HomeMy WebLinkAboutPermit Fence 1998-10-24sPRINGFIELO
0ffice:
INSPDCTION LIND:
JT*
Pq
225 Norrlr Ftfth Strect
Sprlngflc1d, Oregon 97477
726-3759
726-376'
.r !t'd , ii, r 'r . I.
(-.t.r. r,..j'r,r"lu- r, !.t i..
C:i,,, .,.,, i,.G|.f,.Y, OF i
Job Locatlon:
Asscssors l,lap llr 2 Tax Lo t lt:
0vncr:
Add rcss:Phonc ll:
Cl ty Statc:Za-,zlp:
ffi
a
Valuc of Fencc:a Fcnce Pcrmit is $5.00
Contractor/Insf allcr I rqCt) H
Adducss I Phonc 11:
Cl ty: S ta te:zlp:
ConstructlonContracrorsReg1strat1onll.-Explres:-
Dy slgnlng thls pernrlt/appllcatlon, I agrce to caII for an lnspcctlon oncc my
fcncc has bccn consLructed (726-3769). I also statcd that aII informatlon on
tlris applicatlon/pcrrnlt 1s corrcct and tlrat f vas provldcd vitlr thc Sprlngflcld
Dcvclopnrcnt codc rcqulrcnrcnts [or fencc standards
;
turc tc
FOR OFFICB USIT
Date of Appll,catlon:
TotaI Arnount CoIIectcd:
JOii tt:
.1
Issucd By:
Chcckcd f or Dcllnquettcl e.s:
&
Chcck.ed f or lli s tori ca1 Sta ttts:
T'ITNCIi I'IIITHIT AI)PLICA'I'ION
CITY OI' SPI(INCI'IIILD
IIUILDING'shriU'r'v DMSTON
la,/2./Ar
Rccelprtt E"g/
(
Permit #:
Address:
Issued by:Date
Statement: lnformation Notice to Property Owners
About Construction Responsibil ities
Note: Oregon l-aw, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filedwith the permit.
Fill in the appropriate blanks and initial boxes I and,Z, and either box 3,{ or 38
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3,A.. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
38. I will be my own general contractor
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notiff the office issuing this building permit of the
name of the contractor.
4
Nx
X
OR
I hereby certify thatthe above informationis correct and thatl have read and do
Notice to Property Owners about Construction Responsibilities on the reverse
applicant)
(White copy to issuing agency perrnit file,
pink copy to applicant)
understand the Information
side of this form.
,/.t- 9./ ! ?'/
(s (DF{">
a s/a2a