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HomeMy WebLinkAboutPermit Fence 1991-04-30CITY OF SPR"VGFIELD, OBEGO'V SP;lI]lGFIELE, FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springf ield, Oregon 97 477 Job Location: Assessors Map #: Owner: 1e5 Offi ce : INSPECTION LINE: Tax Lot #: A -b C)) Phone #: 726-3759 726-3769 (_ Address:)lLqiu ,rrr , ,tate:c*Zi p:q 7q7 t Value of Fence:i6c-dD Fence Permit is $5.00 Contractor/ I ns tal I er : City:State:L1 p: Construction Contractors Registration #:Ex pires: By sign'ing th'is perm'it/applicat'ion, I agree to call for an inspection once my fence has been constructed (726-3769). I also state that all information on th'is app'lication/permit is correct and that I was provided with the Springfield Development Code requirements for fence standards. *3o* 9n u FOR OFFICE USE Date of Appf ication:-b Job #: Receipt #:Issued By: Total Amount Collected:5cD \,z\,^-r- Checked for Del inquenc'i e,S: -,2/ Checked for Historical Status z '/' _Phone #: ( Permit No: Addres lssued S:4 {n (/ Date: R OFFICE USE ON 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 2B:. 1 I own, reside in, or will reside in the completed structure. 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 B I will be my own general contractor. lf I hire subcontractors. I will hire onlv subcontractors registered with the Construction Contractors Board. lf I chanoe my mind and do hire a general contractor. lwill contract with a contrattor-who is reoistered 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 is form. gn u o it cant CONSTRUCTION CONTRACTORS BOARD o244J'U90 te wHft COPY TO ISSUING AGENGY PERMIT FILE ftx(copY To APPLIcANT '/ @s c/-go-q /