HomeMy WebLinkAboutPermit Fence 1990-9-24
...,..-.........,
,.
.;.
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3~
726-3769
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
Job Location:
~ \ \ ,\ 9. Dn\,(\() }
Assessors Map #: \71C)9..mm Tax Lot #: Pf)4(Y)
Owner: \ ^-)~ \ \\c\ ~ (CJ\~ \J\wRJ
Address: ~C\ \ \ '\1 flI:l( f'lf\ , Phone #: \~\ '"h\q~
City, '-~k\:\r\~,\Ooo\) st""l)~o~ lip' C\t1t,~
Value of Fence~~.c:<:) Fence Permit is $5.00
""',,,',, 11",,11 '" 0 \f' \'\\ ~l ffi ~ \ (\t\ Q
Address: 4C\?-f\ ~ \m~, Phone #:
City.: ~ rJ. jC'\.Q If'l(L State: ~ ._
Construction Contractb{..s Registration #: Lo('{\Q<:\
Zip:
Expires: QfBf9J
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.
---v~e ~
Signature
9-d.Q- 9/J
Uate '
, FOR OFFICE USE
.
Date of Application: ~(i/,~4/'{OJ Job#: OJ) \ \ 1'\4-
Receipt #: 1\ <K..~4~ \ Issued By: CT\\m )
Total Amount COllected:' ~ ~ .:,-/' - -
Checked for Delinquencies:
L----'
.......-----
Checked for Historical Status:,
--:.......;,
.
.
Permit No: ~'Cf()\ \l+
Address: ~\\ \~ U \\L\\ ,Cb0 l/J~ \
ISSUedby.dl.l)r1) Date: 9.jJ!Jjv
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 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 or 2B:
1 . L,k:...J
'2. A. L.Y..J
. \
I own, reside in, or will reside in the completed structure.
~y general contractor is ~J'0f)\ ~
Contractor registration number l nrYm.
I will instruct my general contractor that all subcontractors who work on
the structure mustbe registered with the Construction Contractors Board.
OR
B. L-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 ao 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.
vij))~'''~ ~ ~
"Srgnatureof Permit Applicant
9-.:h-l-9t'J
Date
. CONSTRUCTION CONTRACTORS BOARD ,,'
0244J 10/24/89
WMl+E COPY TO ISSUING AGENCY PERMIT FILE
P!Nl< COPY TO APPLICANT
~,