HomeMy WebLinkAboutPermit Fence 1993-08-10225 North Fifth Street
Springfield, 0regon 97477
FENCE PERHIT APPLICATTON
CTTY OF SPRINGTIELD
BUILDING SAFBTY DIVISION
SPRTNGFTELD
Office:
INSPECTION LINE:
726-3759
7 26-37 69
CITY OF SPRINGFIELD, OREGO'V
Job Location:*\
Assessors Map #r \-l O13L I I rax Lot *: OtSOo
Ovner:
Address:
Ci ty:
a\Phone #:
State:O.Zip:
Value of Fence:Fence Permit is $5.00
Contrac tor/Ins tal1er :
Address:1OS r,0^-rS!t Phone *: I * l^ *a7 /
Ci ty:Stater Qd Zip:T z y tt
Construction Contractors Registration *:Expi res :
By signing this permit/application, I agree to caII for an inspection once my
fenee has been eonstructed (726-3769). I also stated that all information on
this application/permit is correct and that f vas provided with the Springfield
Development code requirements for fence standards.
\'*:( D\--\* -- \L:r \>
Signature Date \
FOR OFFICE USE
#r r.
Date of Application:?
Receipt * q7qj
Total Amount Collected t ! Of)
JoB *: qu)qa
Issued By:Cle
Checked f or Delinquene'ies: \i Checked f or Historieal Stattts'. Y
?:qt ">'tt I
J
Permit No
Address:
QztnT
Qos N yStt-oSL
lssued by
R OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits. 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 boxes 1 and 2, and either box 3A or 38:
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
A My general contractor is
Contractor registration number-.
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3.8 I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tlon Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction 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 lnlormation Notice to Property Owners about Construction Responsibilities on the
reYerse side of this lorm.
?f ,rl o>
natu re m pp cant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
D.B 9l,olq"e.
1
2
3
OR
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
Date:
1