HomeMy WebLinkAboutPermit Fence 1991-8-15 (2)
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FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth St'reet
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: KQ lo y., \:)C\ l-~ J:'l~ 0\}\ Q 0 b
Owner: . \(\~ \C'\ \. ~, '
Address:' -~Q. \ n ~ r~ '. .- f)l ~hone #: \4 ( ~ ,~~
City:-....,1"" _ fA -' State: H r~ZiP: err\- (
Value of Fence: l~~~ Fence permitOis $5.00
Contractor/Installer: '1,Q()j,\ ~
Addressil~OD l~Q,YYn.. ) ~ }&.\)~~:
Cit~~ m_rL2X\,o ) State: (\f\
Construction Contractors Registration #: 0 \ D~\
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EXPires:.B,3\ ,-q~ ,
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 requiremen~s for fence standards.
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. FOR OFFICE USE
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Receipt #: (91 () <) I sse} : ,!.IJ n ~ )
Total Amount Col1~cted: ~.C) ,
I~ 'Checked for Historical Status:
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Checked for Delinquencies:
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Address:
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Permit No':
o.lssued by:.
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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 staternent. This statementwill be filed with the permit.
Fill in the applicable blanks, 'and initial box 1 and either box:2Aor 2B:
, 2. A\l\ I, My general contractor is . t\" 1)0_ f) _)J ~
, '. Contractor reg,istration number " 0 \ C\.~\ .:,
, 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. I I wi II 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 co 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 fOhn.
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ignature of Per-m1fApplicanl
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Date I
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ONSTRUCTION CONTRACTORS SOARD,
0244J 10/24189 .' , ,~:" ,.; .
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E COPY TO ISSUING AGENCY PERMIT FILE
COPY TO APPLICANT
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