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HomeMy WebLinkAboutPermit Fence 1991-5-16 , ./-. - ~ .. . .......-. -~. . : FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: ~26-3769 Job Location: \ \.D~C:S' \. ~ \ a. ffi~~ Assessors Map #: \1D?2~6\4 Tax Lot #: ~()~ Owner: \\\C\ \\ \. t.. \<, ~ \0 f\ J . ~ Addres s: \ \ () ~ ~\J \. \,)\ am F'f";0rl ~hone #: ~to - (J \2.. ~ C1ty~rt st"" l~~ Z1P'C\Y\ LI Value of Fence: B"D.cD Fence Permit is $5.00 Contractor/Installer: (\J9.. ^~Q .P-J Address: Phone #: City: State: Zip: Construction Contractors Registration #: Expires: By signing this permit/application, I agree to call for an inspection orce 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. J,"iff fb. / . FOR OFFICE USE ~~/6. 1991. ~V '. Date .Of Application:n. \ \nC\\ 8\JOb #: C\\t'AC\ f') Recelpt #: AY)8( ~ Issued By: t ~ I . Lf/ -~ .OU - - - - - /' Total Amount Collected: Checked for Delinquencies: Checked for Historical Status: / ~ ( , \ ..r\. t . . Permit No: q\M--\I_~.......~~ Address: Qo~~ \)\(\ X 1ll.l>l Issued byr3J ,- fY\ ) Date: 0 \ \ lol~ \ \ FOR OFFICE USE ONLY 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 underORS 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 or 2B: 1.~ / I own; reside in, or will reside in the completed structure. . 2. A. c=J 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 /J B. G I will be my own general contractor. r 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 Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ~{J tl/?A~ Ig at He;: Permit Ap.icant ~ It ;qq / ../ .- CONSTRUCTION CONTRACTORS BOARD 0244J 1/90 ~ .. COPY TO ISSUING AGENCY PERMIT FILE LD COPY TO APPLICANT . .".