HomeMy WebLinkAboutPermit Fence 1996-07-17225 North Fifth Street
Springfield, Oregon 97477
rBNCE PBRHTT APPLTCATTON
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPrlTNGFrELI)
Office:
INSPECTION LINE:
726-37s9
726-3769
Job Location: L3& b. G+ S-f-
Assessors Hap #:
Ovner:lr.l <-i \ $ Lr ^A-S"\",,^a\(.r
Address' 63F N b Lst Phone #:
Ci ty:S \otL Zi p:State:
Value of Fence:?Soeg Fence Permit is $5.00
/r.J.i\ *L\^f,* S -L.od\*"Con t rac tor/Ins taller :
Address, t 3 f 6tla s f Phone #:
Ci ty:State:o Zip:
Constructlon Contractors Registration *:
lly signing this permit/application, I agree to call- for an inspectlon once my
fence has been constructed (726-3769). I also stated that aII informatlon on
this application/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
7-t7-7 4
gnature Date
POR OFFICE USE
Expires:
Date of Application:
Receipt tt c
Total Amount Collected:5
-\JoB *z nOOq 7)-
rssued By,n - f)4clilAdc)
Checked for Delinqttencie.s:
5D
Cheeked for Ilistorieal Stattts:
Tax Lot *:OOTC'D
- LiJ- trfi ?
9)Yl7
fYf a)
'7--la-qA
Address: (eqK (p+ 3*ew
Issueduy: 0 . Cnlc)-'ado
Permit #:
Date: 1- ll 4V
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 Constructton Contractors Board to sign the
following statement before abuttding permit can be issued. This statement is required
for residentiat building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. Thts statement will be filed with the permit.
Fill in blanks and initial boxes L and2, and either box 3A or 38
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.
3A. My general contractor is
(Name)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
3B. 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 G cig ano 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
on the reverse side of this form.
(Signature of permit aPPlicant)
(White copy to issuing agency perunit file,
pink copy to aPPlicant)
Notice to
(Date)
- /) ?67