HomeMy WebLinkAboutPermit Fence 1995-06-20PENCE PERHIT APPLICATION
CITY OP SPRINGFIELD
BUILDING SAFETY DIVISION
SPI -JFIELO
0ffice:
INSPECTION LINE:
225 North Fifth Street
Springfield, Oregon 97477
726-3759
726-3769
CITY OF OREGON
Job Location: /rqLl 3i-fA'.
Assessors l.lap #: I UL Tax Lot *,437c t
Ovner:D^ru Keitn P"l'l fl'7 t ,'1 o
Address:bq So iA'.Phone *. 7//6 - Sgf Z
Cl ty:5 zi p:q
varue of Fence,'35(n ctD
Fence Permit is 95.00
Contractor/fnstaller: Se t F
Address:S y1 Phone #:
Ci ty:State:Zipz
Construction Contractors Registration *:Expi res :
By signing this permit/application, I agree to call for an ins pection once myfence has been construc ted (726-3769). I also stated that atl information onthis applieation/permi t is correct dnd that f vas provided vith the SpringfieldDevement code requi rements for fence standards.
S gnature
Date of
Receipt
FOR OFFICE USE
te
JOB *:ogApplication:
C Issued By:
TotaI Amount Collected:
Checked for Delinqueneies , ,-/
('D
,
State, O(
Checked for Historical Status, i -/
Permit #:s-r-s 35+tl
Issued by:
,+
Address
Date:
Statement: lnformation Notice to Property Owners
About construction Responsibilities
Note: Oregon l-aw, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered. with the Construction Contractors Board to sign the
following statementbi1orc obuilding permit canbe issued. This statement is required
-for
resiiential building, electical, mechanical, and plumbing permits' Licensed
architect and engineer applicants, exemptfrom registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate btanks and initial boxes I and2, and either box 3,{ or 38:
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.
3A. My general contractor is
(Narne) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
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 informationis correct and thatl have read and dounderstand thelnformation
Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant)
(White copy to issuing agency perrnitfile,
pink copy to applicant)
OR
Notice to
(Date)
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