HomeMy WebLinkAboutPermit Fence 1992-12-14225 North Fifth Street
Springfield, Oregon 97417
FENCE PERHIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPRINGF!ELE,
0ffice:
INSPECTION LINE:
726-3759
7 26-37 69
CITY OF SPR"UGFIELD, OREGO'V
Job Location:
Assessors Map *:Tax Lot #:
Ovner:
Address:Phone *:
Ci t1r:State:Zipz
Value of Fence:Fence Permit is $5.00
Con t rac torlIns taIler :
Address:Phone #:
Ci ty:State:Zipz
Construction Contractors Registration #: Expires:
By signing this permit/applicatiorr, I agree to call for an inspection once my
fence ltas been constructed (726-3769). I also stated that aII information on
this application/permit is correct and that I vas provided vith the Springfield
DeveI t e requirements for fence standards.
I
a Iure Da te
FOR OFFICE USB
oo
Date of App Iication:
Receipt #
TotaI Amount Collected:
,qAl?D
5rt Issued By
Checked f or Delinquene'ies:Checked for Historieal. Statrrs:d
t0rDnoe
Permit No:
Address
lssued Date
OR OFFICE USE ONLY
STATEMENT:
INFORMATTON 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. Li6ensed 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 a pplicable blanks, and initial boxes 1 and 2, and either box 3A or 38
A My general contractor is
Contractor registration num
1
2
3
OR
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be r6gistered with the Construction Contractors Board.
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 iegisiered with the Construction Contractors Board
and I will immediately notify the ofJice issuing this building permit of the name of
the contractor.
3.8
I hereby certify that the above information is correct and that I have read and understand
ttre tnt6rmation ttotice to Property Owners about Constnrction Responsibilities on the
reverse side of this lorm.
gnature Permit p t
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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'