HomeMy WebLinkAboutPermit Fence 1991-4-29
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SPRINGFIELD
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street Office: 726-3759
Springfield, Oregon 97477 INSPECTION LINE: 726-3769
Job Location: \ Q \ ~ \ \.. N"C\~~ f\ St\ 001:--> *
Assessors Map II: \ f} ()'d 8~~4- Tax Lot II: (y)~
Owner:_ ...~\ It ~O n t\n\ i () f\O
Address: \ 0\ ~ \ \'0[\ ~ \\ ~ J Phone II: 19 to -()r4()
City: ~n. State: (\)i\OOm ZiP:QJ41B
Value of Fen~e:~t~c::()~ Fence permi~ is $5.00
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Contractor/Installer: (\ffi. t\\_~}\.L5f\)
Address: ~?-9\~ffi9-J - Phone II: ~ -L\-\2f)
City: &x\9.X\L State: (\IDQ09l\ Zip: C\1MJ2--
Construction co~ractors Registration II: \ o()()?~4 Expires: o).Btf1.1
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 application/permit is correct and that I was provided with the Springfield
Development Code requirements for fence standards.
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- FOR OFFICE USE
O,t, of A"""ti'"' 4-, :;Ie! ,q I ,J Job "_ ~ \~ \ ::)
Receipt II: \ qg-<2f1 Issued By:C/)li) 6. )
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Total Amount Collected:
Checked for Delinquencies:
'L-----"' Checked for Historical Status:
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Permit No: ,q \ m\ 0 '
Address: l Q \ ~ \ mn. Uf\J
. Issued by:Hln(J~ Dat::4,21Q/
FOR 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 statement will be filed with the permit
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
1,~
2,A,~
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I own, reside in, or will reside in the complet~d structyre~
My general contractor is (\ V'\() ffi Dlo1\ "--\if\('Q
Contractor registration number L~ .
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
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OR
B, L-J 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 ao hire a general
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 Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
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Signature of Permit Applicant
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Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1190
)( ~E COPY TO ISSUING AGENCYPER~IT 'FILE
\JlflIR COPY TO APPLICANT
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