HomeMy WebLinkAboutPermit Fence 1996-04-11225 North Fifth Street
Sprlngfield, Oregon 97477
FBNCE PBRI'IT APPLICATION
CITI OF SPRINGPIBLD
BUITDING SAFBTI DIVISION
s;PrlIi.GFTELD
Office:
INSPECTION LINE:
726-37s9
726-3769
CITY OF SPR"VGFIELD, OREGON
Job Location: 331 I,\ BYl-'^
Assessors Hap *:L 31 3
0vner: tlz-,..- L.S-{.;.^.o'rrt
rax Lot S: Ot/ O /
Address: ?.(/ .15o* Zbl
state: c) R-
Phone #: *t4b "7O ct3
Zi p:t?\-17
varue or Fence,ff a 56D .6'o Fence Permit is $5.00
con t ractor/Ins t
Address:Phone #:
Cl ty:State:Zip:_
Construction Contractors Registration *: Expires:
<{-t t4 Q
S ture Date
FOR OFFICE USE
Date of Application:JOB *:b c:50>
Receipt #0>t0 rssued sy /1 . fYl dChnd o
Total Amount Collect
-/l-
Checked for Delinqueneies:
5
Checked for Historical Status:L/'
Ci ty:
By signing this permit/application, I agree to caII for an inspection once my
fence has been constructed (726-3769). I also stated that all information on
this application/permit is correct and that I vas provided vith the Springfleld
Development code requirements for fence standards.
Permit #:50
Address:3 37 /$. 3flL sr7lef
Issued ay, D.Ilfthffi) out", ?-tt 4 b
Statement: lnformation Notice to property owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Liiensed
architect and engineer applicants, exemptfrom registration under ORS 701.010(7),
need not submit this statement. This statement witl be fitedwith the permit.
Fill in the appropriate blanks and initial boxes I and.2, and either box 34 or 38
1. I own, reside in, or will reside in the completed structure
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3,A.. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
E
M
M
OR
38. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and 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 dounderstand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
(Signature of ant)
(White copy to issuing agency pennitfile,
pink copy to applicant)
(Date)
r