HomeMy WebLinkAboutPermit Fence 1992-04-03: :t,r.tthr r-:71:i - I !'
rENCE PERHIT APPLICATION
CITY OF SPRINGTIELD
BUILDII'IG SAFETY DIVISION
225 North Fifth Street
Springfield, 0regon 91417
Office:
INSPECTION LINE:
I 26-31 59
1 26-3t 69
Job Location:
Assessors Map lt:
ovner, tsf l-v\* UXU/n L||
Tax Lot lt:oD
AddreSs:
Ci ty:
-[iq r.Tqr. v Phone n:
S#trf a?-
1.1 b -.(?rlb
S ta te:Zi p:1
Value of Fence:1 5o.dD Fence Permit is $5.00
Con t rac tor/ Ins taI ler :l}IU yu v-
Address:
Ci ty:
Phone it:
State:zip:
Construction Contractors Registration fi: Expires:
Ry signing this permit/application, I agree to call {or an inspectiorr orrce my
fence has been constructed (726-3769), I also stated that aII information onthis application/permit is correct and that I vas provided vith the Springfie)d
Development code requirements for fence standards.
-qt
S gna Da te
FOR OFFICE USE
Date of Application:
Receipt lt 4ztz-
JoB {r, 'i Zr;03b
Issued By: fi 6-'*, ----
Total Amount CoIlected:OU
Checked f or Delinqrrenc i es: '.,'Checked for Ilistorical Statrrsi '''
T?\ Sts
_-
1
2
Permit No:
Address:
lssued Date:
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSI BILITI ES
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 r.equired 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-.
lwill instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
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 lnlormation Notice to Property Owners about Construction Responsibilities on the
reYerse side of this lorm.
Signature of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD
o244J 8191
3
WHITE COPY TO I$SUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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