HomeMy WebLinkAboutPermit Fence 1990-06-14225 Fifth Street
Springfie1d, Oregon 97 477
FENCE PERMiT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
Offi ce:
INSPECTION LINE:
7 26-37 59
7 26-37 69
Job Locat'ion:
Assessors Map ll:o
0wner il e Mtne,Aq l,t/oz; I lr q
Tax Lot ll
Address , (n tN ,' { )fitt" 3f ) ohone rr 7q6 loz-
City:
S i gn ature
0e*State:7i p:7 7
Value of Fence:4 Fence Perm'it 'is $5.00
Contractor/Installer: 5tl.lne1'-
Address: Phone /l:
^.: +., . state :Li p:
Construct'ion Contractors Reg'istration /i:Expires:
By s'ign'ing th'is permit/appl ication, I agree to cal I for an inspection once my
fence has been constructed (726-3769). I also state that all information on
this appfication/permit is correct and that I was provided with the Springfield
Development Code requirements for fence standards.
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fate
FOR OFFICE USE
Date of Application:b- tq -?o Job /i
Receipt Jl:Issued By
Total Amount Collected:
Checked for Del'inquenc'i es: y' Checked for Historical Status i "/
SPRtHGFtELO
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,/'.1"/0c .1,/JtPermit No:
Address iL I CU
lssued by: [li,'r.l^ t-Date:
STATEMENT:
INFORMATTON 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 24 or 28:
2.4 My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B I will be my own general contractor.
1f I hire subcontractors. I will hire only subcontractors reoistered with the
Construction Contractors Board. lf I change my mind and -do hire a general
contractor. lwill contract with a contrattor-who is reoistered w-ith 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 inlormation is correct and that I have read and understand
the lnlormation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
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Signature of Perrnit Applicant
CONSTRUCTION CONTRACTORS BOARD
o2&) 10t24t8g
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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t.f-Tl lown, reside in, or will reside in the completed structure.
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