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Home My WebLink AboutPermit Fence 1990-5-18 . .. --- SPRINGFIELD FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Flfth Street Sprlngfleld, Oregon 97477 Offlce: 726-3759 INSPECTION LINE 726-3769 Job Locatlon 1<637 r rn-kVlI'\ ioJ ~I vd Assessors Map # } 10 ? 2--634 Owner t-hV1))d wDrxls Address )5537 teu+-eVlVt'raY l2,lIJJ Clty ~I;'i 'I\Jhelcl State f)fZ-- Tax Lot #. fJ 7Lfo I Phone #: -;(</iO-3 70 7 Zlp" C}7477 Value of Fence' 11> 2J70, 02J Fence Permlt lS $5.00 Contractor II ns ta 11 er' () 7A In e{" Address' Phone #. Clty' State: ZlP' Constructlon Contractors Reglstratlon #: Explres' By slgnlng thlS permlt/appllcatlon, I agree to call for an lnspectlon once my fence has been constructed (726-3769). I also state that all lnformatlon on thls appllcatlon/permlt lS correct and that I was provlded wlth the Sprlngfleld Development Code requlrements for fence standards. ~~~rU~l<;.~ ~ Slgnature - ~ ~;ho Ua1;e / FOR OFFICE USE Date of Appllcatlon Recelpt #. III ( I /}~/? -q{) Issued By' Job # ~ 9 (JD 10, 35 Total Amount Collected: $r;,d'D Checked for Dellnquencles ~ Checked for Hlstorlcal Status ~ - Permit No qDD036 I X' 37 lfVl tf n 11l1(jJ Blvj '(0" IAQ Date 57-JR-IfO Address Issued by STATEMENT INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note Oregon Law, ORS 701 055(4), requires residential bUilding permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the bUilding permit can be Issued 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 box 1 and either box 2A or 2B 1 [2J I own, reside In, or will reside In the completed structure 2 A L-.J My general contractor IS Contractor registration number I will Instruct my general contractor that all subcontractors who work on the structure must be registered With the Construction Contractors Board OR B I V I 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 00 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 /~ ~ ~~/7//7~~ / Signature of Permit Applicant J~~7J pate / /' - CONSTRUCTION CONTRACTORS BOARD . 0244J 10/24189 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT <fl.