HomeMy WebLinkAboutPermit Fence 1991-5-1
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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: F34i ( AM/M i1dfr-
Assessors Map II: \fJ()Q81QQ~
Owner: Pci7/'l/l' (-lV\. .r:Y; (' 0:::,IJV) - 1J1J.e..<d-"
Address: loY I I LlJ-VV\ I{ idCU'-
,)Oflol (J State: r;fZ-
Tax Lot II:
()4QOO
Phone #:
77JJ -772-b
Zip: 97477
City:
Value of Fence: \'333. cJl) Fence Permit is $5.00
Contract.orRstaller: I... f\\{)\~ >...g y ~ Q D(\ 9- r '
Address:W 0 \::0~ \\09, Phone II: C\'3f) 5J:~
City: ~()\~~ 0 Q~ State: (l\1? ). Zip: ctl1~'d-.
construc~ion Contractors Registration #: I'd (f'o~ Expires: 'Ort!Cl ~
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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S gnature ~ '(,
~- \ -91
Uate <-/
, FOR OFF ICE USE
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Date of Application~ b' \. q.\ J Job II:~ \Cft~4
Receipt II: \qG\6,)\ aY By:r:..J)lrf'LJ
Total Amount Collected: ~ . ~
t f Checked for Historical
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Checked for Delinquencies:
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Permit No: q \ ~~ ,
Address: \'2A 1 (f{lJ)JnJ'LtifJR- ~
Issued bn~ Date: 5 ~ FAT
FOROFFICEUSE 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 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:
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2.A.~
I own, resid. e in, or will reside in the completed ~t?1cture.
My general contractor is \. f\,\ hI ~)Qy .::f. Q 1\ f\ 0 :;
Contractor registration number I [;)nlo.!J.- .
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. L-.J 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 Clo hire a !jeneral
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.y'
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Fignature of Permit ApplicanL Date ../
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
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~:rE COPY TO ISSUING AGENCY PERMIT FILE
COPY TO APPLICANT
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