HomeMy WebLinkAboutPermit Fence 1995-03-07SPFIINGFIELO
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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.