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
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"ccD ry Fence Perm'it is $5.00Value of Fence:
Address:
City:State:
Construction Contractors Registration #:
Phone #:
Zi p:
Ex pires:
By signing this permit/ap
fence has been constructethis appl ication/permit i
Development Code requirem
plication, I agree to call for an id (726-3769). I also state that ats correct and that I was provided wents for fence standards.
nspl'i
ith
ect'ion once my
nformat'ion on
the Springfield
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rgna ure e
FOR OFFICE USE
Date of Application:
Receipt #:Issued By:/]
^n^n
Total Amount Col lected ,fr1. oO
Checked for Delinquencies: ,/Checked for Historical Status:
Contractor/Instal I er: fi N tfi.s_f
Job #; (/no4q'n
4ooPermit No:
Address:D,f
Date: Aa -9,)lssued (o n,no
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicantswho are not registered with the Construction ContractorsEoard to'sign thefollowing statement before the building permit can be issued. Licensed Rrdnitectand Engineer applicants, exempt from registration under ORS 701.010(7), neednot submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 2El:
1.f ,-rt lown, reside in, or will reside in the completed structure.
2. A.
-
My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work onthe structure must be registered with the Construction Contractors Board.
OR
B.d I will be my own general contractor.
u^J,['{..,:tl3iTlR?1""'S,lH[!H::,i1t"."f".fl 1],,',,fi f,Is',s,.J'39s,f,,,,.8%tHJ,t":
EBlg,itt:!"lEl,nf; Bll!?S'rt'llbif Bi"#;:l:;xt$,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€
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WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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nature t ppl Date