HomeMy WebLinkAboutPermit Fence 1991-02-06FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY t)IVISION
SPFIIvGFIELE,
Offi ce:
INSPECTION LINE:
%
225 Fifth Street
Springfield, 0regon 97 477
726-3759
726-3769 tu
C,ITY OF SPRINGFIELD, OREGO'V
Job Location z1q1 u i tla, \,t/ an
Assessors Map #:ov ?
owner , /;a n /. ', -q e-.. ? la/ z
Tax Lot #:ZO
Addres s :
City:d State:DL
vat ue of Fence ,4 'ZCn
Contractor/I ns tal I er :
Address:
City:State:
Construction Contractors Registration #:
gna ure
FOR OFFICE USE
Date of Appl i cat i on :-7
Receipt #:4zt'Issued By:
!V s'iO1ing. this permit/appl ication, I agre
f ence has been constructed (7264169). -i
this application/permit is iorrect anO tnaDevelopment Code requirements for fence st
o call for an inspectfon once myo state that all information on
was provided with the Springfield
ards .
1-7/
Phone #:
Zi p:
Phone #:
Zi p:
Ex pires:
et
alstI
and
e
Total Amount Collected:
Job #:?roo 77
Checked for Delinquencies:Checked for Historical Status i, --
'z6 qq3&
.o-D Fence Permit fs $5.00
Permit No:
Address:
lssued
U CL A(
Date:L
OFFICE USE ONLY
STATEMENT:
INFORMATION NOT]CE TO PRO"-ERTY OWNERS"' ABirUf Cor.rsrnucrloN RESPoNSI Bl Llrl ES
Note: oregon Law, oRS 701,055(4), requires r.esiderrtia.l building permit applicants
who are not regiJti;;d ;iih-ttie'Co-l.'Jt,,ction Contractors Board to sign the
folowing statemeni;;l"i;inebuifding permit can be issued' Licensed Architect
and Engin"., "ppii"ili., "-grol trori iegistration under oRS 701'010(7), need
not submit this siaiemeht. ThG statemeit will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 29
1 lown,residein,orwillresideinthecompletedstructure
2. A. I-l My general contractor is
Contractor registration number
OR
B I will be my own general contractor'
lf I hire subcontractors, I rryill hire-only subcontractors registered with the
*fi',Is,'Jrgn,r$'.'f r:l?,,tifl
:x::liag:#';ii!':i$t3,ii[a:ryqil:,ti
6;iri?ittibn bii;i?;Uib?i'eod;iJ A;d i' wi I i i mmed i atelv-notifv the of f ice
i-slriing this OuiiOihg permit of the name of the contractor'
I will instruct my general contractor that all subcontractors who work on
the structur" ,u.t'6eielisGreO with the Construction Contractors Board'
I hereby certify that the above information is correct and that t have read and understand
in" rni6rration ttotice to property Owners about Construction Responsibilities on the
reverse side of this form.
2-C-1
ure of Perm t Date
CONSTRUCTION CONTRACTORS BOARD
o244J 1t90
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