HomeMy WebLinkAboutPermit Fence 1992-01-13FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILt)ING SAFETY DIVISION
SP,tTi,GFIE<t'
0ffi ce:
INSPECTION LINE:
%
225 Fitth Street
Springfield, 0regon 97 477
726-3759
7?6-3769
CITY OF SPR OREGO'V
Job Location:a
Assessors Map #:
4
Tax Lot #:
0wner z /..,o p,c ,u.tl E Z- A^1,/,'s n J
Address : /22/ 4 &)" //4W Sf Phone #:_74a1bqsS
City:State:a_p Zi pt 4'7428
Value of Fence: / Oo t.. aao*-Fence Permit is $5.00
Contractor/Insta]1er: OWNEI,
Address:Phone #:
City:State:Zi p:
Construction Contractors Registration #:Ex p'ires :
By signing. this permit/app'licatig!r-l agree-to call for an inspection once myfence has been constructed (726-3769). I a'lso state that al'l information on-this_application/permit is correct and that I was provided with the Springfie'ld
Development Code requirements for fence standards.
3, Vtl , /'L^ *, - /, ;.-,,,/-/3"qySr-gnattre Date
FOR OFFICE USE
Date of Application, / -J 1 : 72 Job #:Qzopzs:
Receipt #:35ar I s sued By :'
f ,rO,) -->-Total Amount Co'llected:
Checked for Historical Status:t-Checked for t)elinquencies {'
Note: oregon Law, oRS 701.055(4),. req.uire_s residential construction permitapplicants who are. not registere<i witn ttie Ctnstruction Contractors Board to' sign the following statemeit before tne uiriroin!'plrmit can be issued. This state-ment is required for residential.b_uilding, eieciri;at, mecninl.ill""o plumbingpermits' Licensed Architect and Enginglf .ippii.lnts, exempt from registrationunder oRS 701.010(7), need not subhit tniiitatement. This statement wiil befiled with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
1. l-=-- I own, reside in, or wirr reside in the compreted structure.
Permit No:
Address:/L
lssued Date:
OR OFFICE USE ONLY
I will instrucl my general contractor that all subcontractors who work on the struc-
ture must be registered with the construction contractors.Board.
I N Fo R MAno N * ot;fl%tIlbr.*ry owNERsABOUT CONSTRUCTION RESPONSIBILITIES'-
I understand that I must register as a construction contractor if the structure is soldor offered for sale before or upon completion.
2
Contractor registration numbe
t
OR
3 B. l----___-] I will be my own general contractor.
lf I hire subcontractors, I willhire 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 notify the office issuing this building permit of the name of
the contractor.
I hereby certity that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
/-/G *qz
Signature of Permit Applicant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
-
<-/
r' .'f
INFOI-JATION NOTICE TO PROPERTY r' /NERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This lnformation Notice to Property Owners
*"t O"r"foped by the Construction Contractors Board
passed by the 1989 Oregon Legislature
About Construction Responsibilities
in accordance with ORS 701055(5),
rf you are acting as your own contractor to construct a new home or make a substantiar improvement to an
existing structure, you can prevent *uny proor"r"r 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 residentiar structure, you wiil, in most instances, be ruled to be an
,,employer" and the people you hire witt oe 'iemployees"' ns tne employer' you must comply with the following:
s Withholdin Tax Law: As an emPloYer, You must with hold income taxes from employee wages at
time emPloYees are Pa Yo u will be liable for the tax payments even if yo u don't actuallY withhold the
tax from your emPloYees For more information, call the Oregon Department of Revenue at 378-3390'
Une ent lnsurance Tax: As an emP loyer, you are required to PaY a tax for unemPloYment insurance
purposes on the wages
at 378-3224.
all em ployees. For more information, call the Oregon EmPloYment Division DHR
Workers'Co sation lnsurance: As an emPloYer, Yo u are subiect to the Oregon Workers' ComPensation
Law, and must obtain ' compensation insurance for your emPloYees. lf You fail to obtain workers'
compensatio n insurance, you may be subject to penalties and will be liable for all clai m costs if one of Your
employees is injured on the iob. For more information, call the Workers' Com pensation Division Dl F at 973'74U'
U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees' wages'
r.*"nt","nityoudidn'tactuallywithholdthetax.Formoreinformation,call
the lnternal Revenue Service at 221-3960.
OTHER HESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
coffilequlrements 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: Make sure you have the expertise to act as your own general contractor, to coordinate the work
of roughin and finish trades, and to notify building officials at the appropriate times so they can 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 10124189