HomeMy WebLinkAboutPermit Fence 1991-4-15 (2)
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SPtlOFIELD
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
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Assessors Map #: \f)D030\ 4- Tax Lot #: ()U1 ~
owner:~. ~
Address: \ \nn~\G.J~i\~Phone #:
City: ~~ State: ~
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Val ue of Fence: c:0\ rf'iJ 00 Fence Pennit is $5.00
Contractor/Installer: ~~
Job Location:
Zip: q11-?1
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration #:
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 infonnation on
this applicationlpermit is correct and that I was provided with the Springfield
Development Code requirements for fence standards.
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FOR OFFICE USE
Date of Application: 4 . \~.G\1"
Receipt #: I Q'7SJ
Issued By:
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Job #: q IO~~-=<)
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Total Amount Collected:
Checked for Delinquencies:
Checked for Historical Status:
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Permit No: C\ \ Cl:::>J:)~ _ ^ J\
Address: i\ \ r/2~ U\ QJ))-9![~'/
Issued b(7)J[)t\ ) Date:1f--bti (
FOR OFFICE USE ONLY
STATEMENT:
.. INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NDte: 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.~
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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
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B.~
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 abDve information is correct and that I hBve read and understand
the InformBtion Notice to Property Owners about ConstructiDn Responsibilities on the
reverse side of this form.
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Signature of Permit Applicant I
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Date
CONSTRUCTION CONTRACTORS BOARD
0244J 1/90
&Eh1 ~ COPY TO ISSUING AGENCY PERMIT FILE
r =~Py TO APPLICANT
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