HomeMy WebLinkAboutPermit Fence 1995-03-03225 North Fifth Street
Springfield, 0regon 97477
FENCE PBRHIT APPLICATION
CITY OF SPRINGFIELD
BUIU)ING SAFETY DIVISION
SPRTt\lcFIELD
Office:
INSPECTION LINE:
726-3759
7 26-37 69
CITY OF OREGO'V
Job Location:
Assessors Map #' l-i OZ 7Q I 3 Tax Lot #:tLlot
laJ/Phone *:
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0wner:
Address:
Ci ty:
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Value of Fence:Fence Permit is $5.00
Contractor/Ins taller :+
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Phone #:
City: State:zi p:
Construction Contractors Registration *:lres:
By signing this permit/application, I agree to caII for an inspection once my
fence has been constructed (726-3769). I also stated that aII information onthis application/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
3-- 3-"f'R_
S ture
Date of App
Date
FOR OFFICE USE
Iieation:3 1775
Receipt #b5 e5
JOB *:0
Issued By:q_cu lo
Total Amount Colleeted
Checked for Delinquene
5. fD
r e.s:Checked for Histor:ica1 Status:
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Permit #:a5 LAddress:Ttx r-l :1 ,/
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Statemeht: 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, exemptfrom registratton 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 1 and2, and either box 3A or 38:
K 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 forsale
before or upon completion.
3,A.. My general contractor is
(Name) Contractor regis. #
I will insffuct 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 huilding permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and thatl have read and do understand the Information
Owners about Construction Responsibilities on the reverse side of this form.
(Signature of applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
OR
Notice to Property
(Date)
a)
x'
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