HomeMy WebLinkAboutPermit Fence 1995-03-01225 North Fifth StreetSpringfield, Oregon 97477
FrygE PERUTT APPLrcArroN
CTTY OF SPRTNGFTELD
BUTI,DTNG SAFETY DTVTSTON
*(
SP'TTNGFIELD
0ffice:
TNSPECTTON LINE:
726-3759
726-3769
Owner:
Addres
Job Location:
Assessors H"p #,Tax Lot #:O)-a o
Phone #:
Zip:z7
Fence permit is 95.00
o
Phone #:
Zipz
Ci ty:
Va1ue of Fence:
Con t rac tor,/f ns tall_er:
Address:
Ci ty:
Cons t ruction tractors Registrat
State:
.O
State:
ion #:
('
By signing this permit/applicatiglr r agree to carr for.an inspection once myfence has been constructed (726-3log). "r
"r"" ",ra"d that all information onthis application/permit is eoriect and that r vas provided with the springfieldDevelopment code requirements for fence "trnJ".a".
ture e
FOR OFFICE USE
CITY OF
Date of A
Receipt
Total Amount CoIIected:
JOB *:?so zs?
Ct y)r""u"iG4 - f)La ./--*.1,
ication: 3-- I -g S
IChecked for Delinqueneies:
P
Checked for Historical Stattts:
41o s/L/1
-61)q,'Q
Permit #:
Address:5 LYzl >T-
(VVil"J* Date: ?l-7Issued .>
Statement: 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 3A or 3B:
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 fo. ,al"
before or uPon comPletion'
3A. My general contractor is
Contractor regis. #
structure must be
(Name)
3B. I will be my own general contractor
OR
If I hire subcontractors, I will hire only subcontractors registered with the construction Contractors
Board. If I change my mind and hire u g"ne,al contractor,f will contract with a contractor who is
registered with the cig una will immediately notify the office issuing this building permit of the
name of the contractor'
IherebY certify thatthe above information is correct and that I have read and do understand the Information
Notice to ProPertY Owners about Construction ResPonsibilities on the reverse side of this form'
3--qI
permit aPPlican0
(Wite copy to issuing agency permit file'
\ " 'rY" -
i*u coPY to aPPlicant)
(Signature of
(Date)
I will instruct my general contractor that all subcontractors who work on the
registered with the Construction Contractors Board'
rru
Information Notiee to Property CIwners
rYrltr;?}al.rfnformaIioltNrsti*tctPrrsp*rlyownersab{}utC$nstrtlt:tirsnfl'e'rponsibilitilei
was rlerrfoy;ed by th,: {onstrur:tio* Contract*rs {l**rd in str*rr}cnce witlt ORS 7E I .055(5), .
If you me acting *$ yi)*r *wrl contratt{}}- to r*nstrut:t s n*w hom* cr m;rke a substar-:tiai impr*vement to an existing structure,
yoll ciiil prevent many problemr.by being aware of the faliowing r:esponsibilities and areas of concem.
EMPLOYER RESPONSI BILITIES:
If you hir*: persons **t registered with trhe Construcai*n C*ntractors Boia'd to do labor in constructing or assisting in the
cot"lstruction nr irnpr*vem*nt cf a resiciential structure, you will, in most instances, be ruled to be eur employer and the people
you hir* will be employees. As the enrplcyer, you must comptry with thr: foilowing:
Oregon's withholding tax law: Ai an employer, you must withhold income taxes from employee wages atthe time employees
are paid. You will be Iiable for the tax payments even if you dont actually withhold the tax'from your employees. 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 ernployees" For more information, call the Oregon Employment Division at the DepartrUent of Hr,rman Rbsoufceg
at378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and must
obtain workers' coEipensation insurance for your employees. If you fail to obtain workers' compensation insurance, you may
besubjecttopenaltiesandwillbeliableforallclaimcostiifoneofyouremployeesisinjured"!;"j"t..F";moreinformagon,
call the Wnrkers' Compensation Division at the Department of Consumer and Br:siness Services it 945-7888"
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. you will be
iiable for the tax payment even if you didn't actually withhold the tax. For more information, call the Intemal R"u"nu" Service
at r-800-829-1040.
CITHER RESPONSIBILITTES AND AHEAS OF CONCERN:
prop-own.pm4
t/94
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirexqgnl'that may be brought to your attention through inspections. ; - '-,*'"":*t
Liability snd property damage insurancs Contact your insurance agent to see if you have adequate insurance coverage foraccidents and omissinns such as falling toots, paint or"rrp.uy, water damage rrom pipe punctures, fire, or work that must bere-done.
Time to supervise ernpl*yees: Make sure you have sutficient tirne to supervise your employees.
Expertise: Make sure yotr ha ve-the expertise to act as your own general contractor, to coordinate the work of rough-in and finishtrades' and to notify buitding .fficials ar the appropriate times*so they can perform the required inspections.
If you have ddditional questions' write or call the consrruction contracrols loard (po Box l4l4o, salem, ox grr0g-sbsz,503/378-462r). The BoarcJ is rocated ar 700 summer st. NE s*ire:oo, in sarem.