HomeMy WebLinkAboutPermit Fence 1994-09-29FBNCB PBRHIT APPLICATION
CITY OP SPRINGFIBLD
BUIIDING SAFBTY DIVISION
SPR:NGFIELD
0ffice:
INSPECTION LINE:
%
225 North Fifth Street
Springfield, Oregon 97477
726-37s9
726-3769
CITY OF OBEGO'V
Job Location:
Assessors +
Ovner:
Address:
S tate:
Tax Lot #:
Phone *:
ziCi ty a i{Y)?tt(A,gg 1
Value of Fence:tvt Fence Permit is $5.00
Con t rac torlIns taIIer :
Address:Phone *:
Ci ty:State:zip;
Construction Contractors Registration f :Expires:
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 with the Springfield
Development code requirements for fence standards.
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tt
t'
gnat ure Date
FOR OFFICE USE
Date of Applicati o,^, Q -
Receipt * 0lqC?1
roB *,qnl5&
Total Amount Collected:
Issued By:
-/
Checked for Delinqueneies: u'/Checked for Historical S ta ttts:
-a
7
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Permit #:/50
Address:,"q" N. lf1t.Sr
Issuod by:Date:7 -2q -7a
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon l-aw, 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, exempt from 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 L 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 genelal 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.
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 notiff the office issuing this building permit of the
name of the contractor.
Ihereby certify thatthe above informationis correctand thatl have readand do understand the Information
Owners about Construction Responsibilities on the reverse side of this form.
OR
J
of permit
(White copy to issuing agency perrnit file,
pink copy to applicant)
Notice to
((Date)
fr
@
lnforrnation Notice to Propenty Owners
About Construction Hesponslbltrities
Nrste: '{kis !nf*rwation Nr;ii.ce t{, Pr{}p€rty Owners aboul {krnstrwrti*n Responsibilities
v,*s r{eve lrsperl &-v r&r Cr:ryzs/r'ttcficn trti*r*$*rs Bor.rt} in *tc*rr{arzce u,itl,r Otls 7CI1.A55(5).
I{ ycu :rrr: ae ting es }'$ilr {iwn **ntvii{:t*r t$ es&strilrt it r}crv hq:}me or *"rak* x suhs{antlai impr*vemen{ [r: an existing strllcture,
you ca"n prevent mmy problems by being aware of the followiug responsibilities and areas of concern.
EM PLOYEB RE$PONSIBILITIES:
If you hire persons not registered with the Construction Conkactors Baard to do labor in constructing or assisting in the
constluction or improvement of a residential structure, yor-l will, in most instances, be ruled to be an ernployer and the people
you hire wllX bre empioye*s. As the employer, vou musr cornpll' with the foilowing:
Oregon's withholding tax law; As an ernployer, you rnust withhokl income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if yrlu don't actually withhold the tax from your employees. For more
information, call the Oregon Ilept. of Revenue at 945-8091.
Unemployment insurance tax: As an ernployer, you are required to pay a tax for unemployment insurance purposes on the
wages of ali empioyees. For more information,' call the,Oregon Employrnent Division at the Department of Human Resoures
at378-3524.
Workers'compensation insurance: As an employer, you arc subject lo the Oregon Workers' Compensation Law, and must
obtain porkerqlcompensaiion insurance for ycur ernployees. 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 ReYenue Serviee: As an employer, you must withhold federal incorne tax from employees'wages. You will bd
liable for fhe tax payment even if you dic{n't actuaily withhold the tax. For rnore inforrnation, call the Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIEILITIES 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 damage insurance: 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 punctures, fire, or work that must be
re-done.
Time to supervise employees; Vlake sure you have sufficient tirne to sup*rvis* your employees.
Expertise: Make sure you have the expertise to act as your ov/n general contractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at t!:e apprr-rpriate times sri they can pedorm the required inspections.
If you have additional questions' write or call the construction Contractors Boanl (po Box 14140" salem, oR 97309-5052,503/378-4.621). The Board is iocated ar 7{}0 Surnmer Sl. |,{E Suite 300, in Salem.
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