HomeMy WebLinkAboutPermit Fence 1990-08-31FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPRlNGFIELE,
Off .ice:
INSPECTION LINE:
726-3759
726-3769
225 Fifth StreetSpringfield, 0regon 97 417
Job Location: b /./
)a OREGONC,'TY OF
Assessors Map #:Tax Lot #:no5/ (\
Owner:
Rddress: L tlt el\r)
City:State: A
vatue of Fence: 6UO C)?)
Contractor/Ins tal 1 er :
Address:
City:State:
Construction Contractors Registration #:
gna ure
FOR OFFICE USE
Date of Application:
Receipt #: (1X1"- rssued By:
Total Amount Collected
Phone ##7/,-v/5/
zi p,? -;/7k
Fence Permit is $5.00
Phone #:
By siqninq this permit/app'ligqtig!r^l agree to car] for an inspection once mvfence has-been cbnstrucl6i t;i6-ii6ri."'i"urio !tute that ar-!nformarion on-35:,:BHll;.ffi!,p:[T][j:.i:1::ir:*.,lti.i.lj;.provided with the ip,.insii.ro
.Cfl
7i p:
Ex pires:
Job #:
Checked for Del inquenc.ies:r Checked for Historical Status 2 v---
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.u<-1,
P
?otos4Permit No:
Address:
lssued by Date:
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:.
1 I own, reside in, or will reside in the completed structure.
2. A.My general contractor is
Contractor registration number
I will instruct my general contractor that all sub-contractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B I will be my own general contractor.
lf I hire subcontractors. I will hire onlv subcontractors registered with the
Construction Contractors Board. lf I change my mind and do hire a general
contractor. I will contract with a contrattor -who is reoistered w-lth the
Constructibn 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 lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
t
ignature rmit App cant
CONSTRUCTION CONTRACTORS BOARD
o2a,+l 1g,r**
Date
*]AIHI-Tf COPY TO ISSUING AGENCY PERMIT FILE
PI}TK-GOPY TO APPLICANT
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