HomeMy WebLinkAboutPermit Fence 1993-05-10CITY OF SPF"UGFIELD, OREGOA'
225 North Fifth Street
Springfield, Oregon 97477
FENCE PBRUIT APPLICATION
CITY OF SPRINGFIBLD
BUITDING SAFBTY DIVISION
SiP,lINGFIELD
0ffice:
INSPECTION LINE:
726-3759
726-37 69
Job Location: 3 n A) a<,/t-!.1)6 el -
Assessors Map #:rax Lot *z O1@1
Owner:
Address, QLfr N eSuJ Plu ", - phone *:1.t)-8S3"
Ci ty:h"' r\AG k"-Or.l- state, OA zip: Q'> V -h
J
Value of Fence 2 6 oo"Fence Permit is $5.00
Contractor/Installer: Ot rn- nn )
Address:Phone #:
Ci ty t State:Zipz
Construction Contractors Registration *: Expires:
By signing this permit/application, I agree to caII for an inspection once my
fence has been constructed (726-3769). I also stated that aII information onthis applieation/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
3)
I
a ture Date
FOR OFFICE USE
Checked for Delinqueneies:
lq>
Checked for Historical Status ' ,./
Date of Application:elto
Receipt #
Eg 1a'-l
Total Amount Collected, -X
Issued By:DR
JOB *:oQz )
1
2
Permit No:Q5ouaz
Address:?ar> A)ES@ PL
lssued by OB Date:Are>
R OFFICE USE ONLY
STATEMENT:
!NFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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 required for residential building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
underORS 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-.
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
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 certify that the above information is correct and that ! have read and understand
the lnlormation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
3) rcl qt
nature rm p cant Date
CONSTR UCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ]SSUING AGENCY PERMIT FILE
P]NK COPY TO APPLICANT
3