HomeMy WebLinkAboutPermit Fence 1991-04-24FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
suiuotNs sAFETY DIVISIoN
SPEIilGFIELO
Off i ce:
INSPECTION LINE:
726-3759
7 26-37 69225 Fifth Street
iptihgii.'ld, 0regon 97 477
CITY OF
t-| f, t /\,Job Locat'ion :
Tax Lot #:C\:ir (
Assessors MaP #:\'l ('\ '-V
(LOwner:
Address:
City:
.'\r O n
Phone #:
Fence Perm'it is $5.00
-t 1 / -1 (
7Yt
/Lt t ui7-tr
Li p/f\\State:Lt \
Value of Fence:1,-., no'\ / )( --.)\
Contractor/ I ns tal I er :C I . 11,4€ ;'--
Phone #:Addres s :
City:State:
Construct'ion Contractors Registrat'ion #:
By s'ign'ing this permit/appliqq!i9!r l agree-
flnce-has-been constructed (7?6-3769). I al
this appf icat'ion/perm'it is correct and that
Development Code requ'irements for fence stan
Li p:
Ex pires:
to cal I for an i
so state that alI was provided w
dards.
ection once my
nformation on
the Springfield
nspti
ith
4tot)q't
Slgnature De[e
FOR OFFICE USE
Date of App'l i cat i on :Job #:
Issued By:A/vL-
L
Receipt #:[?Yb3
Total Amount Col 'lected :5.DD
Checked for Del inquenci esz ,r'Checked for Historica'l Status: w-'-
.l
(
r.)\r
/(
,l u 1/vtl/t-Permit No:
Address:
lssued
d?,n /i{ '2il-1\
,t ('i l*n-q**-/L 2,4Date:
OFFICE USE ONLY
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 staternent will be filed with the permit.
Fill in the applicable blanks, ald initial box 1 and either box 2A or 28;
1 I own, reside in, or will reside in the completed structure
ure m t Applicant
I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors reoistered with theConstruction Contractors Board. lf I chanoe my mind and Eo hire a oeneralcontractor, lwill contract with a contrattor-who is reoistered with theConstructibn Contractors Board and I will immediately-notifv the officeissuing this building permit of the name of the contraitor. -
2. A.
-
My general contractor is
Contractor registration number
! will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B.
I hereby certify that the above information is correct and that I have read and understand
the lnformation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
--
sig
CONSTRUCTION CONTRACTORS BOARD
0244J 1t90
)Atfrtr @py To rssutNc AGENcy PERMIT F|LE' PNKEOPY TO APPLTCANT
@s
*--"a /t,/ /q t
Datd