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HomeMy WebLinkAboutPermit Fence 1990-1-17 "-.- SpA'ELD FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 F1fth Street Spr1ngf1eld, Oregon 97477 Off1 ce: 726-3759 INSPECTION LINE: 726-3769 Job Locat1on: (~1 0 <K ~ CJ\Q mY 0 Q Assessors Map #. \)<0 8l) CO\ 'rl-." -- " Owner: \(\ ffi '\ \ C\ 0 bD - Address ,q () R ~ ('\ t\- Q xn ~ Q. ~_~ Phone #. 'VVI1"\ R4- e"" ~~ n 06 st"" (\)\~ %f'iII Z'D' Qf\4,ry g Value of Fence' ~ Fence Perm1t 1S $5.00 l')51 \\ le. ;~X. -LO~ #: r:(t=~ OC) Contractor/Installer. '\ n kJ\\QY) Address Phone #. C1ty' State: ZlP: Construct1on Contractors Reg1strat1on # Exp1res' By slgn1ng th1S perm1t/appl1cat1on. I agree to call for an 1nspect1on once my fence has been constructed (726-3769). I also state that all 1nformat1on on th1S appl1cat1on/perm1t 1S correct and that I was prov1ded w1th the Spr1ngf1eld Development Code requ1rements for fence standards. ,J~d ;;r~ ~lgnature )-/7-'70 Uate FOR OFFICE USE "ot, of Appl"",,,. (- (0-qo W Job', q(Yyj(\ I) ReGelpt #: \~<r-tA ~Ufd By' l/) (fY) _ ) Total Amount Collected- ~ ~ Checked for Del1nquenc1es ~ Checked for H1stor1cal Status: ~ '1 ~ Permit No q {'('{l~ f) Address ?J\ ~~C(.-C' V'\O Irr;C_O 0 / Issued by (-f; I /'C( ,Date 07/QO ~ -. I ' I 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 01O(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 L-----.J lawn, 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 '----1::::J 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 /i' ~ tLrYLc c-/ ~/J~ Signature of Permit Applicant /- /7- '10 Date CONSTRUCTION CONTRACTORS BOARD 0244J 10/24/89 WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT @,