HomeMy WebLinkAboutPermit Fence 1990-08-31FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILt)ING SAFETY DIVISION
SPRt}EFtELD
Off i ce:
INSPECTION LINE:
225 Fifth Street
Springf ie'ld, 0regon 97477
7 26-37 59
726-3769
CITY OF OBEGO'U
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Job Locat'i on :
As ses sors #
Address:
C'ity :
Val ue of Fence
Contractor/ I ns tal I er:
Address:
City:State:
Construction Contractors Registration #:
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FOR OFFICE USE
Tax Lot #:_otftc
Phone #, 7{7 -//A Y
7.i p 7' ''. ,^
Fence Permit is $5.00
State , i L
Phone #:
Z1 p:
Ex pires:
By signing this permit/appligqli9!r l agree to call for an'inspection once myfence has been constructed (726-3769). -I also state that all ini;rmition-on'this-application/permit is correct ana tnat I was provided with the SpringfieldDevelopment Code requirements for fence standards.
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Date of Application:
Receipt #:
Total Amount Collected:
Job #, 7 o/b8(
Issued By
Checked for Delinquencies:
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Checked for Historical Status:
0wner:
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Permit No:
Address:-2 </r "/?.r'r"a
lssued Date:
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSTB!LITIES
Note: Oregon Law, ORS 701.055(4), requires residential building permit applicantsyl.o ale not registered with the Construction Contractors Bbard to sign thefollowing statement before the building permit can be issued. Licensed Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), neednot submit this statement. This statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or 28
1 I own, reside in, or will reside in the completed structure
2. A. l--_l My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B 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 "do hire a odneialcontractor, lvyill contract with a contrattor-who is reoistered wjth the
9onstruction Contractors Board and I will immediately-notify the officeissuing this building permit of the name of the contraitor.
I hereby certily that the above information is correct and that I have read and understand
the lnlormation Notice to Property Owners about Construction Responsibilities on the
reverse side ol this form.
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Signatuie of Permlt Applicant
CONSTRUCTION @NTRACTORS BOARD
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Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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