HomeMy WebLinkAboutPermit Fence 1990-07-20,-:
225 Fitth Street
Springf ie'ld, 0regon 97 477
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDiNG SAFETY DIVISION
SPRINGFIELD
Offi ce:
INSPECTION LINE:
7 26-37 59
7 26-37 69
Job Locat'ion:
Assessors Map #:3
Owner:
Tax Lot #:
Phone ll:
t3lD'
Addres s :q4, N +<r lo-
City:
Value of Fence:00
Contractor/I nstal I er :
state: 9{Lhty\Z'ip:4- T,T
Fence Permit is $5.00
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Addres s :
c;ty: fujlAltttl-z State:
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Construction Contractors Registration #:
By s'igning th'is permit/application, I a
fen c ha bee on s tru cted (7 26-37 6sts app ca 0n
Phone /l:b4- 4t
Zip:
Expires:
ree to al I for an 'i
I
nspection once my)
l"lnTdi"rn-afion on'
perm s correct and that I was prov'ided with the Springfield
Development Code requirements for fence standards.
7-ad - ?b
g ure Date
FOR OFFICE USE
Date of App'li cat'ion:
Rece'ipt ii:Issued By:
Total Amount Col I ected :47sot6-T;[_
s0s a a
o
Job /l
Checked for Del'inouencies:Checked for H'istorical Status:
I
Permit No:
Address:
lssued Date:
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 28l
1 I own, reside in, or will res
My general contractor is
Contractor registration nu
id in the completed structure.
mber
2. A.
OR
---I
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
B I will be my own general contractor.
lf I hire subcontractors. I will hire only subcontractors reoistered with the
Construction Contractors Board. lf I chanoe mv mind and 6o hire a oeneral
contractor. lwill contract with a contrattor'who is reoistered wlth the
Constructibn Contractors Board and I will immediatelv-notifv the office
issuing this building permit of the name of the contraitor. -
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 this form.
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Si gnature of Permit Appilicant Date
CONSTRUCTION CONTRACTORS BOARD
o244J 10t24t89
COPY TO ISSUING AGENCY PERMIT FILE
COPY TO APPLICANT
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