HomeMy WebLinkAboutPermit Fence 1996-05-24C'TY OF OFEGO'U
SPNINGF!ELCI
Office:
INSPECTION LINE:
**d*k
P\
%
rENCE PBRHIT APPLICATION
CITY OF SPRINGFIELD
BUIIJING SAFETY DIVISION
225 North fifth Street
Springfield, Oregon 97.477
726-3759
726-3769
Assessors Map *:
0vner:. [)i(-.
Address t (Cbq N
i-et&
Con t rac tor/Ins taIler:
Address, [O Q4 n
r.t 54 Si
S'{
rax Lot $: JZCfO
phone +' l+l-qYtZ
, Q'tr)lCi ty:State:E-R-zip
Varue of Fence, al5b - 6'o Fence Permit is $5.00
Phone #:
Ci ty:S tate :OL zip:
Constructlon Contractors Registration *:.Expi res :
lly siglting tlris permi t/application, I agrce to call- f or an inspectlon 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.
tt)^lC -l
--l-z -I L/L-/u4SIffi|*e c
5-eE -'/L
Da te
FOR OFFICE USE
Date of App rication,5li^4)qA
Receipt lt L
Total Amount CoIIected:
JOB {:4r*ozo7
Issuedsv'fl.rYlcVh.VCl
Checlced f or Delinqttenei es:
5D
Checked for Histor:ica1 Stattts ' V'
Job Location:
t1
/
Permit #:
Issued by:
5t-{.- s"1-
E:(Date: r-/
C
Address: iOkq N\
Statemeht: lnformation Notice to Property Owners
About Construction Responsibi lities
Note: Oregon Law, ORS 701.055(4), requires residential 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, exempt from 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.
3,A'. 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 the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and thatl have readanddounderstand thelnformation
Notice to Property Owners Construction Responsibilities on the reverse side of this form.
E".}'^l -1U
(Signature of permit
(White copy to issuing agency permit file,
pink copy to applicant)
(Date)
tr
u