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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 fuUrc__@py ro tssulNc AGENcy pE+t{itr Ftt-.PINK copy ro nppr_icArur'-- !, U