HomeMy WebLinkAboutPermit Fence 1993-11-08CITY OF OREGO'V
225 North Fifth Street
Springfield, 0regon 97477
FENCE PERMIT APPLICATION
CIfY OF SPRTNGFIBLD
BUILDING SAFETY DIVTSION
SPRINGFIELO
0ffice:
INSPECTION LINE:
726-3759
726-37 69
Job Location: |t-Ct qSfu PI
Assessors Map #r ! 3 O2OS /f, Tax Lot #:G 8oo
Ovner:
Address:
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Ci ty:State:
Phone *: ) L+')'L+VO /
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Value of Fence:8 l3oo"''Fence Permit is $5.00
Contractor/Ins taller :
Address:Phone #:
Ci ty, state:zip:
Construction Contractors Registration #:Expires:
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that all information onthis application/permit is eorrect and that I vas provided vith the Springfield
Development code requirements for fence standards.
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ignature Date
FOR OFFICE USE
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Date of Application:
Receipt + lO: 19
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Issued BVt CI6
Total Amount Collected . fu 3oa
Checked for Delinquenei est ,-/ Checked for Historieal Stattts:
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Permit No:
Address:
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1
2
Date:g3
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSTBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permitapplicants who are not registered with the Construction Contractors Board tosign the following statement before the building permit can be issued. This state.ment is required for residential b_uilding, elecirical, mechanical, and plumbingpermits. Licensed Architect and Enginebr applicants, exempt from registratiotunder ORS 701.010(7), need not sudmit this statement. Thib statement wiil befiled with the permit.
Fill in the applicable blanks, and initial boxes 1 and 2, and either box 3A or sB:
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 soldor offered for sale before or upon completion.
A My general contractor is_.--
-,
Contractor registration number-.
I will instruct my general contractor that all subcontractors who work on the struc-ture must be registered with the construction contractors Board.
3.8 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 certily that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
roYerse side of this form.
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gn ure o pp cant Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8t91
3
OR
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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