HomeMy WebLinkAboutPermit Fence 1994-05-05\--l
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T'BNCB PBRT{IT APPLICATION
CITY OF SPRINGFTBLD
BUILDING SAFETY DIVISTON
225 North Fifth StreetSpringfield, 0regon 97477
0ffice:
INSPBCTION LINE:
726-3759
726-3769
Job Location:
Assessors Map #:
rDt
Tax Lot It:
0wner:
Address:
Ci ty:
.?A Phone *r 72G - 72ZS
Zip:c-:gState:
Value of Fence:
Con t rac tor/Ins taller:
Address:
Ci ty:State:
Construction Contractors Registration #:
gna ure
Fence Permit is $5.00
Phone *:
By signing this permit/apprication, r agree to carr for an inspection once myfence has been constructla (zzo-glog>. "r also "t"t"d that arl informatlon onthis application/permit is correct and that r vas provlded vlth the springfieldDevelopment code requirements for fence standards.
Date of Application:
ZLpt
Expi res :
te
FOR OFFICE USB
JOB #:
fssued By:Receipt lt
Total Amount Collected: g f
Checked f or Detinquenc.i e.s :Checked for Histor:ieal Statrrs:
c_5-2/
,{'f30
/00Address:
lssued Date:
OR OFFICE USE ON
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. Tlris state-
ment is required for residential building, electrical, mechanical, and prlumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under ORS 701.010(7), need not submit this statement. This statemenrt will be
filed with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
t F I own, reside in, or will reside in the completed structure.
I sft(
2 I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
My general contractor is ,
3.A
Contractor registration number-.
I wlll instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3.8 I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction 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 information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
Signat ure o rm Applicant at
CONSTRUCTION CONTRACTORS BOARD
0244J Bt91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
Permit No:?iZ r 3'
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