HomeMy WebLinkAboutPermit Fence 1995-06-22a
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225 North Fifth Street
ii-titeii"ra, oregon 97 477
FENCE PBRHIT APPLICATION
CITY OF SPRINGTIELD
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siPFll IELD
0ffice:
INSPECTION LINE:
726-3759
726-3769
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Tax Lot *:
.Qr oR"-3SJob Location:
Assessors l'laP *:
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State:
d-Ovner:
Address:q"Phone *:
M NQzo [,1 zip:q a4
Ci tY:
Value of Fence rOO Fence Permit is $5'00
Con t rac tor/Ins taIler :-, (>l-L C i+:
Phone *:
Address:
State:Zip:
Construction Contractors Registration S:q 3 Sqt Expires:r e t -'46
By signing this Permit/r
fence has been construc
this apPlication/Permi t
Development code requir
application, I agree to caII for an inspection once my
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"I"o stated that all information on
is correct and tt"t-i-""s provided vith the Springfield
'ements for fence standards'2L+{)
Datesgnature
FOR OFFICE USE
Date of Applicati *, a-ZZ - lS JOB *:
Receipt */77 7t:Issued By:
Tota1 Amount Collected:e
Checked for Delinqueneiesi <----- Checked for Historical Status:
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Permit #:/s
Address . Z,Z
Issued by:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon l-aw, ORS 701.055(4), requires residential construction permit appti-
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 and,2,and either box 34 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.
3A. My general contractor is _
-
(Name) Contractor regis. #I will instruct my general contractor that a]l subcontractors who work on the structure must beregistered with the Construction Contractors Board.
OR
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If I hire subcontractors, I will hire only subcontractors registered with the Construction contractorsBoard' If I change my-mind and hire a general contractoi, I will contract with a contractor who isregistered with the ccB and will immediately notify the office issuing this building permit of thename of the contractor.
I hereby certify that the above information is correct and thatl have read and do understand the InformationNotice to Property Owners about Construction Responsibilities on the reverse side of this form.(
(Signature of permit applicant)
(Wite copy to issuing agency peftnitfile,
ptnk copy to applicant)
(Date)
&- oxe: 1T *
R 38. I will be my own general contractor.