HomeMy WebLinkAboutPermit Fence 1991-10-182?5 Fifth Street
Springfie'ld, 0regon 97 477
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPRI1\.GF!ELD
Office:
INSPECTION LINE:
7?.6-3759
726-3769
CITY OF SPF"VGFIELD, OREGO'U
Job Location: I-+) I S WQD S+
Assessors Map #: l-l Op 3 t 9Y fax Lot #:o lUog
0wner
Addres s :o-t, S+.Phone #: 7q7-5L8L
city/ S,po.,*{* td State:0e
o 5oo o'Fence Permi i. is $5.00
Contractor/Instal ler: ()r ilwt rf
Address:Phone #:
City:State:Li p:
Construction Contractors Registration #:Ex p'ires:
ti p:17"tt 3
Value of Fence:
C
By signing this permit/application, I agree to call for an ifence has been constructed (7?6-3769). -I also state that althis applicat'ion/permit is correct and that I was provided w
Development Code requ'irements for fence standards.
nspection once myI i nformat'ion on'ith the Springfie'ld
I
gna ure
FOR OFFICE USE
Date of App'l'ication:
Receipt #:7/63s
Total Amount Collected:
Job #:
Issued By:
d_o-T
Checked for Del inquencies:Checked for Historica'l Status
Y
Date
/o -/ g" -?/
Permit No:?t tP-
.,w q
Address:
lssued Date: /rc 'ir! -'7/
R OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUGTION RESPONSIBILITIES
Fill in the applicable blanks, and initial box 1 and either box 2A or 28:
#I own, reside in, or will reside in the completed structure.
Note: Oregon Law, ORS 701.055(4), ryquires residertial building_permit applicants
*no "ie iot regi6tered with ttie'Cohstruction Contractors Board to sign the
fottowing statemenibefore the building permit can be issued. Licensed Architect
"nJenginrer
applicints, exempt frori iegistration under ORS 701.010(7), need
not subhit this itatemeht. Thii statement will be filed with the permit.
1
2.4
OR
My general contractor is
Gontractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must-be registered with the Construction Contractors Board.
B
t hereby certify that the above information is correct and that I have read and understand
ttre lnt6rmation Notice to Property Owners about Construction Responsibilities on the
reverse side ol this form.
I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors reg.iste.red with the
ici;;i*;ti6;-Conia;iiiri iio'aio. lf I change my mind and -do. hire,a gerteral
iiniridio'i:'l'ilfi]'';onii;it w-ith.a contia"ctor'who..is resistered With the
d;n;i?i'ctibn bohir;;ib;;'Boa;ii;nd i-witi-immediately-notify the office
Gsuirig ihii OuitOing permit of the name of the contractor.
k
ig ture of A pp cantna
CONSTRUCTION CONTRACTORS BOARD
0244J 1t90
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANTi'J /.LfL
@s