HomeMy WebLinkAboutPermit Fence 1992-4-15
FENCE PERMIT APPLICATION
CITY OF SPRINGfIELD
BUILDING SAFETY DIVISION
225 North F,[th Street
Spr1ngf1eld, Oregon 97477
Offlce
INSPECTION LINE
726-3759
726-3769
Job Locat1on Zd8/ r 11 (tJvW:;! W,
Assessors Map #, 1)( ()::o, I J 7 z..
Owner ')'f'tY\();' J3'l/~on....J
I
Address dO!1 IYl/''''l1J.. !~1""7
C1 tv ~?/-L/) State
Tax Lot #, O/'ODU
Phone #, -;?~/ ::>-/C/=<r'
/?/~- Zlp' ~ 7'7"'/ ?
Value of Fence -gL/~, pO
Fence Perm1t 1S $5 00
Contractor/Installer . CLr../,<;r;L;;:? .
Address
Phone #
C1ty
State'
Zlp:
Construct1on Contractors Reg1strat1on #
Exp1res'
By slgn1ng th,S perm1t/appl1cat1on, I aglee to call for an 1nspect1on once my
fence has been constructed (726-3769) I also stated that all 1nformat1on on
th,S appllcat1on/perm1t 1S correct and that I was prov1ded w1th the Spr1ngf1eld
Development code requ1rements for fence standards
y ~~?~6<~--t_
Slgnature r
~r7ft~
Date
FOR OFFICE USE
Date of ApphcatlOn LJ -/0-q7_
Rece1pt # 7"73'~
Issued By:
JOB I: q 71)17J?/
~~,
(~'
Checked for Dehnqupnrl pS'
5co
/'
Checked for H,stonce' <;tetl1~
~
Total Amount Collected'
.
.-
Permit No q z.ry::;g J
Address -2..Qgf I/j)rh1f!! IAj~
Issued by 0-~ ~ Date 'l..::fi!iL
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
-
Note Oregon Law, ORS 701 055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the bUilding permit can be Issued This state.
ment 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 applicable blanks, and Initial boxes 1 and 2, and either box 3A or 3B
1
V I I own, reside In, or will reside In the completed structure
I
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 I My general contractor IS
CDntractor registratIOn number
I will Instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board
OR
3 B 1.-\ I I will be my own general contractor
If I hire subcontractors, I will hire only subcontractors'reglstered with the Construe.'
tlon CDntractors Board If 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 ' " . . J
I hereby certify that the above information IS correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse SIde of thiS form.
X4/I/i,~ ~/-~6f~~'
Signature of Permit APPlicant;." .
Dt~J?~ .
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
,
INFOR,......~TlON NOTICE TO PROPERTY 0... ,-IERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE This Informalion Nolice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board In accordance with ORS 701 055(5),
passed by the 1989 Oregon Legislature
If you are acting as your own contractor to construct a new home or make a substantial Improvement to an
eXisting structure, you can prevent many problems by being aware of the follOWing respDnslbllltles and areas
of concern
EMPLOYER RESPONSIBILITIES
If you hire persons not registered With the Construclion Contractors Board to do labor In constructing 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 comply With the follOWing
Oregon's Withholding Tax Law As an employer, you must Withhold Income taxes from employee wages at
the lime employees are paid You Will be liable for the tax payments even If you don't actually wlthhDld the
tax from your employees For more information, call the Oregon Department of Revenue at 378.3390
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, call the Oregon Employment DIVISion DHR
at 378-3224 .
Workers' Compensation Insurance As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' compensation Insurance for your employees If you fall to obtain wDrkers'
compensation Insurance, you may be subject to penalties and Will be liable for all claim costs If one of your
employees IS Injured on the Job For more Informalion, call the Workers' Compensation DIVISion DIF at 373-7434
US Internal Revenue Service As an employer, you must Withhold federal Income tax from employees' wages
You Will be liable for the tax payment even If you didn't actually Withhold the tax For more InformatlDn, call
the Internal Revenue Service at 221.3960
OTHER RESPONSIBILITIES AND AREAS OF CONCERN
Code Compliance As the permit holder for thiS proJect, you are responsible for resolVing any failure tD meet
code reqUirements that may be brought to your attention through Inspecllons
Liability and Property Damage Insurance Contact your Insurance agent to see If you have adequate Insurance
coverage for aCCidents and omiSSions such as failing 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 emplDyees
Expertise Make sure you have the experlise to act as your own general cDntractor, to coordinate the work
of rough'ln and finish trades, and to nolify bUilding offiCials at the appropriate times so they can perform
the required Inspections
If you have additional questions, write to
ConstructlDn Contractors Board
700 Summer St NE, SUite 300
Salem, OR 97310-0151
Phone 503.378.4621
0244J 10124189