HomeMy WebLinkAboutPermit Fence 1995-10-025P'IINGFIELO
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INSPBCTION LINE:
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I'UNCU I'III(HIT AT'T'LICA'TION
CITY OI' SI'RINCITIELD
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225 North Flfth Streer "
Sprlngflcld, 0regon 97477
726-3759
726-3769
-CITY OF
Job Locatlon:
Asscssors Hap *r l? 03 3Q Zt rax Lot ttr O0O (n)
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Address , ?a.+ t{ 1,il<Phone ftz '7/Z *y',e^
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Value of Fencei A il- Fence Permit ts g5.oo
Con t rac tor/Ins taller:
Addrcss:Phone lt: ".33l -J-1^Ja)
ctwl4rA94.yr ,fuC- srare, QZls-1T-zipr-
Constructlon Contractors Reglstration llr <ltZ a S Explres:'- /-q{
By slgnln8 thls pel'ntr/appltcatlon, I agree to caII for an inspectlon once my
fencc has been constructed (726-3769), I also stated that all lnformatlon on
thls appllcatlon/permtt ls correct and that I vas provlded with tha Sprlngflcld
Dcvcloprrrcrr t code requl rcmen ts f or f encc s tandards
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tu te
IIOR OFFICB USE
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Date of AppI rcatron, lD ' 2-75
Recclpt ll 0tQ a
Total /unount CoIIect 5
Jori n:15155(
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Issucd Dyr NM
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Clrcckcd for Dclinquencles; t-/Check.ed for Ilistorical Status:
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Permit #:5E
Address N. iVtL sr
Issued by:rv-&Date:lj-oL-qs
Statemeht: Information 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
foltowing statement before a buitding permit can be issued. This statement is required
for residential buitding, 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 appropriate blanks and initial boxes I and2, and either box 3A or 38
E 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 J/-121--
Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
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 thatthe above information is correct andthatl have readanddounderstand thelnformation
Notice to property Owners about Construction Responsibilities on the reverse side of this form'
(Name)
(Signature of permit aPPlicant)
(White copy to issuing agency perrnit file,
pink copy to aPPlicant)
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(Date)
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