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.
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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.
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~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:
~
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Permit No q {'('{l~ f)
Address ?J\ ~~C(.-C' V'\O Irr;C_O 0 /
Issued by (-f; I /'C( ,Date 07/QO
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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
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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
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