HomeMy WebLinkAboutPermit Fence 1995-05-01SPRINGFIELO
PBNCB PBRHIT APPLICATION
CITY OT SPRINGTIELD
BTIII,DING SATBTY DIVISION
225 North Fifth Street
Springfield, Oregon 97477
0ffice:
INSPECTION LINE:
726-3759
726-3769
CITY OF OREGO'U
Job Location:
Assessors Hap *,lao > 3l 4z
I
Address:
Ct ty ,9P+,L
Tax Lot #: Cy'5(rf
state , O R-f-
Phone *,7db-o&15
, q747 rZip
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Value of Fence:
A
8M^ /,CDd Fence Permit is $5.00
Con trac torlIns taller :
Address:.lt .lt.
Cl ty:Zipz
Cons truc t i on Contractors Registration *: Expires:
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that aII information on
this application/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
gnature Dat
tr
Date of Applieation:
Receip t * (9/
Total Amount Collected .$ *'(v)
qs JoB *: q5c5s7
r""r"alf , --YYLaz/',
+
Checked for Delinquenc.i.es'. \,/Checked for Historical Status:
Ovner:
FOR OFFICE USE
I
Permit #:
DateIssued
Address >r"lqo /r
Statement: lnformation 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 ftled with the permit.
Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38:
X 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.
3A,. 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.
E 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 information is correctand thatl have read and dounderstand thelnformation
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
OR
(Signature of applicant)
(White copy to issuing agency pennit file,
pink copy to applicant)
)
3
Information Notice to Property Owners
About Construction Responsibilities
:,,'. .Note : Tltis lnforntation Notice to Property,awners about Cortstrut:tion Responsibiltties''' .
was rlivrloped bv ilte Con.tlrut-tion Contra'ctors Bourd itt ot't't)r(lurtct,tvith ORS 7Ut.055(5).
I{'you are acting as your owlt contractor to construct a nt: w home or rnake a substantial irrrprovenrent to ifi existing structure,
you can prevent many problerns by berng aware of the followrng responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persgnS lot registered lvith the Construction Contractors. Board to ds labor in constrqcting or assisting in the
construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comp{y with the following:
Oregon's withholdlng tax law: As an employer, you must withhold income taxes from employee wages at the rime employees
are paid. You will be liable for the trx 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 employees. For more information, callthe Oregon Employment Division at the Department of Human Resouroes
at378-3524.
Workers' compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law, and uiust.
obtain workers'compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you,may
be subject to penalties and will be liable for all claim costs if one of your employ'ees is injured on the job. For more information;
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. You will be
liable forrhe tax payment even if you didn't actually withhold the tax. For more information, call the lnternal Revenue Service
at l-800-829-tO,!0.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requiremerrts
that may be brought to your attention through inspections. , ,
.,
LiabiH,ry and property damageinsuraRco: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions suc[,as falling tools, paint qverspray, water damage from pipe punctures, 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 rough-in and finish
trades, and to notify building ofhcials at the appropriate times so they can perform the reqriired inspections.
If you trafrdAitional questiois, write or call the Construction Conffactors 3€Ard (PO Box.l4l40,,Salem, OR-97309-5052,
5031378-4621). The Board is located at 700 Summer St. NE Suite 300, in Saleh.
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