HomeMy WebLinkAboutPermit Fence 1996-3-15
; ,
'7
. ....~.
.'
I......
"
,.
........
FENCE PERMIT APPLICATION
. I
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
"
Job Location: \,~ .l..S'_~ ~ ~ ~~.
Assessors Map #: l'7 03 ~5 43 0 3 &0 ,
::::::5: ~~~'~" t~\'-~~ \
- -
City: ~~',.,.,~"-\._~
Value of Fence:~CJi\ ~
Tax Lot #:
State:
~ \l.~\""",,'C-. ~
_ -r\_
Phone #: \~~ _\ - ~ J...,~f1
Zip: ~\'\~
Fence Permit is $5.00
Contractor/Installer: ~_1?-'" '"\ .\\. 1>.",--,\ ,,_ \ \
Address: '<1_\ ,,\\ ~~'\\ ~, Phone #:\'\"-<::>.-;1... ~~(')
.-.. ." .
City: ~ ~[;l('''~\'_\~_ State: ~\l;-~~ ",r) 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.
~(}.~
Signaturf g - . rr
/~ J)J -/~.
Date '/
FOR OFFICE USE
Date of AP,Plication:3- \5-'1 ~
Receipt #OtfOt64
JOB .: q (a 0 3 '-t ~
Issued By: 0. .Mu..-e....,e.-O--e'(~
Total Amount collected:\..<() CS .6"0
/
Checked for Delinquencies:
Checked for Historical Status:
~
t.
.
Q(' ')~/ll/'l
Penhit #: l (l( l J-ti..V
Address:!') ,,(Of> Q S Tt,l3;- 0 I
Issued by: 0. M~o.J..6Date: ~-tS-l y.,
.'
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 1 and 2, and either box 3A or 3B:
ll<
u
1. I own, reside in, or will reside in the completeq 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
, ~r 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 permita!>plicant)
~.~
~
~ ~~I\.L.L/~ -/tu
(Date) ,
(White copy to issuing agency permit file,
pink copy to applicant)
,.1 , c.
~..
c.-
\'. \
.' ">-.. _ 1
., j - - . \. \ .
][lffi~<<Jll1'mal~o~ll'il:..-lNl(0)~OC@ tOl !PU'~LC>>@1li1' OWll'ilt!?;rr$
A~@{lJft C@ll\$~~l1JI(Cfto@ll'il 1Rl@~IP@Ilil$olbJo~ofto@$
.J .
.' 'Noti: This lnformation,N,6tice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors' Boardin accordance with ORS 701.055(5), .
If you are acting as yaur awn contractor to construct a n~w home .or make a substantial improvement ta an existing structure,
you can prevent many prablems by be~ng aware of the follawiu.g responsibilities and areas of concern. ,
!EM IP-lOYIEIRlIA(ES~O~S~ B~ ~n~IE~:
If you hire persons not registered with ~he (::()nstructian Contractors Board to do labor in constructing or assisting in the
construction or impravement .of a residential structure, yau win, in mast in~tances, be ruled to be an employer and the people
yau hire will be employees. As. the ~mployer, you must comply with the foli6wing: '.
Oregolfll's wfithlbt.ondilfllg tax Raw; As an employer, you must withhold incame taxes from employee wages at the time employees
are paid. Yau will be liable for the tax payments even if you don't actually withhold the tax from yaur employees. For more
infarmation, call the Oregon Dept. of Revenile at 945-8091.
UlTI.employmelfllt ilTl.s1im:mce mx:: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages .of all emplayees. For mare information, call the ,Oregon Empl.oymentDiyision at the Department of Hl,.lJ.nan Resources
at 378-3524.
Workers' compelTl.sanmllh.slJJJ.Jr3Il11Ce: As an employer, you are subject to the Oregon Workers' Campensation Law, and must
obtain workers' compensation insurance !or your emplayees. If yq~ fail to obtain -,:"orkers' compensa~ioninsurance, you may
be subject to penalties and will be liable for all claim costs ifone- Of your employees is injured on the j?b.. For'more information,
caU the Workers' Compensation Division at the Department of Consumer and Business Services at '945-7888. .
u.s. Internal RevelluJle SenTJice: As an employer, you must withhold federal.income taxfrom employees'wages. You wiU be
liable for the tax pay.ment even if you didn't actually withhald the tax, For more information, caU the Internal Revenue Service
at 1-800-829-1040:;, '. ..
01}fllElRllRl!ESf?ONS~B~Uu~IES AND AIPi!EASo.lF Co.NCERN:
Code compnn:ilJJl1lce: As the permit holder for this project, you are responsible for resolving any failure to meet cade requiremepts
that may be brought to your attention through inspections.
Liabilnty aJrndl property damage DlllSUllJralfllce: CQntact your insu~ance agent to see if yau have adequate insurance coverage for
. . .
acc~dents and,omissions such as falling tools, paint overspray, water ~amagefrom pipe punctures, fire, or work that must be
re-done. . .
Time to sllIpervise employees: Make sure you have sufficient time to supervise your einployees..
Expertise: Make su're you have the expertise to act as your awn general contractor;to coordinate the work of rough-in and finish
trades, and to riotify building officials at the 'appropriate- times so they can perform the required inspections.
:I(you-havea~ditioDaI.questio.h-S, writ.eor call the Construction Cantractofs--B0ard (PO,Bqx 14140, ~.alem,:OR97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in\Salem., .
prop-own.pm4
1/94