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
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Address:)lLqiu
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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.
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FOR OFFICE USE
Date of Appf ication:-b Job #:
Receipt #:Issued By:
Total Amount Collected:5cD
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Checked for Del inquenc'i e,S: -,2/ Checked for Historical Status z '/'
_Phone #:
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Permit No:
Addres
lssued
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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
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wHft COPY TO ISSUING AGENGY PERMIT FILE
ftx(copY To APPLIcANT
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