HomeMy WebLinkAboutPermit Fence 1982-3-31
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
Job Location: ~lZD fl S~
Assessors Map #: '0 ICJ'))"lJ~ \ ~
owner:\2-uY\ C,VZ< ~-Cl'
Address: \'2.&-2), Q,' '-S.:.-r
City: ~~~~I rd State:
Value of Fence: ~'Lf02), c)t9
Tax Lot #:~3\W
Phone #: -7 4-1 -XZ+ Lf 9
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Zip: q7tf//
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Fence Permit is $5.00
Contractor/Installer: lYu )\/\ 0/(
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 stated 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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Signa ture I
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Date '
FOR OFFICE USE
Date of APplication:,,\
Receipt # l{ (\0 ~
Total Amount Collected:
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Issued By:
JOB :it: -1llLle...=l
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Checked for Delinquencies: ~~,,'-'"
Checked for Historical Status: ,....--"'-'"
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Permit No:
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Address:
Issued by: /1 ,~\_A.i'...IL__
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Date:
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FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits. 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 boxes 1 and 2, and either box 3A or 3B:
'-,
1 . 1'--.
I own, reside in, or will reside in the completed structure,
2.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3. A,I
I My general contractor is
Co"ntractor registration number
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
OR
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3. B. r ''\-, I I will be my own general contractor,
I
If I hire subcontractors, I will hire only subcontractors registered with the Construe-
tionContractors Board. If I change my mind and do 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 is~uing 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 Applicary
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,3 - 3/- q2-
Date
CONSTRUCTION CONTRACTORS BOARD
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT