HomeMy WebLinkAboutPermit Fence 1994-11-30CITY OF SPRINGFIELD, OREGO'U
225 North Fifth Street
Springfield, 0regon 97477
FBNCE PERHIT APPTICATION
CITY OP SPRINGFIBLD
BUIIDING SAFETY DIVISION
SP,rINGFIELD
0f f ice:
INSPECTION LINE:
726-37s9
726-3769
Job Location:,{
Assessors Hap #:tt oz cv 13 Tax Lot f:oGSa p
Owner:
Address I q?g- S. 3gZ .9.,jtr,t6,z-/.. /-7. &
Ci ty , \92,,-r,lFrZzrt State t oZ
Phone *: ?-26.2/
Zip:cl 7y'zf'
varue of Fence,$ .?6 O ' 60 Fence Permit is $5.00
Contractor/Ins tal1er | ,tic i *t(z'cpf*.- 60n)
Address | 1?g' 5. Sfr'*Phone #:
City: -.*/r-a.F/z/"2 State:or{Zip:./7/,7r'
Construction Contractors Registration #: Expires:
By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that aII information on
this application/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.t'
I - Z) 7. fZrZ-
SiEnatrrre
Date or Appricati"r,SO /Jd (
Receipt #ZI
Total Amount Collected,SS
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te
FOR OFFICE USE
JOB #:?t-t l8q q
Issued By
-yxacAa/a
Checked for Delinqueneies:
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Checked for Historieal Status:
Permit #:
Address: ??s s'3tr/1 =sr
Issued
Statement: lnformation Notice to property owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appti-
cants who are not registered with the Construction Contractors Board to sign the
following statement before abuilding 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 ftled with the permit.
Fill in the appropriate blanks and initial boxes I and}, and either box 3A or 38:
tr 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
R 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 notiry the office issuing this huilding permit of the
name of the contractor.
I hereby certify thatthe above informationis correct and thatl have read and do understand thelnformation
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
,,'/* Sc-Vg-
(Signature of permit applicant)
(White copy to issuing agency permitfile,
pink copy to applicant)
(Date)
4 ruru out"//-so-??
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