HomeMy WebLinkAboutPermit Mechanical 1993-9-17
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FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
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225 North Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location:
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Assessors Map :it:
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Tax Lot :it: L\ 400
Owner:
Address: l ~ 1 n
C~ ty: ~-'-f)l
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Phone:it: '47 - ~5
Zip: Q7y 77
State: ufZ--
Value of Fence: 'Z-fjO - DD
Fence Permit is $5.00
Contractor/Installer: ~ ~~
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Address:
Phone :it:
City:
State:
Zip:
Construction Contractors Registration :it:
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.
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Signature ~
FOR OFFICE USE
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Date
Date of Application: tj -(7 - q~
Receipt:it 10z.-qq
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Issued By:
JOB #:q ~ I Li:::l f\
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Total Amount Collected:
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Check!ed for Delinquencies:
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Checked for Historical Status:
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Permit No:
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1 ~l 0 C~ +-!-n-vt lA.Ta? d A-vv
()~ Date: q-J7Jjj
Address:
Issued by:
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBI L1TI ES
Note: Oregon Law, ORS 701.055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the 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
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 3B:
1 .
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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. I '-P I I will be my own general contractor.
I
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.
Signature of Permit Applicant
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT '
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INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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NOTE: This Information Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with OAS 701.055(5),
passed by the 1989 Oregon Legislature.
If you are acting as YOur own COri~rac~or to construct a new home or make a substantial improvement to an
existing s~ructufe, you can ~revv;:t many prob~ems by being aware of the following respoi1sibmtlss a(~d areas
of concern,
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Time La S'_:parv:s(-) E7"':1;:::c~'e3s: 1v:5.xe ST~ YOi..! ::C1VO s~l1k~iei1l lims to s~p3n;:s0 yo;.:r
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E){partisa: lVla~e sure yo;..; :,e.ve the expertise to aCI: as your ow;: genera: con1:ractor, to ccord:;;a.10 1:he work
01 rough-in and finish trades, and to notify building oHicials at the appropriate times so th0Y can perform
the required inspections.
If you have additional questions, write to:
Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
0244J 10/24/89