HomeMy WebLinkAboutPermit Fence 1991-4-22
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SPRINGFIELD
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Owner:
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Job Location:
Assessors Map #:
Address:
City:
Val ue of Fence:. b I So 00
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Contractor/Installer:
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Address:
City:
State:
Construction Contractors Registration #:
Office: 726-3759
INSPECTION LINE: 726-3769
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Tax Lot #: Ofo I ok:,
Phone #: ;;;). b ' SG,."j ()
G~ Zip: CJjYJ R
Fence Permit is $5.00
Phone #:
Zip:
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
t~is application/permit is correct and that I was provided with the Springfield
Development Code requirements for fence standards.
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. FOR OFF ICE USE
Date of Application:
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Receipt #:
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Issued By:
Job #: -H- C) .103 51 S-
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Total Amount Collected: 3, S_Oo
Checked for Delinquencies: ,~ Checked for Historical Status:
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Permit No:
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@ ~ . Date: 4/7:) I'll
Address:
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FOR OFFICE USE ONLY .
.' ..' STATEMENT: .,
. INFORMATION NOTICE TO. PROPERTY OWNERS
. .. :ABOUTCONSTRUCnON .RESPONSIBILlTIES
". ..Note':' Oregon Law;ORS701.055(4); requires residential building permitapplicants
. 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,.'exemptfrom registration urider'ORS 701.010(7), need
:not submit this statement. This statement will be filed with the permit.
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. Fill ,in the applicable blanks, and initialbox 1 andeitherbox2Aor 2B:
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OR
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B. I \ /1 I wi II 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 Clo 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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.,Slgn&,ure I1f Perm~PPlicant
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CONSTRUCTION CONTRACTORS BOARD
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WIIITC COPY TO ISSUING AGENCY PERMIT FILE .
,.aNK COPY TO APPLICANT
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