HomeMy WebLinkAboutPermit Fence 1996-03-07.--a
225 Norrh Fifrh StreetSpringfield, Oregon 97417
TENCIi PIJIIHIT API'LICATIONcITt ot? SPITINGFIBLD
BUII.DING SAI'ETY DIVISION
SPrlINGFIELE,
0ffice:
INSPECTION LINE:
726-3759
726-3769 h,l
,
Job Location:
Assessors Mup *,N1)Tax Lot #:
Owner:
eaOress, //Phone *:
Ci ty State:Oo Zi p:?t+t7
Value of Fenc de 67)Fence Permit is 95.00
Con t rac tor/Ins taIIer:J.Je>tu. r+
Address:Phone $:
Cl ty:S ta te:ZLpz
Constructlon Contractors Reglstration #:Ex pires
this pernri t/a pplication, I agree to caII for an inspection once mybeen construct ed (726-3769). I also srared that all information oncation/permi t is correct and that I vas provided vith the Springfieldrequirements for fence standards.
S gna t c
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FOR OFFICB USE
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Date of Application: c5- /-JOB *:
Reeeipr ll -<,fssucd By:
To taI /rmoun t CoIIec ted
5+{e"-+
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Dy signing
fencc hasthis appli
Developmcn
Clrecked f or Delinquenei e.s:
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Checked for Ilistorical Status:
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Permit #:
Issued by:
Address
3a
17 2+L y
Statemeht: lnformation Notice to Property Owners
About Gonstruction 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, 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 3,\ 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.
3,{. 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 building permit of the
name of the contractor.
I hereby certify
about Construction Responsibilities on the reverse side of this form.
= /r/r,
(Signature of permit applicant)
(White copy to issuing agency permitfile,
pink copy to applicant)
Notice to
(Date)
A
above information is correct and thatl have read and dounderstand the Information
t_
Inlsrmation Notice to P:'operty Owners
',i'.-About Constquctlon Hesponsibilities
- -'.Nate: This lnfornrati*.nqifi? P f rfiri1, Qtw,le,rs abour Cctnsrrucrion Respons
wa.t rlevelopi,.l fry'ilte' trn:ifr'urtion Cbwracror.i Board itt act'ordance vvirh ORS
ibilities'
70 t a5_\(5).
If you are acting iis your own coyrtr-iictcr to construct .i rlew horre or make a siiilstarrtial iurprovtlneltt to alt r.risting c{ruciurr,
you cim preyent mau:y probleras b_v bernq awarc of the following resp=a$;bttities and ar3as of
,toageg.rr.^; r * .
,:' ..,;EMBIOYER.RESOIEIEILITIESj,.""..'if;"il
If yor hire persons not registered with the Ccrnslruction Contractors Board to do labor in constructlng r)r .rssisting ln the
consl,ruction or improvi:rnent of a.residential sir:r:cture, yorl wili, ln *:ost instarrces, be mled to be an'e;npiiiyer ancl rhe oer:ple
you hirc rvill beernployees. Astiie employer, you niusi'comply with the following: . "
Oregon'swithholdingtsxlaw: Asanemployer,yor.lmustwithhttldincometaresfromernployeewagesatthetimcenrpioy'ees
are paid. You will be liable for tho tax payments even il'you clo'nt actually withhold thb tax from yonr empkryees. For ulore
infornration, call the Oregon Dept. of Revenlre at 945-8091
Unemployment insurance tax: As an ernployer, you are iequired to pay a tax for unempiovment insurance purposes on the
wagesofallernployees. Formoreinformatiqn,calltheOregqpEmployme.plDivisienat$$,Dg1grygryp{f{4gpn",geffiqrms
at378-3524
Workers' compensafion insurance: As an employer, you are subjeit to the orego;Wtlikill C;;p"';'r'ution torr,'rnalJJ,
oQtain workers' compensation insurancc for your ernployees. If you f,ail to obtain workers' compQnsation insirrance, youJray
U?stiUieirfo penalties and will be liabte f'br all claim costs if one of yourenrpltrye6's'is iniuieaioniiiesbO.''Fo. *oi.'infornlltio,i,
call the Workers'Compensation l)ivision at the Department of Consniler and Buiittest$5efvibel'm945-76d8.
US.Intennal Revenue Service: As anemployer, you must withhold i'ederal income taX firortiturtployreedsv6les. Ybu , iilt$
liab{te.for the rax paynrcnt even if you didn't actually ivithhold th€ tax. For more information, call the Intemal Revenue Sefvtct:
:. . ;!,, ;: , _r-,.ri: .'--:i.l;':.:'-l,:,1-.-..:,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
i,. ,
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. ! ,,, ,,.i.rir -.-: ,r ,.,. :{[: ,i ,i: , ii, lr*{
Liabilitlr and,property damage insur*ncc: Contact your insur:urce agent to see il you h;rve irdequate insurance coverage l'or
accidetrt.; and omissions such as falling tools, paint o\ elspray, water damage iiom pipe punctures, fire, or work that mr,rst be
re-dont'.
Time to snpervise ernployees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expedise to act as your own general contract<ir, to of rough-in and frnish
trades, and tb notify building officials at the appropriate times sti'they can perflorm the rdiluired
If you have eldditional questions, write
54y378-4621)" The Board is located,
97309-5052,
propown.pm4
1/94
or call the Construction Contractors Board
at70$ Summer Sr. NE Suite 300, in Salem.
nn D^