HomeMy WebLinkAboutPermit Fence 1990-09-07225 Fitth Street
Springfield, 0regon 97 477
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFII{GF!ELD
Offi ce:
INSPECTION LINE:
726-3759
726-3769
CITY OF OFEGO'V
Job Locati on :
Assessors Map #: 17 D37] Ll 3
0wner:
Address , ?-t t o UJI Sf- 2 s-f-
C'ity:state fr fZ-
vatue of Fence rfil.ar:-OZ;
Tax Lot *: O 3ee
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Fence Perm'it is $5.00
Contractor/Installer : ft t,t t t,a. \l{
Address:
City:State:
Construction Contractors Reg'istration #:
na ure
By signing this permit/appf ication, I ag
fence has been constructed (726-3769).
this application/permit is correct and t
Development Code requ'irements for fence
Phone #:
Zi p:
Ex pires:
ree tI als
hat I
o cal I for an
o state that a
was provided
ards.
'inspection once myll information on
with the Springfie'ld
s tand
on Ltau '* rndf-Lte6'3 1cu,rur) s)3no-:!u
FOR OFFICE USE
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Date of App l'icat:onz 4:17 -?e Job #:lutlzz
Receipt #:
Total Amou
Issued By:
nt Col I ected :%"oa
Checked for Del inquenci es:-/ Checked for Historical Status: a'
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Exlstlng Buildlngs or
lmprovements on
E Barn
EELGarage
E tvlotile. Home
El Shed
SEPTIC INSTALLEDt- Yesl-I t\b
Water District
Sttg
Property
6dour.
Please complete all lines inside white boxes, if possible.
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CITY
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Directions to site
from Courthouse
MAP, PARCEL NUMBER
We#'#,m-*?Hc
Town3hip Bangc Scction 1/4 S€ctioo Trx Lot
T6,-o'sTilF-'Itiiii. $;iffi- rTiEc-ii6i- -tiifti-
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SITE AD FESS
For Mobile Home
Placement Only
No. of Tip-outs
-
No. of Bedrms
License #-
Brand
Year
Size
MAIL PERMIT TO:
ADOit t SS
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Land Management Div. staff can
not be hetd responsible for
evaluatlons or recommendations
based on false, lnaccurate or
lncomplete lnformatlon
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Permit No:
Address:
lssued
it !
),
( l-u,v-'.s--Date:
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicantsy!.o ale not registered with the Construction Contractors Board to'sign thefollowing statement before the building permit can be issued. Licensed Architect
and Engineel applicants, ex€mpt from registration under oRS 701.010(7), neednot 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 28
1
My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work onthe structure must be registered with the Construction Contractors Board.
wHtrE copy To tssutNc AGENCY PERMIT FILEPINK COPY TO APPLICANT
I will be my own general contractor.
lf I hire subco4tra.ctors, I will hire.only subcontractors registered with theConstruction Contractors Board. lf I cha-nge my mirid ano "oo nire a oriiielalcontractor, I will contract with a contrattor'who is- reoisteieO-wltn tnGuonstruction Contractors Board and I will immediately-notify the offiCeissuing this building permit of the name ot inecontiiitoi. .''' .'
2.A
OR
B.
l.herefy certify that the above information is correct and that I have read and understandthe lnformation N.oti.ce to Property Owners about Construction nlsponsibilities on thereverse side of this form.
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CONSTRUCTION CONTRACTORS BOARD02M) 10t24l89
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t/'l.r :A
rT-l I own, reside in, or will reside in the completed structure.
Date