HomeMy WebLinkAboutPermit Fence 1990-08-27CITY OF SPR,INGFIELD,OREGON
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFINGFIELD
Offi ce:
INSPECTION LINE:2?5 Fiflh Street
Springfield, 0regon 97 477
726-3759
726-3769
Job Locat'ion :A1 '1,{t q 5-l-
Assessors Map #: -il 6Z.7'Z Vl rax Lot #:
0wner:
Address:N Ll4 s+-Phone #:(,,q Eb/
State b€--Zi p:7 7City:
Address:
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Contractor / I ns tal I er :
Fence Permjt is $5.00
Phone #:
State:Zip:C'ity :
Construction Contractors Registration #:
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Ex pi res :
By signing this permit/appficatig!r^l agree-to cal'l fol an inspection once my
f'ence"has"been cbnstrlc[bb e26-3log). -I also state that all information on
inii-.ppiiiitionipermit is iorrect anO that I was provided with the Springfield
Development Code iequirements for fence standards.
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FOR OFFICE USE
Date of App I icat'ion I I ->f -?b
Recei pt r, )Ff 47
Job #:ot ,O7O
Issued By n*^. -a
Total Amount Collected fr-df>
Checked for Del inquenci es: *--- Checked for Historica'l Status , y''
Value of Fence:
'74
?n
Permit No:
Address
Fill in the applicable blanks, and initial box 1 and either box 2A or 28:.
1
2. A.My general contractor is
Contractor registration number
OR
STATEMENT:
INFORMATION NOfiCE TO PROP-E-RTY OWNERS"' ABiiUf Cor.rsrnucrloN RESPoNSIBI LITI ES
Note: oregon Law, oRS 701.055(4), pquires residerrtial building-permit applicants
who are not regisiei.O *itn tnei'Co-i',itiuction Contractors Board to sign the
f olowing statemeni|Lioi" ihe building permit can be issued' Licensed Architect
and Engineer apptit"tii,.ig,,Ot trori iegistration under ORS 701'010(7)' need
not submit this stat".eht. Thii statemeit will be filed with the permit'
I will instruct my general contractor that all subcontractors who work on
the structure mrisibe registered with the Construction Contractors Board.
B I will be my own general contractor.
lf I hire subcontractors. I will hire only subcontractors registered with the
Construction Contractors Board. lf I change my mind and -do hire a general
contractor. lwill contract with a contrattor-who is registered 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.
A:| ".*,<t 4 )i -q )^>_ ? 0,.. -l -1Signature of Peimit Applicant
CONSTRUCTION @NTRACTORS BOARD
424il 10t24t89
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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I own, reside in, or will reside in the completed structure.