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HomeMy WebLinkAboutPermit Fence 1990-5-30 .....- .., . . SPRINGFIELD - 1 l~ ", @Jfi1J@I?~~ FENCE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: ~2..~-~2 1 ,.. v Assessors Map II: /1 D 3 2. 7 L/ 2- Owner: Wa./\-vw 13~' Address: ::g 7 to 3 & ~ .A/f; City: p~ State: V Value of Fence: X ()f). 019 Tax Lot II: (J 3100 z.. Phone II:J ~CJOq-c;J (f)~ Zip: 9710,'/ Fence Permit is $5.00 , \ Contractor/Installer: ~t(J'A.l./\.- j{)~ R~.J!nY . . -L . ~ Yo/a 5/2-1 Address: S 710 3 . t? ~ ~ Phone 11:-f.QX':-r)(!~9c, City: ~~~, _state:-&!VJE....(7'1N Zip: q1~tJ~ Construction Contractors Registration II: c1 Expires: " 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. !AJ IlN\W . ~ Signature / ~. Z.CX/CZO Uate I I FOR OFFICE USE Date of Application: '5 - 30 - '1D Receipt 11:_1'7 j q 2- , Issued By: Job II: G:.M.!''\..P....-- Q()7Jlo 7;:::; Checked for Delinquencies: C;.6D / Checked for Historical Status: /' Total Amount Collected: C-,. ...... . . Permit No: CfObCo75 Address: 020 52";f.II<dl-KI.'J,uIL.. ,/ Issued by: (j JuAL- Date: f?'~, 'In 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. ~ I own, reside in, or will reside in the completed structure. 2. A. L-.J 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. 4-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 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 Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. <\;. J2) --gjJ2/ -Signature oUmit Jq:lplicant ~ /3:J / 10 Da\e I CONSTRUCTION CONTRACTORS BOARD 0244J 10/24189 WHfFE COPY TO ISSUING AGENCY PERMIT FILE PIlIIK-COPV TO APPLICANT <!l.