HomeMy WebLinkAboutPermit Fence 1990-08-07C;ITY OF SPFTTVGFIELD, OREGOTV
225 Fifth Street
Springfie'ld, 0regon 97 477
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFI,VGFIEL(,
Offi ce:
INSPECTION LINE:
726-3759
726-3769
Job Location: 4'7b S 35fq *
Assessors Map #:OZ Tax Lot #: OC
owne* Dri ^;, Ba h, nl(n
Address: 3l fo
._tzrt-ft^ .);/-Phone *: a4/ -/o?
Ci ty , *.^^#rl"/State: i) F-zi p ,9zlz8
7 I
Value of Fence:Fence Permit is $5.00
Contractor/ I ns tal I er :ltt )e-rl
Phone #:
City:State:ti p:
Construction Contractors Registration #:Expires:
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By signing th'is permit/app'licatig!r^l agree.to call for an inspection once my
fence has been.EnrtrultLl ti2o-i7ogl. "I arso state that ail'information on
this appl.ication/permit is correct ano that I was provided with the Springfie'ld
O.r.fobi'ent Code requirements for fence standards.
a egnaure
FOR OFFICE USE
Date of ApPf ication:
Rece'ipt #:1qy ''7(/Issued By:
Job #:Db
I
Total Amount Collected:4-o-D
Checked for Del'inquenci es:/ Checked for Historical Status:
^07)
(-5 - /-7r q
Permit No:o +Address:
lssued by
STATEMENT:
INFORMATION 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 2A or 28:
1 I own, reside in, or will reside in the completed structure.
2. A.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.! will be my own general contractor.
lf I hire subcontractors. I will hire onlv subcontractors reoistered with the
Construction Contractors Board. lf I chanoe my mind and -do hire a qeneral
contractor. I will 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 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.
{)I 7- 1-'io
CONSTRUCTION CONTRACTORS BOARD
0244J 10t24t$
Date
\AI+{trE COPY TO ISSUING AGENCY PERMIT FILE
PJAUGCOpY TO APPLICANT
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