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HomeMy WebLinkAboutPermit Fence 1990-7-19 ... - :i . , SPRINI~LD FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Assessors Map #: Owner:' (Vi Gh Job Location: lo7Cf7 E G+ fl ()~ ~C) ~?1 , f2o-n 1".- /1-1.- Address: '(0795 c= LA Ci ty : 3fJ-;c, I/l j R p/r) Val ue of Fence: 1t 50ZJ . DD " Tax Lot #: \ \ fl CY') dot: '1 qJ ~s. l\JU..o.... - State: Phone II: 72-b ~ 8t..J7o (j II Zip: q 7t.J72' Fence Permit is $5.00 Contractor/Installer: f)l/UY\~yr Address :' Phone II: City: , ' State: Zip: - Construction Contractors Registration II: ,- Expires: ---- By signing this permit/application, I agree to call for an inspection once my fence has been constructed (726-3769). I also state that all information on this appl' tion/permit is correct and that I was provided with the Springfield Developm n Code requirements for fence standards. ?-/~ ~ Signature Date FOR OFFICE USE Date of Appl i cation:'7 - /'? -16 Receipt II:, /7751' Issued . Total Amount Collected:~c.)_D() / Job #: 000CJDfo , . By: () A/V./'-..fL Checked for Delinquencies: Checked for Historical Status: /' .. I'" , . . I \ \ Issued by: 1()Dynfo 0"7q; r t-J- TP AA./~ Date: H1-tf() , , Permit No: Address: 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 B()ard 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 or2B: 1.1 )( 2. A. I I own, reside in, or will reside in the completed structure. 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 'Y-' 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 Qeneral 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 Informati Notice to Property Owners about Construction Responsibilities on the reverse Sid~:1Y~7~ 4Adi r;~/9- to Sigri~re-of Permit Applicant Date CONSTRUCTION CONTRACTORS BOARD ' 0244J 10/24/89 .. , WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT @s