HomeMy WebLinkAboutPermit Fence 1990-07-24FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPRINGFTELD
0ff i ce:
INSPECTION LINE:
225 Flfth StreetSpringfield, 0regon 97 477
7 26-37 s9
7 ?6-37 69
Job Locat'ion: t08t AVntAcilasl Dr;rlz-
Assessors Map tl: l-TnVZ4 I b Tax Lot #: (2 oz2()
Owner:
Addres s :bg t rNn.n4 r.Dv"i J<- Phone lt:Z
City:State: OE-Z1 p:7
Value of Fence:Fence Permit is $5.00
Contractor/I nstal I er :
Address:Phone //:
City:State:
Construction Contractors Registrat'ion /l:Ex p'ires :
QV s'iOling th'is permit/appl iqat'i01, I agree to cal I for an inspection once my
fence has been constructed (726-3769). I also state that all 'information on-this appfication/permit'is correct and that i was provided with the Springfield
Development Code requirements for fence standards.
L c 7-2+-O
a ure a
FOR OFFICE USE
Date of Appl icat'ion:7- 2,1 -?Job li:
Receipt #: )B tb Issued By:fi*r,n
Total Amount Coltected ,flt.6D
checked for Del'inquencies: ,/ checked for Historical status
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Permit No:
{$ t r,a r:it;! {:r*f I)r ,Address:
lssued by fiunuoo-Date: 7 ';4 'i,-t
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 f rom 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 28;
1.1--I lown, reside in, or will reside in the completed structure.
2.4 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.
If I hire subcontractors. I will hire only subcontractors reoistered with the
Construction Contractors Board. lf I chanoe mv mind and Eo hire a oeneral
contractor. lwill contract with a contrattor'who is reoistered with the
Constructibn Contractors Board and I will immediately-notify the office
issuing this building permit of the name of the contraitor.
I hereby certily that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Gonstruction Responsibilities on the
reverse side of this form.
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a reo rm Date
CONSTRUCTION CONTRACTORS BOARD
o24N 10l24t8p
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WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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