HomeMy WebLinkAboutPermit Fence 1994-03-29225 North Fifth StreerSpringfield, Oregon 97477
FBNCE PERHIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAPETY DIVISTON
SPF|INGFIELO
0ffice:
INSPECTTON LINE:
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7 26-37 59
726-3769
CITY OF OFEGO'V
Job Location:
Assessors Mrp #t
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ll
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0vner:
Address:lu Phone #:
Ci ty:State:
varue of Fence . -fl ISOO Fence Permit is 95.00
Contractor/InstaIIer: O
Address: f L),
Tax Lot *: C8 600
zi p:?7/7g
Phone #: -7 15 -t 3Z.l
Ci ty:(.State:Zipt Qzrl 7?
Construetion Contractors Registration #, Lt t I t b Expires:D
gnature 3-L 7- ?q
Da te
FOR OFFICE USE
Date of Application: -3 t-l JOB #:
Receipt # ]) lO v fssued By:
Total Amount CoIIected : r#q ob
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By signing this permit/application, r agree to carr for an inspection once myfence has been constructei (zzo-g169). -r arso stated that alr information onthis application/permit is correct and that r vas provided vlth the springfieldDevelopment code requirements for fence standards.
Clrecked f or Delinquene i es: '.L/'-Checked for Historieal Starrrs: /
2
Permit No:Qqoqtz
Address:qzM
lssued nv: DA Date leleg
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS701.055(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:
/--1. f--7) 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.
3.A My general contractor is
Contractor registration num 4 t ll,b
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 certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
3/n/q,,
ignature of it Applican Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
OR
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT