HomeMy WebLinkAboutPermit Fence 1995-08-22225 North Fifth StreetSpringfield, Oregon 91417
PENCE PERHIT APPLICATION
CITY OP SPRINGPIBLD
BUIDING SAFETY DIVISION
SPFTl.GFTELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
Job Location:,ru
Assessors Hap f t /Z-O5-26 q/ Tax Lot #:Byeo
0vner:
Address:Phone *z 7/ -d1)*r
Ci ty:State: 4:24 , zip, ?2*)>
Value of Fence: ?4%.* Fence Permit is $5.00
Con tractor/Ins taIler :
Address:Phone *:
Clty: State:zip:
Construction Contractors Registration #:Expires:_
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that all informatlon on
this application/permit is correct and that I vas provided vith the Springfleld
Development code r equ irements for fence standards.
-2"
tere
FOR OFFICE USE
Date of Applieation ,$ ^?? .2{
Receipt * /A?A3
Total Amount Collected | 5;e
JOB *c
Issued By:
Checked for Delinqueneies:Checked for Historical Status:
Permit*, ??z?Z-
Address:
Issued by:Date:?>
Statem€ht: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, 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 filed with the permit.
Fill in the appropriate blanks and initial boxes I arrdZ, and either box 3A or 38:
W 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,{. My general contractor is
Contractor regis. #(Name)
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board'
w
OR
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 witl contract with a contractor who is
registered with the cig ano will immediately notify the office issuing this building permit of the
name of the contractor.
Ihereby certifY that the above information is correct and that I have read and do understand the Information
Owners about Construction Responsibilities on the reYerse side of this form'
(Signature of Permit
(White copy to issuing agency perrnit file,
pink coPY to aPPlicant)
Notice to
(Date)