HomeMy WebLinkAboutPermit Fence 1996-7-26 (2)
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FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North Fifth St~eet
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: ,'3 tfJ7/)oudt?--5. /)e/~)-€J ,
,,""'" lip ., Lto l 01017 JJ To. "" .' 02&U? ;)~
Owner: &3t1e(aI44 &f!iJ_~ !I)ttdaht:?/ L~U11/{
Address: {~cf9;7 l)o~J),e, Phone #: 7cJcf-~~\'? 17
City::5krJ.-fJ{~ (~ate: (J IC Zip: c?7~7~
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Value of Fence: ,~J'~
Fence Permit is $5.00
Contractor/Installer:
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State:
Phone #:
Address:
City:
Zip:
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Construction Contractors Registration #:
Expires:
lly 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 provid~d with the Springfield
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FOR OFFICE USE
Date of Application: 7- Z(o - q ~
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Total Amount Collected: 5, UO_
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Receipt II
Issued By:
JOB II: qro I()t Co
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Checked for Delinquend es:
Checked for Historical Status:
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Permit #:
Address:
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kb Date: 7-U_
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:
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L 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,
OR
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 cer that the above information is correct and that I have read and do understand the Information
Notice t 0 ~r ~ cons:/1/f Z;:ies on the reverse si?~~r~f 0
(Sig.iat~;e o~' applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
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Note: This Illformation Notice to Property OWllers abollt Constructioll Re'ponsibiliiit,s
was del'eloped by the COllstmetior, Contractors Board ill accordance with ORS 70/,055(5),
If you are acting as your own contractor to construct a new home or make a substantial improvement to an t:~biini; structure,
you ean prevent many problems by heing aware of the following responsibilities a;:d art:as ('f concern,
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If you hire persons not registered with the Construction Contractors Board to do labor in consr.Llcting or ""islii1~l in 'h.-
construction or improvement of a residential structure, you will, in most instances, be ruled to he an .:mployer """,d t:", people
you hire will be employees, As the employer, you must comply with the following:
Q~2g0~ 's wm1to!dbg tax htw: As an employer, you must withhold income taxes from employee wuges at the lime employ "s
are paid, You will bc liable for tl:e tax payments even if you don't actually withhold the tax from your empl.,) .:cs, I:or IT'''e
information, call the Oregon Dept. of Revenue at 945-8091 ,
:J~2:n::!O,Y~:2n~ ::1s::~::~e ~Jr: As an employe:, you aR r~quired to pay a tax for un~mploymcnt insurance purpo"'l" on t;lL'
wages of all employees, For more in'ormation, call the Oregon EmploYIT',cl:t Divi<ion ,'t thc Dcpa1rr.ent of HUlmr '(_'\C"""
at 378-3524,
V~/OZ"~2::"S' co:n~:~~szjc.:: i::5i!7!:::C2; As an employer, you are subject to th~ Oregon \Vorkei"~' Compen~atlon Law. Jnd ITiu...t
obtain workers' compensation insurance for your employee" If you fail to obtain worl,.:r, compemation insu,anc.:, yo:! n' JY
be subjectto penalties and will be liable for all claim costs if one of your employees is injured on th~ job, For ml'j'~ in~"rlT'"ti, 1,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7R8l\,
':J.8. !.::1ernl1.1 Revc:lI!e S2~vice: As an employer, you must withhold federal income tax from employees' wages, Y'llI \', ill be
liable forthe tax payment even if you didn't actually withhold the tax, For more information, call the Intemul Re\enul' Sl'f\ Ii'e
at 1-800-829-1040,
O':}2E?J :~F.S~O~S~3JU1~IES AC\!:O ACR![(;AS O? C:Ji\:Cp,:<i:l::
Cede cO-:1plh:_'1ce: As the permit holder for this project, you are responsible for resolving any failure to meet code re!ju ireIT''' '1h
that may be brought to your attention through inspections,
Li:;:bili1y and prop2J:'1y ol1.mage insurance: Contact your insurance agent to see if you have adequate insurance cov-'rag, lor
accident.; and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or \\'l'rl- that must be
re-done,
Time to sup2rvise employees: Make sure you have sufficient time to supervise your employees,
iEli?er'ds2: Malee 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 officials at the appropriate times so they can perform the required inspections,
If you have additional questions, write or call the Construction Contractors Board (pO Box 14140, Salem, OR 97309-5052,
503/378-4621), The Board is located at 700 Summer SI. NE Suite 300, in Salem.
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