HomeMy WebLinkAboutPermit Fence 1993-8-23
i' '\
~J
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North Fifth Street
Springf~eld, Oregon 97477
Office:
INSPECTION LINE:
726-3759
726-3769
Job Location: rQ(J4{ ,0 \
Assessors Map #:- 'I '7D33L.O-t -
Owner: ~~nl ~ ,-~'r\g)"\(\f\ QrK-.>
Address:_~~ Q , IJl\f~sLL . Phone #:~ -46QPJ
City: \"S~_n . State: t}JH ~ ~f)411
Value of Fence: 4rn.cx.:J Fence Permi t is $5.00 '
Contractor/Installer: Q _~'Jf\Q V
" f;'llJlQb
Tax Lot #:
()!)ncD
Address:
Phone #:
City:
State:
Zip:
Construction 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 all information on
this application/permit is correct and that I was provided with the Springfield
Development code requirements for fence standards.
4: /"! ..1-.,
A1..ttl1../
s,gnature
~/cfl--'
,
8";)6~C13
Date
FOR OFFICE USE
Date of Application: R .~lo'qs
\ r::fJoq
\
Total Amount Collected:
Receipt #
, if)
~.
Checked for Delinquencies: - 0
(
Issued
JOB t: q(2-, I R Q3
BY:CI)~1
Checked for Historical
Status: P
I
, .
Permit No: q3\~f}3
Address: ~~lo -r. QtQo t
Issued bY:CJ) \ffi ') Date: B {lfoCf.3
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS701.055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
signthe 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
fi led with the permit.
Fill in ,the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
c/! -
1. I ~ I own, reside in, or will reside in the completed, structure. '
2. I
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
,I'My general contractor is
, ,Contractor 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. M I will be my own general contractor.
( If I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors 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.
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. .
~ ~'~M~
STgnature of Permit Applicant
'8 -:)(0 ~q_l
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COpy TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
:0"';'- ,
--.INFORMATION 'NOTICE' TO PROPERTY, OWNERS
ABOUT' CONSt~~~TION 'RESPqNSIBIUTIES
}J'a ~~~ (.
" ",
'\ :': .: ' --NOT!;:.' J."]hi~il~iq~r.!liC!i~n':N<?~iCe.)<?lerop6riy b~hers.About construction 'R~sponsibiliti~S."
" '. ",'. ", was~'deve.loped bY,t~~ Constr~ctior:1 Cdntractc;>rs Board in ac~ordance with O,RS !OtQ~5.(?5;: ", , .
,~;, '. .::,.'pass.ed..;,by. theJ9.8~VOJegor;l Legislature: ' J' ",".', ':.:-:,':.. J.,,:. ",
I, " " '. .' ,,' ,,", ".' '.;'., '" " ,"
\:. "'.': :.,..{?" ,,' '/:~', .,..;,s,,>.., """', ,'. " .(~~~,":~;:;//:~,.: ",.' ,
If you:'ars: acting' a~you'r-d~n: c&ntracto'r' tb d)n~truct~.n.ew hOl1Je,'or'make a substa!1ti:alin1pro~erTf~.nt to an ,
I 'existing structl!~e, you can 'prevent .l11any prpblems by,!qeing.aware of the fOl,lowing responsibiHJiss" and ,areas .
'~of"concern~ '.: h, " i","-."" '.' ',,, ,l. ~,;..~. -,.. .. ,,' ' '\~<'\"
......
. '."i ' ....'~~1:- '
,'::.t<-; ..
.' ',' ,:<-:-:';"Ul"/,,' .;
,..'EMPLOyER RESPONSIBILITIES: . .'. r. - "
~ r~. ."~'~_.;:):=:;~::. . .
?-'" _J, ~
f"'..
- . ,;
" If you hire persons 'not registered wit~ theCon$tru,cti6hC9ntr~Ctors Board to do labor in constructing or assisting
irl"the constru9iibh' o(:imp,joyet6'emt 'o(~, te5ttfehtiar-:$Jfu~tlif~,~y'()ll ~il!: :In ,rri()$t~,in5tahces" :b;e.i"lIled to be an
. .. .~/., -, ',' ..' .,'. .. ... . .,', ."', ".. ..,._ ~ j ,., "._. _',~ .....-I:._..~..'- .. . '"'.' .~.,' t. '~'. ., .'<,.f, ,'.. .-
"er'T1plby.~t"an9 tl:le R~opl~-VQu,hire Will'9r~.'~eril'p'lby.~es'J';' /~s,th:eE#Jlp,19y~r;,yoJrn)ustcQQ1plyvvitt't.the following: '
...._.....' . .><~:.:...::~ ..;,~.~~~:~-~':-.~'t.''''_,..,~~i>~ .!...~:__i.~. ',:., :-I.~.:.,:~.~;....~_..~-. ...~...l<-...~ ,._.:..~~~~~~.f~~,.~~../'_~.:~..__~~~:~.'......:~. ~<:~'"
.,' "
" Oregon's, Withboiding,T~x. LaW:'~~$:,a~~e.th'p.loye,~, 'Ybb':rnyst' withhJI~l'i~--CQme fax~~,'ir9m 'eo1ptQyee wages at
., ,_ .;,. "Co.. ..,. ". 't \ ." _ -J:'." : .' ',l .". 0'.. - .' ~. _.t. ,.' - . . . .
the time emplp~~e~';'~repajd. . you wi'l:b~,liaIDleforthe. r~xpay'ments,ever,df.youdon'tactually withhold the
. tax' fro~ 'your employe,as', ~.:,For more, i nfo'r'ma\iorlr; 'call" the Qreg'on " Depal1rne.r.lt' 9f ,Reven u~, ~1 378-3390,
.' .
~,~. <4. ;".'~. ~~..:;. -:..!-2'" ;{;;~~ . '.::'" . a..... ~. ~ ':.~'" .' -"'. ''''~!It ,"'.' '\~:>.::.c.~-, :-~t:" . .
U hemployment Insur9-nce Tax: As. an e~ployer, Y<?u are required to .pay a tax for unemploymen.t insurance
purposes 'on the wCiges of all employees. ,Fqr.mor~ i'nformatiqn,.caltthe o.~~gqrl qrT!ployrrrsill Division DHR
, at 378-3224:' ',' . . , , ,. ", ' '" ". --. .
"_.<,"" .~.' .~. 'J" ""~~h:":; ,.r.!::.'" >: ":"i':;!:\:',' ,:;:u,:' :.:'. .-' ;~. , .:;r.. ,f';, "".,_,,' .
, , 'Workers' -ComRensatiqn Insurance:' As a:ner:pployerryot!l!are~sufujecHOJhe"OregoqWorkersJ Compensa,tion
I,.,aw,-'aridmust ot;>tajnworkers' compensation insu'r~riceforyol.ir employees. If you 'fajl)oobtain workers'
compens~ti.on,.in'~uranGe;.;:You may be~subj.~Ct-'to,p~n'alties.~nd\\~;j1l b"s"liable';f6r-all c.li:lim Gosts if,orie of your', '
employees isihju.redorrt.ti~10b. F9r,more:information, call)he Workers' C6mpensationQivision OiFat 373-7434. "
~ -...". .._...~"'" ~_ .;>1.9':f':~~~~"'t / . :~;:.":~~.:~~.,:-.. ..~::.~. ' -
,,-' ,; .
U.S. .1 n}~r~a\ ~~'l~n~~$~rvi~e:. A$ ~n,~mRI8~~~,r. :Y9~. ml~~tvyi~h:tiR..'?,J~ger~l.i~g?)~,~ .t~x.Jrome~pl~yees'. wages. " '
. ',Yoll will b'e liable "for~l:l:e t~x p~Yr:Den.t.~ven)t, ~ou ,9!? n~t ~ClYI~' IY'yyI,'r.J:H?!~ trye ;tax .', F9t: lJlor~ Inform~tlon, call
thelnternaIRevenue~Se';-viceJat;221'::3'96b.>;':''::~''-'': ' "'~." " "., ". " " "
'.- .
OTHER RES'P'ONSII3'iUTIES .AN'O AREAS'OF CONCERN:' "'.. ;4;', .;" ,,""~ -~ ?
. :":', ,: ,:'.: ',- ':~-' .'~". .' '.. .,,' ,':'Y::':'~' ',., , .;: \," .
Code Q.9mplicince: 'AstheperQJ:il hold~r. for this project, ,YoU',are respo.nsipleAor Tes.dhi,!n'g any,!ailureto meet
cod.~ ,requirements; that may 6~ibro,ught;.t9, your.,a~tentiori-,through, inspeCtions. <,,'-'[ : " ,.~
. ~.\ ; ',:.';t;o.. .~'~....~ " '~.\ :'\~:~'l~."."". ~"", _:.....: .:;.~..~>,-: '.;'!; ,~~,. :=:~ .t"/.' '~~T~;'-'~'V. .~~_li.<-'~"~...,t: .:~:""" '
,,' Uabilffy and 'Pr6perty Damag'e:i~si:JF~mce:"~c6nta6t, your:iriSlJr~nee'.a@eMttosee~.Wyoi.rha:ve adeq~ate ir.lsurance '
~cbverageforaccidents and om~ssions suc/1'as falling;tools', paint OV~r$pray;'water damage'from pipe punc- '
tures,.Jire,:o.r work that must. be i'e-done., ,',' ' , .; ,
~>~f~-..f' ....: , ~ ~'~~'}'. \ i: ~.c, >, ,t: ~ ' . ~ :',t .?.<:;..~~_.;,.,:-:.,~.'j,:~;,/~;' ~t:.~;: ~__" ;:~.~.:i.~:..i..: 7
Time 'to: Supervise 'Employees:",Makel'su're ~you have, 'suffiGien.t.;tiIl,lE{to super;vi~e your: employees,
. ~ .. . .~.~... . ..)-~ ,'of' ','- ....,'. ." . ~.- ,...~ .:-\-:
.. .-' ;' .'::,;" , ., '. _ ,.,........ .
,,' Expertise:" Mak~. s4re YOll.ha,.ve, t~.~;. eXP13rt!se .to act as ;your: ownge~enil cont~~ctot, t~) c09~dinate th~work;:
, of rough-in and finish' trades;;$'nd t6'notify' buildihg'officials.atJheappfopniat~ times 'so they' can perform."
. \..,: '.... ',_.' - . ,'_ . .0' -: 0 _' _ ;\. .." _,.' t'" ''< - .
,the required7inspections.' -"'"":,:,, ".." , . ,';. , ,.;..'. ~".J' ,..," ::.',', ,:,"; -,...;-.: ,;- .
. " '. ,. . r 4~.q~.l>-~ . . ,. ' ,.~l:':",,,.. ~ . :.- 'j .:: ~.,~ ':~:}.~~-B."~~;,f~.-.'~",~,
. ~.;" .
,..,
'Construction Contractors Board
700Sumnwr St.. NE, Suite '300
Sa.leiTI;.jQ,~~~1310-0f5{'::;;i;,~.. '.' :
. , 'Phone',503-318-4621 .
:::i'~" ',J ;~.;~~. ;::. :.)
, ,
,If, you 'h~~~ addit~onal'questiCj'n~, write t<;>:
r: .~.~:~ :.~.:.J~{J :
:L l02'~4~'!1b/2,4/89~:":n~:;;~~;j~~~1'T ' ",~K;[~:~~t~;~ " '
.':-",
.~;.,..
, :
.~ 1
t: