HomeMy WebLinkAboutPermit Fence 1990-05-11SPFI1r.GFIELD
OFEGO'UC'TY OF
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILOING SAFETY DIVISION
225 Fitth Street
Springfield, Oregon 97 477
Offi ce:
INSPECTION LINE:
726-37 59
7 26-37 69
Job Location:
Assessors Map #:11-o3-ab24
owner, Oln rr,u'l(s JoeLsor:
Tax Lot #: bZZo<)
Address, 6*Z N I7t"r Phone #: 7Zb boL
City:State:7i p :47L|77
vatue of Fence: {AaZ Fence Permit'is $5.00
Contractor/Installer: DUngt/
Address:Phone #:
City:State:Zi p:
Construction Contractors Registration #:Ex pires:
By s'igning th'is permit/application, I agree to call for an inspect'ion once my
fence has been constructed (726-3769). I also state that all informat'ion onthis appfication/permit is correct and that I was provided w'ith the Springfie'ld
Development Code requirements for fence standards.
8'--/l-7o
gn ure Date
FOR OFFICE USE
Date of App licationz ltt-7O
Receipt *: "l7O 3 -l Issued By:
Total Amount Collected r9 5.OO
Job #:g
Checked for Del inquencies:Checked for Historical Status:
Permit No:
A fiAddress:
lssued by Date:
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors Board to sign the
following statement before the building permit can be issued. 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 applicable blanks, and initial box 1 and either box 2A or 28
1 I own, reside in, or will reside in the completed structure
2. A.My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
5.itio
B I will be my own general contractor.
lf I hire subcontractors. I will hire only subcontractors reoistered with the
Construction Contractors Board. lf I chanoe my mind and do hire a general
contractor. I will contract with a contrattor -who is registered w-ith the
Constructibn Contractors Board and I will immediately-notify the office
issuing this building permit of the name of the contradtor.
I hereby certify that the above inlormation 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.
t / /^ 70
nature t icant
GONSTRUCTION CONTRACTO RS BOARD
0244J 10t24189
Date
WHITE @PY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
@r
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