HomeMy WebLinkAboutPermit Fence 1991-6-13
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SPRINGFIELD
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Owner:
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Tax Lot #:
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Job Location:
Assessors Map #:
Address:
Phone #:
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Zip: qjL/J K
City:
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Value of Fence: ~J
Fence Permit is $5.00
Contractor/Installer:
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Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration #:
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 application/permit is correct and that I was provided with the Springfield
Development Code requirements for fence standards.
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Date
. FOR OFFICE USE
Date of Application: b- l~ -0 I
Receipt #: ;.:::} 0 ~lnr Issued By:
Job #:
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Total Amount Collected: C:;.OO
Checked for Del inquencies: K Checked for Historical Status: ..\-
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Permit No:
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Issued by:
'FOR OFFICE USE ONLY
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. STATEMENT:
. ".INFORMATION NOTICE TO PROPERTY OWNERS
','., ',ABOUT CONSTRUCTION RESPONSIBiliTIES
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, , 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 arid either box. 2A or 2B:
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1. , ~ I own, reside in, or will reside in the completed structure.
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2. A. I My genera,1 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. , \ ~ will be my own general contractor.
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If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and co 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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ySignature of Permit Applicant
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Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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Wffi+E COPY TO ISSUING AGENCY PERMIT FILE
u}\rvi Ce. mNK COPY TO APPLICANT
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