HomeMy WebLinkAboutPermit Fence 1990-9-4
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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'
Job Location:
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Tax Lot 1/:
Assessors Map 1/:
Owner: ~_l'\dA,/.'l, '-f..Jt^""""':'^"<~
Address: I-/::J >? (n \A) 0 "",...11)\.JA./"
Phone 1/:
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Zip: Cjjt./()l./
City: 'f I ..11 ,~" 0
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Value of Fence: ~u
State:
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Fence Permit is $5.00
Contractor/Installer:
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Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration 1/:
Expires:
By s i gni ng th i s permit! app 1 i cat i on, I agree to ca 11 for an inspect i on 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
D~lopm~ Code requirements for fence standards.
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Date of Application:
Receipt #: \ 'x )"} u
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Job #:
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Issued By:
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Checked for Delinquencies:
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Checked for Historical Status:~
Total Amount Collected:
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Permit No:
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LO'R Date:
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Address:
Issued by:
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS.
. ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit appli.cants
who are not registered with the Construction Coritractors 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.~
I own, reside .in, or will reside in the completed structure.
2. A L-.J 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 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 Information Notice .to Property Owners about Construction Responsibilities on the
reverse side of this form.
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, Signature' iWPer7pPlicant
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Date
CONSTRUCTION CONTRACTORS BOARD.
0244J 10/24/89
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WHITE Copy TO ISSUING AGENCY PERMIT FILE
P-INK-COPY TO APPLICANT
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