HomeMy WebLinkAboutPermit Fence 1996-08-27225 North Fifth Street
Springfield, Oregon 97477
FBNCE PBRHIT APPLICATION
CITY OI' SPRINGTIELD
BUILDING SAFETY DIVISION
SPRINGFIELD
0f f ice:
INSPECTION LINE:
726-37s9
726-3769
Job Location:,' ):70 ilf,' 3sfr
Assessors Map *:lt o>3o 3+Tax Lot #: O9OoO
0wner:
Address:
Ci ty:
+A
aR,
Fence Permit is $5.00
Phone#: {F& -{tjJ-
Zi p:o7/o ZS ta te:
4ooValue of Fence:
Con t rac tor/fns taI Ier:
Address , l3 7O
C lo^Ju C,raLts a2-(
Nf?^3-5-'74 J f Phone s: lU - *
Ci ty:f State (1 <zipz 777 7 7
Construction Contractors Registration #:lres:
lly signing this permit/application, I agrce to caII for an inspectlon once my
fcnce ltas becn constructed (726-3769). I also stated that aLl informatlon on
this application/permit is correct and that I vas provided vith the Springfield
Develollnren ode requirements for fence standards.
S 1gl1 ture
FOR OFFICE USE
Date of Application JOB *:
Receipt *D>zC Issued By , 1l) , rY) ae/n ad cs
To taI /trnoun t CoIlec ted h
Checkcd for Delinqueneies: , -Check.ed f or IIis torical Sta ttts:
6r-27-7{
Date
i?o N' 3s1l+ t>
MkJ,w<lo Date: Xlz</q Q
Permit #:
iAddress:
Issued
Statement: Information Notice to Property Owners
About Construction 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, 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 I and2, and either box 3,\ or 38:
a 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.
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 that the above information is correct and that I have read and do understand the Information
about Construction Responsibilities on the reverse side of this form.
t-27-7{
(Signature of permit applicant)
(White copy to issuing agency permitfile,
pink copy to applicant)
OR
Notice to Property
(Date)
ff ,u I will be my own general contractor.
. f ,.
Iilformation{toiice to Froperty Owners
r * - -*'-'"
Nalv: !.,J iti,,'()rmutit.'u Notice.tq P,rctrer4'On't;t,r.; alnut Crtrt.strttt !ion Rt'.tymsil;ilities : ..
\7'G5 ,lr r:!r l:'t! b-v the {'on.siritt:fton Co*riclors Boartl in er:r:rtrtl{tnt-'e wirli ORS 70 1.055(5).
If you are acting as your i;r'i,n contractor to construct a new home or make a substantial improvernent to an existing strucfire,
you can prtr\.ellill\xry problcnu by being aware of the Icllowlng rr'sponsll-ri&ties and areas of yo1em.
EMPLOYER HESPONSIBILITIES:
If you hire persons not registcred rvith the Construction Contractors Board to do labor in constructing or assisting in the
constructiort or impiovem,:nt c,f a residential strucfuie. you w:ill, in rnost instances, be ruled to be an employer and the people
you hire will be emplolces. As the employer, you rnusf 'cbmply with the following: , ,'"
Oregon'swithholdingtaxlaw: Asanemployer,'yournuslwithholclincometaxesfromemployeewagesatthetimeemployees
arc paici. You will be liable t'or theitax payments even if you clon't actually withhold the tax from yoilr'ernployees. For more
informaticln,calltheor.cgonDept.ofRevenueat945-809I;
Unemployment insurance lax: As an employer, you iue required to pay a tax I'or unempioyment insurance purposes on the
wages of all employees For urrrre inf'snnation, call the,O-regon EmploymertD.ivision at ttreDe.partrnent of,lltlrll4l]F€qqprf;e-B
at378-3524.
Workers' compensation insurance: As an employer,'you ** subject to ihe Oregontivo.k".r' Compensation'Lo*, *d fr#
obt$t.ypql,ers' cornpensalit::i insuramce for your entployer-'s- If you tail to obt:Jn workers' coynpensation insurance, yoqmet
u. dtUjStt rt penaltie.s an,J rr,ill Ub iiaU'le rointt .ili*.otti if t;t uiy6ur"r',plciye'es isirij.ured on tie job. r9in15re inror*itiord
call the Workers' Compr:nsation Division at the Department of Consumer and Busiriesi Savices at'g+S-?8AbY
U.S.Internal Revenue Servies As an employer, you must withholcl feder:rl income tax from employees' wages. Vo, ,iliU,i
liabE fo+heti$i:iroyrhent everi iiyou ditJn't actually withhold the tax. For more in{brmation, call the Intemal Revenue Servfcri
atl-80&829+1040. ' :. : ;.r,'
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code complian,i:e; A> thc, D{:r.r:ril hoiLier ibr this project, }'ou are respiusibli ilrresolving an,v- failure tc meet codc' requircmcnts
that may be brought io vollr *ilcntion thr*ugh inspections. ,
, -_a
Liability and property damage insurance: Contact ,vour insurirnce agent to see il you have adequate insurance coverage tbr ,
accidents.and omrssiolis such .ui falling tools, palnt oversprey, water danrage tiorn pipe punctures, fire, or work that must be
re-done.
fime to supervise employees: Make sure you have sufficient time to supervise your employees
Expbrtlse: Make sure you have the expertise 1o act as yourown general contractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate'times so they can perform the required ihspections.
If you hav'i additional qu".iionr, write or call the Construction Contractors {ioard'(P.o Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board rs located at 700 Surnmer St. NE Suite 300, in Salem.
prop-own.pm4
lt94