HomeMy WebLinkAboutPermit Fence 1990-8-10
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FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING, SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: '740 ( ~!I LA
Assessors Map #: LS< 0 I. Or; ~J
Owner: t7J JI1 aid -:r;:hffi V(lV)
Address: 4 tf () I t-IV u U1 -
City: Sfr;Y':J4e!P! State:
Value of Fence: Q 26D - 0[)
Tax Lot II: () Cd? ()O
Phone II: /47-7/z:;k,.
6f2- Zip: 17LfZ?
Fence Permit is $5.00
ContractorlInstaller: fiJu.}vt ev
Address: Phone II:
City:
State:
Zip:
Construction Contractors Registration II:
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
this application/permit is correct and that I was provided with the Springfield
D"~7t'2' '~Od'ro'. ~~ ~
Signature ' (/ Uate /
. FOR OFFICE USE
Date of Application: 5? -/0 ~9()
Receipt II: 120/2' Issued By:
Tota 1 Amount Co 11 ected: 1:), c5D
Checked for Delinquencies:, ~
Job II:
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Checked for Historical Status:
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Permit No:, q 0 /620
Address: 'I L! II r ~.1'011 (.^(
f~ u ';?-lo-9D
Issued by: (,(/i\.;\rU! _ , Date:
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES'
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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.f-J I own, reside in, or will reside in the completed structure.
2. A. L-.J My general contractor' is
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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. T 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 (lo 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
tho ','olm""', Nolloo to prope7,m 'boot Co."rod'o, '"po",ibilU;.. o. tho
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CONSTRUCTION CONTRACTORS BOARD'
0244J 10/24/89 .
~-vOPY TO ISSUING AGENCY PERMIT FILE
~OPY TO APPLICANT
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