HomeMy WebLinkAboutPermit Fence 1995-04-20CITY OF OREGO'U
225 North Fifth Street
Springfield, Oregon 97477
PBNCE PERHIT APPLICATION
CITY OP SPRINGFIELD
BUIIDING SAFETY DIVISION
SPRINGFIELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
Ji^
Job Location:
Assessors Map S:l1 0'535 tz Tax Lot *: I l5n )
,lv,Ovner:
Address:
Ci ty:
Cl ty:
"?, Sf
0 rz-
Fence Permit is $5.00
Y-
Phone *:lLl t-Zt t?trY-
zi p:
"bt t, -
zsqS
State:
7D
Con trac tor/Ins taller :,13 L*
Address:/L( t6'T^Phone *:1Lltn1
zip:f 7 L{77
nt,,
State:
^.{#Construction Contractors Registration *:Explres:
By sign ing this permit/aPP Iication, I agree t o call for an insPection once mY
fence has been constructed (726-3769). I also st ated that all information on
this apP lication/Permit is correct and that I vas provided vith the SPringfie Id
Deve t code requlremen ts for fence standards'
Dat
FOR OFFICE USE
'bate of APPlication:JOB *:
Receipt * 11 05O Issued BY:
Total Amount Collected:5,c7)
S
l,
I
Checked for Delinquenc'ies" V Checked for Historical Status:
4 7 177
Value of Fence:
U.1/\/'\/--g-
Permit#:
Address 1?E N trT^ Ef"
Issued by:Date:
Statemeht: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residenttal 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 registratton 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 3A 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.
(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 the above information is correct and thatl have read and do understand thelnformation
about Responsibilities on the reverse side of this form.
4 /-z-o,/n,-
(Signature of applicant)
(White copy to issuing agency perrnitfile,
pink copy to applicant)
Notice to
-ro"d
tr 3,A.. My general contractor is
s
\Ji
ffioffhation Notice'tb'PiOperty Owners z* ,?r].=.,
About Consjrucrigns?gfonsibitities i .+#*, I ;:,, .5;4;-.i{ftdJgi;-,:
Note: Thiq,Wrmation Notice to Property Ownqyl abdut Construction Responsib;l;f&
was developea by thE Ciiistriction Contractort
-Bo:,r:!n
accordance with ORS 70t.05X$*{{;/
Ii vott itre aciing as your {}wn contractor [o construct a ncw home or make a sLrbstantial improvelnent to an existing stnlcture,
you can prevent mary problerns by being aware of the following responsibilities and areas of concem.
EM PLOYER RESPONSI BI LITIES:
If you hire persons not registered with the Construction Contrattors 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 withholcl income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your einployees. For more
information, call the Oregon Dept. of Revenue at 945-8091
Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For rnore information, call the Oregon Employment Division at the DefiarEneat of Human:Resoirars
at378-3524.
Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and must
obtain workers'compensation insurance for your employees. If you fail to obtain worke{s'compensation insurance, you may
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreinformation,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Inttrnal Revenue Service: As an employer, you rmrst 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 Internal Revenue Service
at 1-800-829-lO4O. " ':;:; :
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 requirernents
that may be brought to your attention through inspections.
Liability and property darnage insurance: Contact your insurance agent to see if you have adequale insulance coverage for
accidents and omissions such.as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient timc to supc'rvise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and frnish
trades, ard to notify building 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 l4l4}, Salem, OR 97309-5052,
54y378-4621). The Board is located at 700 Summer St. NE Suite 3fl), in Salem.
prop-own.pm4
U94