HomeMy WebLinkAboutPermit Fence 1993-12-03SPFlTNGFTELE,
CITY OF SPRINGFIELD, OREGO'U
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FENCE PERHIT APPLICATION
CIfY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North fifth Street
Springfield, Oregon 97477
0ffice:
INSPECTION LINE:
726-3759
7 26-37 69
Job Location:lu-14 N, lqLSt'
Assessors Map *:)D Tax Lot #:
Owner:
Address:/t-lJ Phone #:"t t+b- 43Ltb
Ci ty:Statet 0A Zip:Ql q))
Value of Fence:4 )oooo Fence Permit is $5.00
Contrac tor/Ins taIler :,l)u/Yt/-rr
Address:Phone *:
Ci ty:State:Zipz
Construction Contractors Registration *:Expi res : _
By signing this permit/application, I agree to caII for an inspection once my
fence has been constructed (726-3769), I also stated that all information on
this application/permit is correct and that I was provided with the Springfield
Developm code requirements for fence standards.
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s a e Date
FOR OFFICE USE
Date of Application:t)nn *z Q3 )R /)
Receipt # llCbl Issued By:C
Total Amount Co}lected, 4 oc)
Checked for Delinquencies: L/Checked for Historical Status z ,-z'
141r-'
Permit No
Address:
Q3t t2
lssued by fre Date l) t*',,
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
underORS 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
1
2
Gq4 /v lqw>t-
WHITE @PY TO ISSUING AGENCY PERMIT F]LE
PINK COPY TO APPLICANT
3 My general contractor is ,
Contractor reqistration number-.
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
3. B.l - -l I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion 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 lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
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rmit App cant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8t91