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Home My WebLink AboutPermit Fence 1995-6-20 '~'. \;> . FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 North Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: ~053 ~d .snz~CT ~b, Assessors Hap II: 1/62- 3L.i ?,? ~ax Lot II: O\3f{) Owner: WAL7lE-L- ;.;:;. .:::I::"..sM.~ Address: 60S-3 .A!fp.;,H cs:n<~~ Phone II: 7~f-~bD Ci ty: .:5"J7Z;"/6FJEUJ State: oi2 Zip: 97'f7F ~ Value of Fence: flOP, "Y' Fence Permit is $5.00 Contractor/Installer: ow..v'bLkv)L]JEiL- ,/ Address: Phone II: City: State: Construction Contractors Registration II: AIH Zip: Expires: A/'LfJ -- By signing this permit/application, I agree to call for an inspection once my fence has been constructed (726-3769). I also stated that all information on this application/permit is correct and that I was provided with the Springfield Development code requirements for fence standards, ;J~it!.~ Signature JlhM Dafe ' FOR OFFICE USE Total Amount Collected: ~.oO Issued By: - t ~OB ,; q~D~q~ "0\\ tft ) D t f A 1, ,\ a e 0 pp lcatlon:, Receipt II \1~ \4 lo .?D .c\'S Checked for Delinquencies: Checked for Historical Status: " ...., :;:... ~:.:: ~ "::"\'-"~:: :. < ,.. ......., Address: . qS\J-\L\ S ~~~ ~\f\lL) Date: )().?D$ ...~G' '. l.. . Permit #: Issued by: 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 and 2, and either box 3A or 3B: lRl D I, 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 ~r - Ml:n!X ::;::~ _____ (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, ~ OR .0 3B. 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 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 Notice to Property Owners about Construction Responsibilities on the reverse side of this form. JJ~~.~ (Signature of permit applicant) ?~A>s- " <(bate) (White copy to issuing agency permit file, pink copy to applicant) . . , I V.... d"\ . .-.1 . Hni'orma'/:ion No'/:ice '/:0 Propeiiy Owners Aboll'/: Cons'/:ruction Responsibilities Note: This lnfonnation Nqtice to Property Owners about Construction Responsibilities was developed by the Construction Colltractors Board in accordance with ORS 701,055(5), If you are aCling as your own contraclor 10 conslruct a new home or make a substanlial improvement to an existing structure, you can prevenl many problems by being aware of Ihe following responsibilities and areas of concem, EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contraclors Board 10 do labor in constructing or assisting in the construction or improvement of a residential structure, .you will, in most inslances, be ruled to be an employer and the people you hire will be employees, As the employer, you must comply wilh the follow in!;: Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees are paid, You will be liable for the tax payments even if you don't actually withhold the tax from your employees, For more information, call the Oregon Depl. of Revenue at 945-80.91. 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 informalion, call the Oregon Employment Division at the Department of Human Resources al 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensalion Law, and must obtain workers' compensation insurance f9r your employees, If you fail to obtain workers' compensation insurance, you may be subjecllo 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 al the Department of Consumer and Business Services a1945-7888, U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages, You will be liable for the lax payment even if you didn't actually withhold the tax. For more informalion, call1he Inlemal Revenue Service at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for Ihis projecl, you are responsible for resolving any failure to meel code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Conlact your insurance agenl to see if you have adequale insurance coverage for accidents and omissions such as falling tools, painl overspray, water damage from pipe punctures, fire, or work Iha1 must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees, Expertise: Make sure you have Ihe expertise to acl as your own general contractor, to coordinate the work of rough-in 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 or call the Construction Conlractors Board (PO Box 141 ~O, Salem, OR 97309-5052, 503/378-4621), The Board is located at 700 Summer SI. NE Suite 300, in Salem. prop-own.pm4 1/94 . . FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 North Fifth Street Springfield, Oregon 97477 Office: INSPECTION LINE: 726-3759 726-3769 Job Location: 6D53 /l11'wJ S7: ' Assessors Map #: /7e/d;! 3,/ 33 ~~ Owner: rJ/lL'TiE.1C G, [~MC Address: (;,~ /v!1114 STJ<~.t'T Tax Lot #: /~~ ~ Ci ty: -.s;-7J<,~Alb;::-IIEL.J> State: OiL Phone #: 7~/-<3~:S Zip: ??<(..?c9 ~'Y Value of Fence: ~3~ Fence Permit is $5.00 Contractor/Installer: ~~~~~~~ Address: ...:5ct'lftfiL /!S flB"';.tE.... Phone #: City: State: Zip: Construction Contractors Registration #: Expires: ~y signing this permit/application, I agree to call for an inspection once my fence has been constructed (726-3769), I also stated that all information on this application/permit is correct and that I was provided with the Springfield Development code requirements for fence standards.' ;)ott-i1~~ b -<5?&>-?f Date Signature FOR OFFICE USE Date of Application: C -.::?R-9V Receipt # /,.~~ Issued By: JOB 1I: 99'09~ -~~-, Total Amount Collected: s-:.= Checked for Delinqu'mri es: ,~- Checked for Historic"l Statlls: r