HomeMy WebLinkAboutPermit Fence 1995-05-09225 North Fifth Street
Springfield, Oregon 97477
FENCE PERHIT APPLICATION
CITY OF SPRINGFIELD
BUIIDING SAFETY DIVISION
SPRINGFIELD
0ffice:
INSPECTION LINE:
726-3759
726-3769
CITY OF OREGO'V
Job Location:
Assessors Map *, /-7 o,33 5/3
-0wr1er:LL {t7
Address:Sl
Ci ty:State:
Value of Fence:2
Con tractor/Ins taller :
Tax Lot *:ZK5-?)
Phone #: 141- Lr/:3 )
Zip:q'7 + e)
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Fence Permit is $5.00
Address.bO? /,) el'l*S{Phone *:
crWr*S.np-) taQ-G,/4 State DL zip:
Construction Conkactors Registration *:
Qtn77
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 all informatlon onthis application/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
{- f -
S gnature Date
FOR OFFICE USB
Z4f/o
Date of Application:5
Receipt #
JOB *:
Issued By:
6\)Total Amount Colleeted:+
Checked for Delinquene.ies:l/ Checked for llistorical Status:
f ut/
Permit #:
t)
Issued eq-q{
Statem€nt: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon law, ORS 701.055(4), requires restdential construction permit appli-
cants wlto are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exemptfrom 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 andZ, 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.
tr 3B. I will be my own general contractor
If I hire subcontractors, I will hire only subcontractors registered with the Consffuction 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 that the above informationis correct and thatl have read and dounderstand thelnformation
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
f .-q--qJ'_---------\
(Sjg$ure of permit applicant)
(White copy to issuing agency permit file,
pink copy to applicant)
OR
(Date)