HomeMy WebLinkAboutPermit Fence 1992-03-24225 North Fifth Street
Springfield, Oregon 97477
FENCE PERHIT APPLICATION
CTTY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFINGFIELD
0ffice:
INSPECTION LTNE:
726-3759
7 26-37 69
CITY OF OREGON
Job Location:0f1' 5 o iul.
Assessors Map #, /AdL 05 2 t
Ovher:6tt .(
Tax Lot *: OB*OI
Phone *:7,{7- z f gat
zip, f 7?,76
,
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Ci ty:'t't fi n;ap State:
ss:-?/
Value of Fence, ^ ft Fence Permit is $5.00
contractor/rnstaller , fuJC
Address:Phone #:
City: State:Zipz
Construction Contractors Registration *: Expires:
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that all- information onthis application/permit is correct and that I vas provided vith the Springfield
Develo t code requir ments for fence standards.
r'l '[-t't,S ur Dat
FOR OFFICE USE
Date of Applieation:-Z JOB *:a
Receipt #
TotaI Amount Collected:
h Issued By:
aO
Clrecked for Delinquencies: j--Checked for Historieal. Status:
-
l^ ft 6,tl#t
O-n'
Permit No r'?r )4 <a
57J /z*)Address:
lssued by:- Date:
OR OFFICE USE ONLY
Note: Oregon Law, ORS 701.055(4), requires resident'ial construction permit
applicantJwho are not registered with the Construction Contractors Board to
sign the following statement before the building per,mit can be issued. This state-
ment is required-for residential building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
i.rnder ORS 7O1.O1O(7), need not submit this statement. This statement will be
filed with the permit
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
1
2
>r.<I own, reside in, or will reside in the completed structure'
I understand that I must register ds a cbnstruction contractor if the structure is sold
or offered for sale before or upon completion.
My general contractor is
Contractor registration number-.
3
OR
A
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3. B.I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is iegistered with the Construction 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 lnl6rmation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
7 U
Signature of Permit APPIicant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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