HomeMy WebLinkAboutPermit Fence 1991-06-13/>
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C'TY OF SPR OREGO'U
225 Fifth StreetSpringfield, 0regon 97 477
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
SPFIiIGFIELO
Off i ce:
INSPECTION LINE:
726-3759
7 26-37 69
Job Location: , aa A)a*w
Assessors Map #:l-l n f,z10(1
0wner:
Addres s :
Tax Lot #:oL 9u
fr,l.J
C'ity:
Val ue of Fence , )bo"
Contractor/ i ns tal I er :
Address:
City:State:
Construction Contractors Registration #:
Phone #: -7 Ll) -q{<a
L'l p z Q19-7Q
Fence Permit is $5.00
State OQ
Phone #:
Zj p:
Ex pires:
By s'igning this permit/appl icat'ion, I agree to cal I for anfence has been constructed (726-3769). -I also state that a
!his_applicat'ion/permit is correct and that I was provided
Development Code requirements for fence standards.
inspect'ion once myll information on
with the Springfield
/'n- zt
gna ure a e
FOR OFFICE USE
0ate of Appl icat'ion:b Job #, 4 ln IS
Receipt #: .xA3€4 Issued By:cg
Total Amount Collected:
Checked for Del inquencies
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Checked for Historical Status: ,/
^ fwr o.h ,th,
/ t<-lfil\)Permit No
Address:-ll5 A) 3 8e-
lssued wl'_:Date:
OFFICE USE ON
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, qnd initial box 1 and either box 2A or 28;
1 I own, reside in, or will reside in the completed structure.
2. A. l-l 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
6 e
I hereby certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Gonstruction Responsibilities on the
reverse side of this form.
I will be my own general contractor.
!f I hire subcontractors, I will hire only subcontractors reoistered with the
Construction Contractors Board. lf I chanoe my mind and -do hire a oeneralcontractor, I will contract with a contrattor'who is reoistered wlth theConstructibn Gontractors Board and I will immediately-notify the office
issuing this building permit of the name of the contraitor.
,-./ -A-
B
S ig natu re ofFeiffiAFFncant
CONSTRUCTION CONTRAGTORS BOARD
0244J'.U90
6- rt- y7
Date
-\/H,'-r l(-
" \A#FTITE COPY TO ISSUING AGENCY PERMIT FILE
i,I..,'.r. Lj'PINK COPY TO APPLICANT
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