HomeMy WebLinkAboutPermit Fence 1995-04-21225 North Fifth Street
Springfield, 0regon 97477
PBNCE PERHIT APPLICATION
CITY OF SPRINGFIBLD
BUILDING SAFETY DIVISION
SPRINGFIELO
0ffice:
INSPECTION LINE:
726-3759
726-3769
C'TY OF OREGO'U
Job Locat iont b(* ,J 3KTL+
Assessors Hap #:6LZll Tax Lot *: O 5
0vner:ffi,U f4vrq fl ;LlE
Address:I +
State:
Phone *:t:7
Ci ty:
Value of Fence:
Con t rac tor/Ins taller :
o{-Zip:
Fence Permit is $5.00
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Address, CO/ /1J' ? B-tlA f{-Phone #: 7q f - )2LZ
Cl ty:S tst\,state , C)dL zip:7Y
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that aII information on
this applicatlon/permit is correct and that I vas provided vith the Springfield
Development code requirements for s tandards .
S ure Date
FOR OFFICE USE
Date of Application --zl-
Receipt #0t1 cal
rotar Amount .or***S561)
JOB *:9 SOSZr;
Issued By
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Checked for Delinqueneies:,/ Checked for Historical Status , /
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construction Contractors Registration # , /'?h nxpires' /h
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Permit #:
Address:/J 3frt+ >r
Issued by:Dat"rZ
Statement: Information 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, 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 3A or 38:
X 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.
3,\. 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.
38. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Consffuction 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 informationis correct and thatl have read and do understand the Information
Notice to Property Owners about Responsibilities on the reverse side of this form.
OR
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(Signature of permit applicant)
(White copy to issuing agency pennit ftle,
pink copy to applicant)
(Date)
X
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