HomeMy WebLinkAboutPermit Fence 1991-10-28225 Fitth Street
Springfield, Oregon 91 477
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SiP'tI]\lGFIELD
Off i ce:
INSPECTION LINE:
7 26-37 59
7 26-37 69
CITY OF OREGO'U
Job Location: 4)q J Llq *lJ
0wner:H
Address, Ll)q X 4q Phone #: _114 - -766b
C'ity:State: - CR.Zi p:9tv-t8
6Value of Fence:Fence Permit'is $5.00
Contractor/I nstal I er :
Address: Phone #:
City:State:Zi p:_
Construction Contractors Registration #:Ex pires:
By signing this permit/app'liqatig!r I agree to call for an inspection once myfence has been constructed (726-3769). I also state that all information on-this application/permit'is correct and that I was provided with the Springfield
Development Code requirements for fence standards.
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na ure Dafe
FOR OFFICE USE
Date of Appl ication t- t%f*lqt
Receipt #:)fl0
Job #, 4J/lIlO
Issued By gr'1
Total Amount Collected V S rlf.r
CheckedforDelinquencies:-CheckedforHistoricalStatus:
Assessors Map #: l-lo)3?3.1 Tax Lot t: 64411
0
Permit No:
Address:-t'-)€) S ,\
lssued by
OR OFFICE USE ONL
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:
2. A. l-l 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
rc8 Date:
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 mv mind and 6o hire a oeneral
contractor. !will contract with a contrattor-who is reoistered wltn tne
Constructibn Contractors Board and I will immediately-notify the office
issuing this building permit of the name of the contradtor.
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.
4 D)QAt
na ure pp
CONSTRUCTION CONTRACTORS BOARD
0244J 1t90
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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1.ftrl I own, reside in, or will reside in the completed structure.