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HomeMy WebLinkAboutPermit Fence 1995-10-06SPRINGFIELD I'IINCII T'IIITHIT APPLICA'TION crTr 0q sPRrNGtrruLD IIUILDING SAITUTY DMSI0N 225 North Flfth Street Sprtngfleld, 0regon 97477 0fflcc: INSPITCTION LINB: 726-3759 726-3769 C'TY OF Job Locatlon:? s- ,1/zd ,* Asscssors l,tap *rl1 OZ 3l zl e++€EeL-+ax Lot tt: Ot-7m Ovncr: Address, b2-f .1/ 3z-S+ Phone n: 7y'/- 7 c/sf Frc/.f o_R ztp , ?7r'24State: varuc of Fence , {{rU Cl ty: dress: nstrucrlon S gnaturc Fcnce Permit is $5.00 Contractor/Installcrr \N tiUO I-WNI S Ad ct Co t.J2 Phone {l: State:0{L zlp: ctors Reglstratlon ll:Bxpi res r By slgnlng thls pernlt/appllcatlon, I agree to caII for an inspcctlon once my fcncc has been constructcd (726-3769). I also stated that all lnformation on this applicatlon/perrntt 1s corrcct and that I vas provldcd vith the Sprlngflcld Dcvclopnrent code requlrcmcnts for fcnce standards \/o- ("-f f Da te FOR OFFICB USB Date of Apprlcatlon,[o -(0- q5 Rccelpt lt TotaI /unount Collected:DC jl Issucd Dy: J0ii *: Nna Checkcd for Dclinquencles , r,/Chcck.cd f or Ilistorical Status: t' Permit #: Address q N' 3z/vD Issued by:I\JM Date: lO-U-qS Statement: lnformation Notice to property owners About Construction Responsibilities Note: Oregon Law, 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 and2, and either box 3,{ or 38 B 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 all subcontractors who work on the structure must be registered with the Construction Contractors Board. tr 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 notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and thatl have read and do understand the Information Notice to Property Owners Construction Responsibilities on the reverse side of this form. /o--Q--?t- (Signature of permit applicant) (White copy to issuing agency perrnitfile, pink copy to applicant) OR (Date)