HomeMy WebLinkAboutPermit Fence 1990-4-18
,.
.
(:)
SPRINGFIELD
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELO
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
,~o~ ~C() HiS (1 UrL , lIP) -
Assessors Map II: I 'lfJ3 ~f} l~ _
Owner~' J\\ \')'f\Q, "'\' (1" QJ1 Q~j)() RJf\ Q ru JUu
Address: R[')~ {)(\f1U ~ ~ t ILJ\ 'CJ\ Phone II:
City:",~), 0 r\J. . State: (() R )
) ~ 40
Value of Fence: j'7aO,
Job Location:
Tax Lot II:
fl4/) - 2 f6Lo
Zip: q rci.2'7
Fence Permit is $5.00
,
Contractor/Installer: <:".)!{ (\Jl5:)/
Address: \ QCJ(j .h\ 0 DO'\. ffiC\A\\~ \\\\~II:
City\ V\ 1) (\ rl. Q VI (}Il ) State: ~ A
n\n~\
Construction Contractors Registration II:
ziP:ql \[Yl
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.
'1] I 07la....,~~W?P'6u
Signature
i!/&/9{}
. FOR OFF ICE USE
. Date of App 1 i cat i on: 4- \ <is .q()
Receipt 1I:J.1iJ?r(J Issued By:
,\ .~_.c:D
Total Amount Collected: ,_)
V
I ;ifb ~Rq \~ \ \_0
Y7)/JY)) .
, -
Checked for Delinquencies:
Checked for Historical Status:
v
.' \
\
.
-
Permit No: Rq I?J \ t 0
Address: ?Jf')Q _ '-~ Nit ~ ~~ '\
Issued by:(3([)(l ) Date: ~0
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
. I." .
Note: Oregon Law, ORS 701.055(4), requires residential buili::ling 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 Engineevapplicants, exempt from registration under ORS 701.010(7), need
not submit ,this statement. This statement will be filed with the permit.
. / II (I, .'
L '
/
Fill in the applicable blanks, and initial box 1 and either box 2A or 2B:
/
1. Ll,LJ
,
lawn, reside in, or will reside in the completed structure.
_ 1\ 0 ~ 1I--S-
2. A. L..JLJ
My general contractor is
-
Contractor registration 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.
OR
B.~
,- (1 ~
.~ /
J will_be my own gef'leral contractor.
" -~7 ~ 7" / r /',
_ - :..'\. t-" ( ~ "f-/ j , ,
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and Clo 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.
"1./ (. / 7::
'\'.
'-
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.
L17l/?//? ~;)"'?1l"'~{~)
'Signature of Permit-Apphcaii ,- -
. -<l 0t. /9/')
D"i' / I .'
CONSTRUCTION CONTRACTORS BOARD
0244J 10/24/89
, D~ COPY TO IsiUING AGENCY PERMIT FILE
'-'"'\ ~Py TO APPLICANT
L0 ~.