Loading...
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