HomeMy WebLinkAboutPermit Fence 1995-06-16C'TY OF SPRINGFIELD, OREGO'U
FENCB PERHIT APPLICATION
CITY OP SPRINGFIELD
BUILDING SAFBTY DIVISION
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0ffice:
INSPECTION LINE:
225 North Fifth Street
Springfield, 0regon 97477
726-3759
726-3769
Job Location: 11)) jiorth l+th 3treet
Assessors Hap *2 17 )3 2; 3 b Tax Lot #: 03?OO
Ovner: FraC l-cv E . ler
Addressz 11J9 lriorth [th Srreet
Ci ty:
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3pringfield State: Cre2on zi p:1 ?
d4o, u'Value of Fence:Fence Permit is $5.00
Contractor/Ins taller : €{fil'!:a'TraJ l<D a
Address , l t O't AI .[T'^ Sf Phone *:1 z(e \ g&3
Ci ty:&(,,!State C€-Zipt ?tq T3?53
Construction Contractors Registration #:l.pA--Expires Nfr-
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that all informatlon on
this application/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
(A^,*ra, A-Ar^oSililture l I te
FOR OFFICE USE
Checked for Delinqueneies:t / Checked for Historical Status:
o 3zDate of Application:
Receipt #
qTota} Amount Collected:d)
Issued By:
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Permit #:
-tb -Issued by:n^*Date:
Statemeht: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires resi.dential construction permit appli-
cants who 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 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
(Narne) 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
38. 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 the CCB and will immediately notify the office issuing this huilding permit of the
name of the contractor.
Ihereby certify thatthe above informationis correctand thatl have read and dounderstand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
I Ld ;-tw a/?1{
of permit
(White copy to issuing agency pelrnit file,
pink copy to applicant)
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(Date)
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