HomeMy WebLinkAboutPermit Fence 1991-03-06FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
State:
SPRIalGFTELl,
0ffi ce:
INSPECTION LINE:?25 Fifth Street
Springfield, 0regon 97 477
Job Locat'ion :
Assess S Map #:noba
0wner:
Address:
City:
726-3759
726-3769
0\
Value of Fence:
Contractor/I nstal I er :
Address:
City:State:
Tax ot #:
Phone #:
Fence Permit is $5.00
Phone #:
,45D?o
By signing th'is permit/appl!9q!i9!r-l
f-ence-has-been cbnstructed (726-37 69)
Zi p:
71 p:
this application/perm'it is
Development Code requ'ireme
agree to call for an inspec-tion once my
. - I al so state that al I 'informati on on
d that I was provided with the Springfield
ce standards.
correct an
nts for
k-3* O -Q r
gna Date
FOR OFFICE USE
t)ate of App'l i cat i on :ob t:
Receipt #:Is5 sued
Total Amount Collected:
CITY OF OREGON
Checked for Del inquenc'i0sl r*' Checked for Historical Status:
Construction Contractors Registration #; Expires2--
L/
Permit No:
Address:
lssued
R OFFICE USE ON
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 28;
I own, reside in, or will reside in the completed structure.
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
Da
1
2.
B I will be my own general contractor.
lf I hire subcontractors. ! will hire onlv subcontractors reoistered with the
Construction Contractors Board. lf I chanoe mv mind and Eo hire a oeneralcontractor, lwill contract with a contrattor'who is reoistered with tneConstructibn Contractors Board and I will immediately-notify the office
issuing this building permit of the name of the contraitor.
I hereby certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of_-this form.
/--L,e 3-6-€r
gnatu rm
CONSTRUCTION CONTRACTORS BOARD
0244J 1t90
Date
COPY TO ISSU]NG AGENCY PERMIT FILE
COPY TO APPLICANT
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