HomeMy WebLinkAboutPermit Fence 1990-7-19 (2)
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. SPRINI~LD
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Assessors Map #:
Owner:. (Vi Gh
Job Location: lo7Cf7 E G+
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Address: -(0795 c= LA
Ci ty : 3fJ-;c, I/l j R p/r)
Val ue of Fence: 1t 50ZJ . DD
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Tax Lot #: \ \ fl CY')
dot: '1 qJ ~s. l\JU..o.... -
State:
Phone II: 72-b ~ 8t..J7o
(j II Zip: q 7t.J72'
Fence Permit is $5.00
Contractor/Installer: f)l/UY\~yr
Address :'
Phone II:
City:
, .
State:
Zip:
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Construction Contractors Registration II:
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Expires:
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By signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also state that all information on
this appl' tion/permit is correct and that I was provided with the Springfield
Developm n Code requirements for fence standards.
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Signature
Date
FOR OFFICE USE
Date of Appl i cation: '7 - /'? -16
Receipt II:. /7751. Issued
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Total Amount Collected:~c.)_D()
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Job #: 000CJDfo
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By: () A/V./'-JL
Checked for Delinquencies:
Checked for Historical Status:
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Issued by:
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TP AA./~ Date:
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. Permit No:
Address:
STATEMENT:
...INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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. Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants
who are not registered with the Construction Contractors B()ard 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 statement will be filed with the permit.
Fill in the applicable blanks, and initial box 1 and either box 2A or2B:
1.1 )(
2. A. I
I own, reside in, or will reside in the completed structure.
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 'Y-' I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and 00 hire a Qeneral
contractor, I will contract with a contractor who is registered with the
Construction Contractors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Informati Notice to Property Owners about Construction Responsibilities on the
reverse Sid~:1Y~7~ 4Adi r;~/9- to
Sigri~re-of Permit Applicant Date
CONSTRUCTION CONTRACTORS BOARD .
0244J 10/24/89 .. .
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
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