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HomeMy WebLinkAboutPermit Fence 1990-08-01SPRINGFiELD FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97 477 Offi ce : INSPECTION LINE: 7 26-37 59 7 26-37 69 Job Location: llTq /q 7 # Assessors Map #: owner, fulr ) Tax Lot ll:/=o o() !-"u 5I /'t Address , I (7t<Phone l/:33 City:n'State e Zi Vatue of Fence, €ZCZ. dZ)Fence Permit is $5.00 Contractor/Installer 0Uln ef Address:Phone //: City:State:Zi p: Construction Contractors Reg'istration #:Ex pires: By s'igning. this permit/appliSq!i9!r l agree-to call for an inspection once myfence has been constructed (726-3769). -I also state that all 'information on"th'is_application/perm'it js correct and that I was provided with the Springfield Development Code requirements for fence standards. -i-?D gna ure a FOR OFFICE USE Date of Appf ication:?wzz Recei pt l/:Issued By: Total Amount Collected: Checked for Del inquenci es: ,,,/Checked for H'istorical Status / Job ll: Permit No: Address: Issued "/() t./t l/\4 7h Date: Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. Licensed Architect and Englneer applicants, exempt from registration under ORS 701.010(7), need not subhit this btatement. This statement will be filed with the permit. Fill in the applicable blanks, and initial box 1 and either box 2A or 28: STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES I own, reside in, or will reside in the completed structure My general contractor is Contractor registration number reverse side of this form. 1 2. A. OR I will instruct my general contractor that all subcontractors who work on the structure must-be registered with the Construction Contractors Board. B I will be my own general contractor. lf I hire subcontractors, I rryill hire-only subcontractors registered with the s$,"*,"Jrg?r$".1?l:,'l,iifl.xlg[i,r"i:#"lH[!u"ls'?&xi:"q!qil]iflffi"iiilti'ibn b6;i;;tb;;' Bod;a a;d i' wi I i immed iatelv-notifv the off ice i-slriing ihis OuilOing permit of the name of the contractor. I hereby certify that the above inlormation is correct and that I have read and understand the lnformation Notice to property o*nerr about Construction Responsibilities on the /t//- 7c re App cant CONSTRUCTION CONTRACTORS BOARD 0244J 10124199 Date WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT @s I tl