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HomeMy WebLinkAboutPermit Fence 1990-05-10SPRIilGFIELD FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth StreetSpringfield, Oregon 97 477 Offi ce: INSPECTION LINE: 7 26-37 59 7 26-37 69 CITY OF SPRINGFIELD, OREGO'V Job Locat'i on : *i I 0 Wn"rl (,v^.p=tDr Assessors Map #:l7 nz 3l) t z-Tax Lot #: Owner: Address:1tD W z nd n,resl D'r City: Phone #: State z hE-Zi , q7477p t- "ccD ry Fence Perm'it is $5.00Value of Fence: Address: City:State: Construction Contractors Registration #: Phone #: Zi p: Ex pires: By signing this permit/ap fence has been constructethis appl ication/permit i Development Code requirem plication, I agree to call for an id (726-3769). I also state that ats correct and that I was provided wents for fence standards. nspl'i ith ect'ion once my nformat'ion on the Springfield -,// -?a rgna ure e FOR OFFICE USE Date of Application: Receipt #:Issued By:/] ^n^n Total Amount Col lected ,fr1. oO Checked for Delinquencies: ,/Checked for Historical Status: Contractor/Instal I er: fi N tfi.s_f Job #; (/no4q'n 4ooPermit No: Address:D,f Date: Aa -9,)lssued (o n,no STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential building permit applicantswho are not registered with the Construction ContractorsEoard to'sign thefollowing statement before the building permit can be issued. Licensed Rrdnitectand Engineer applicants, exempt from registration under ORS 701.010(7), neednot submit this statement. This statement will be filed with the permit. Fill in the applicable blanks, and initial box 1 and either box 2A or 2El: 1.f ,-rt lown, reside in, or will reside in the completed structure. 2. A. - My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work onthe structure must be registered with the Construction Contractors Board. OR B.d I will be my own general contractor. u^J,['{..,:tl3iTlR?1""'S,lH[!H::,i1t"."f".fl 1],,',,fi f,Is',s,.J'39s,f,,,,.8%tHJ,t": EBlg,itt:!"lEl,nf; Bll!?S'rt'llbif Bi"#;:l:;xt$,i'",,;'i'"tk1,g,l,il:issuing this buitding permit of the name ot ine coniiiitcii:"'' " I.hereby certify that the above information is correct and that I have read and understandthe lnformation N,otice to Property Owners about Construction nisponsibilities on thereverse side of this form. CONSTRUCTION CONTRACTORS BOARD 0244') 1U24t8€ -/o - 9d WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT @s 'zry' nature t ppl Date