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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 llt