HomeMy WebLinkAboutPermit Fence 1995-04-21225 North Fifth Street
Springfield, Oregon 97477
PBNCE PBR}IIT APPLICATION
CITY OP SPRINGPIBLD
BUIIDING SAFETY DIVISION
SPrlINGFIELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
CITY OF SPF"VGFIELD, OREGO'V
Job Location:"45,
^l
ItrT- Sf-
Assessors Hap *:)4VZ
Ovner:
Address:
Tax Lot #:
Phone #:
t*Zi p:
Fence Permit is $5.00
1 q b L{LI}
c I fy State:
{10ailValue of Fence:
Con trac tor/Ins taIler :C l,auffz-be, L
Address, %) it[ ( {"7^ SJ-Phone #:)t
Ci ty:TrrTZ xtQ| 1t--'Zip:C-L{7State:
Construction Contractors Registration #:Expires:IJF
By signing this permit/application, I agree to caII for an inspection once my
fence has been constructed (726-3769). I also stated that all information on
this application/permit is correct and that I vas provided vith the Springfield
Deve}opment code requirements for fence standards.
S ture Date
FOR OFFICE USE
Date of Application:JOB *:
.t/',I ro?7'l Issued By:L"Receipt *
Total Amount Collected:t
O c,-{ tte
n
\
4 -t.t -4 c,(4
Permit#:c 1
Address 35,> AJ l?',v-
Issued by:li ur-".,-l-- Date:,1 -7.l -.6'
Statemert: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon l-aw, ORS 701.055(4), requires residenttal construction permit appli-
cants who are not regtstered 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 registration under ORS 701.010(7),
neednot submit this statement. This statement will be filedwith 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.A.. 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.
38. 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 informationis correct andthatl have read and dounderstand the Information
Owners Construction Responsibilities on the reverse side of this form.
OR
of
(White copy to issuing agency permit file,
pink copy to applicant)
Notice to
(S (Date)
trnformation Notice to Propeffiy Cwners
Ahmut ffonstructisn Flespommihi$$tIes
a'-
Nofe: ?}ris lnf*rm*tirrn Notice t* ?r*pe.rl ,* Owryers al;out Construacllsn &*,,ry:onsj&i/ities'' ','-.-'. '
w'*s detvloped by- t?tc Crsnslruction Cr;r$r*ttors lloc,rd in **tr;v'd*nr:e witlz $trS 7t11.055(5).
If you are acting as your own contractor to construct a new home or make a substantial irnprovement to an existing strucfure,
yor.l c;i{lpr"*vent nxmy problems by being aware *f the follawing responsibilities and areas of concern.
EMPLOYER NESPONSIBI LITIES:
If you hire persons nct registered ivith the Construction Contractors Baard tr: eJo lahor in constructing or assisting in the
construction or imprcvement of a residential structure, you will, in mcst instances, be ruled to be an e mployer and the people
you hir"e r,r'ill be employees. As the employer, you must cornply with thc following:
Oregon's withholding tax law: As an employer, you must u'ithhold income taxes from employee wagcs at the rime cmployees
are paid. You wiltr be liable for the tax payrnents even if you don't actually withhold the tax frcm your ernployees. For more
information, cali the Oregon Dept. of Revenue at 945-8091 .
Unemployment insuranee tax: As an empioyer, you are required to pay a tax for unemployment insurance purposes on the
wages of all employees" For more information, call the Oregon Employment Division at the Departrnent of *{uman Resources
at378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Cnmpensation Law, and rnust
obtain workers' compensation insura4ce for your employees. If you fail to obtain workers' compensation insurance, you may
besubjecttopenaltiesandwillbeliableforallclaimcostsifoneofyouremployeesisinjuredonthejob. Formoreirformation,
call the Workers'Compensation Division at the Depa*ment nf Consumer and Business Services at 945-7888.
U.S.Internal Revenue Service: As an employer, you must withhold federal income tax frotrt ernployees'wages. You will be
liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at l-8@829-1040.
OTHHH RESPONSIBILITIE$ AND AREA$ OF CONCERN:
Code 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.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insur:rnce caverage for
accidents and omissions such as faliing tools, paint overspray, water damage frcm pipe puncturss, fire , or work that must be
re-done.
Tirne to supervise ernployees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the experlise to act as your own general contractor, to coordinafe the work of rough-in and finish
trades, and to notify building officiais at the appropriate tirnes so they can perform the required insp*ctions.
If yor-r have additional questions, writc or call the construction contritclors Board (Po Box l4lilo,salem, oR 9730g-5052,5a3fi78-4621). The Board is locared at 700 summer st. NE suite 300, in salem.
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