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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--- & .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 @s