HomeMy WebLinkAboutPermit Fence 1990-03-09CITY OF SPR,,VGFIELD, OREGO'V
SPFTI'YGFIELD
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth StreetSpringfield, 0regon 97 477
Off i ce:
INSPECTION LINE:
7 26-37 59
7 26-37 69
Job Locat j on : 2ZD5 ?Lvto\ 3l
Assessors Map #:
owner, Ar.t,t^
Tax Lot #:
Ltor^,^"J
Address Lzo5 N 37-nA S-Phone *: 1Zb -7 Z5
City:
Val ue of Fence , # L6q/
State:6L Zi pz 7t 411
Contractor/Ins ller:
Address:
City:State:
Construction Cont ctors Reg'istration #:
g a ure
FOR OFFICE USE
Fence Permit is $5.00
Phone #:
Zi p:
Ex pires:t1
Date
(
By s'ign'ing. this permit/appligq!i9!r I agree to call for an 'inspection once myfence has been constructed (726-3769). -I also state that all information-on'thts_application/permit js correct and that I was prov'ided w'ith the SpringfieldDevelopment Code requirements for fence standards.
s-7-70
Date of Appl ation:1
Receipt #:
Total Amount Collected:
Issu ed Bv
o"
Checked for Del 'inquenci es:
o
Checked for Historical Status
,lcio *:
C-
Permit No:
Address:
lssued by
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITTES
Note: Oregon Law, ORS.701.055(4), requires residential building permit applicantsyLo ale not registered with the Construction Contractors-Board to'Jgn thefollowing statement before the building permit can be issued. Licensed Architectand Engingel.aooticants, exempt from iegistration under ons%r.oidd), neeonot submit this statement. This statement will be filed with tne permiil
Fill in the applicable blanks , and initial box 1 and either box 2A or 2B;
1 I own, reside in, or will reside in the completed structure.
2. A.My general contractor is
Contractor registration nu
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
mber
! 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 lorm.
-7- o -? D
Date
CONSTRUCTION @NTRACTORS BOARD
02e) fitz4t89
I will be my own general contractor.
lf I hire subcontractors, ! will hire only subcontractors reoistered with theConstruction Contractors Board. lf I chanoe my mind and Eo nire-a oeneratcontractor, I will contract with a contrattor'who is reoistered witn theConstruction Contractors Board and I will immediatelv-notifv the officeissuing this building permit of the name of the contraitor. '
B.
IAIIfl+E @PY TO ISSUING AGENCY PERMIT FILE
ffi ro APPLTcANT
@s
iL.L/\/<-4,p a
L
u
Signature of Permit Applicant