30a
Phone #: -14)'+3<g
Z1 p:Q1v
Fence Permit is $5.00
State:
---!-
Value of Fence: I (-n 0t)
Contractor/Installer: OwSW^f
Address:
City:State:
Construction Contractors Registration #:
gna ure
FOR OFFICE USE
Phone #:
Zi p:
Ex pires:
By signing.this permit/applicatig!r l agree_to call for an inspection once myfence has been constructed (726-3769). I a'lso state that all information on-this_app'lication/permit is correct and that I was provided with the Springfield
Deve'lopment Code requirements for fence standards.
"] a u l.re
Date
Receipt *: 3? lq Issued By OL
Date of App'lication:)laqlea
Tota'l Amount Co] 'lected :S Or)
Job #: 4lO )qu
Checked for Delinquencies:Checked for Historical Status:
Permit No:
Address:
lssued by
c)l
S /t/
Y-Date
1
2
R OFFICE USE ONLY
STATEMENT:
!NFORMATION 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 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.B I will be my own general contractor.
lf I hire.subcontractors, lwillhire 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 notity the office issuing this building permit of the name of
the contractor.
I hereby certify that the aboye information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side ol this form.
Signature of Permit Applicant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
3
,/-)rls-
te
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
.Y
v-l
llr. ORIL,".fION NOTICE TO PROPER. / Ollr-rERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This lnformation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701O55(S),
passed by the 1989 Oregon Legislature.
lf you are acting as your own contractor to construct a new home or make a substantial improvement to an
existing structure, you can prevent many problems by being aware of the following responsibilities and areas
of concern.
EMPLOYER RESPONSIBILITIES:
lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the construction or improvement 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 em ployee wages at
the time employees are paid. You will be liable for the tax payments even if you don't actually rrvithhold the
tax from your employees. For more information, call the Oregon Department of Revenue at {}78-3390.
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 Employrnent 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 obtain workers'
compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your
employees is injured on the job. For more information, call the Workers' Compensation Division DIF at g7&74U.
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees' 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
code requirements 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: lt/ake sure you have the expertise to act as your own general contractor, to coordinatte the work
of rough-in and finish trades, and to notify building officials at the appropriate times so they c;an 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
0244J 10t24189