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HomeMy WebLinkAboutPermit Fence 1995-03-07SPFIINGFIELO % FENCE PERUIT APPLICATION CITY OF SPRINGFIBLD BUILDING SAFBTY DIVISION 225 North fifth Street Springfield, 0regon 97477 0ffice: INSPECTION LINE: 726-3759 726-3769 Job Location:n +h Assessors Map #:1103 '7G r l ovner, $\Au\A GtusqsLo Tax Lot *:-\(1 Address t )O \t n &5"1l: Value of Fence:/aoo."" Con t ractor/Ins talIer : Phone +: 5o3 Statet OK -zip : Qr\ll Fence Permit is $5.00 Dnu\ \ [\r..,1rr>co Cl ty:,YLrri tu\ t' Address:(-tnn> - >€- Diar,.,.--- Phone *: Ci ty: ' State: Construction Contractors Registration #: zip: Expires: By signing this permit/application, I agree to caII for an inspection once my fence has been constructed (726-3769). I also stated that all information on this application/permit is correct and that I vas provided vith the Springfield lopment eode requirements for fence standards. 3--7 l1 ture Date FOR OFFICE USE Date of Applicati on, '!r:J -t <JoB *: 9:rc >74 Issued By:[V-ar-l e J-.Receipt * Total Amo 2 unt Collect 5- Cheched for Delinqueneies: 6r) Checked for Historical Statns: rl-D o . {Y\LWt}c Date: 3ari{ Permit #:5tl-(\ t/ fr Statement: lnformation Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not regtstered 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 archttect 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 L andZ, and either box 3,A, or 3B 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. tr 3B. I will be my own general contractor I hereby certify thatthe above information is correct and thatl have read anddounderstand the Information about Construction Responsibilities on the reverse side of this form. 1- 1{ (White copy to issuing agency perrnitfile, pink copy to applicant) OR Notice (Date) 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.