The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 1999-1-8 ( ) i . . WOOD STOVElINSERT INSPECTION APPLICATION CITY OF SPRINGFIELD COMMUNITY SERVICES DIVISION - BUILDING SAFETY 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: 5597C4cra O~ I <6t Z. ~'t {/ tlkh 6eA/~1t. Address: S-S'Cj 7 0=;( c( ~7I- City: 5f'~ f'r...r/ State: {?/t. Value O~OOd Sto~ellet Stove!Insert: .:Pj~ _ ~ Tax Lotti: ~3(/OO Assessors Map #: Owner: Ott. Phone#: 7 Lc' - 'I? 1 '1 Zip: '1 rlf 7 f (please circle appropriate appliance) Type of!nspection Requested: Preliminary Inspection is $15.00 (prior to installation of insert) Wood StovelPellet/Insert Pennit is $ 15.00 + $ .75 state surcharge + $.45 Administrative Fee + ~lgc090u to Issuance. .'-<11 k:J-.j", :OI'l:ore90nbla~~ecir~9~n Utility follOW rules adopted Yules are set forth "'. .;/.'~ Center. Those r R 952..()01- ,wu,,~'" 1 0010throughOA in OAR 952..()O - . copies of the rules by 'N' Y:w-m'\v obtam . ,-,-~hone \JoJOV' {NOle: \ltg~' . calling the center. uiiliIY Notification "_~Oregon, _'1') IIUlln:""" '. 1 80U.;j;.1~--2v~' - Center IS . Zip: OW //EIt- Contractor: Address: NOTICJ~: PR"U1T cw all ~YPIR~ IF. TH.E WORK I' THIS Gonstrucllon'E:orttractors Reglstral1on~: AUTHORIZED UNDER THIS PERMIT IS NO By ~igl!ipg.this pennitll!!1p'l.!.'CltiO!1?I agree to call for an inspection(s) as required (726-3769). I state that COMM~IiI'm"foh\i.rtih'i\ 'JJi'ffiis"applicationlpennit is correct and that I was provided with the Wood Stove Safety M.iY 1 finf6iriiaiioD1fOl-"wood burning appliances and preliminary inspection standards. I further state that the appliance'i am installing meets smoke emission standards as set by the Oregon Department of Environmental Quality or the Federal Environmental '.v:...:on Agency and I agree to provide the testing approval 'W"'ber to the inspector at the time of inspection. I also understand that if! am requesting a pr~; ~ofrfl6~aY be required to be removed. 1/9 jff J.r:::::el Date FOR OFFICE USE State: Expires: REQUIRED INSPECTION(S): WOODSTOVElPELLETIINSERT IIi /r1 Total Amount Collected: J..&,. -# Receipt #: 0'32. S-O r Date of Application: Job #: PRELIMINARY c(9tJOZS- J Issued By: # tJ, Checked for Delinquencies: Checked for Historical Status: .~ . . Issued by: r9tJ~J.~ ~S7 7 Gkl'i7l. vfJtJJ Date: 1/~/r'J Permit #: Address: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement 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 appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: r[frl. 11~2. D 3A. My general contractor is I own, reside in, or will reside in the completed structure. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR /~!r 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If! change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and 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 do understand the Information Notice to PMJr~ abou onstruction Responsibilities on the reverse Si~~o~h:~~m. ~ (Signatbre of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) /J -~V-,.I ,-- _,-_.__~._, . ~ . __-.-v- -....".._.--,.......,.--~ " \ .S" ... (II Information 'Notice to PropE;lrty Owners About Construction Responsibilities ".... ~. . . . , Note: This Information Notice to Property Owners about COllstructioll Responsibilities was developed by the COllStnu:tion COll/ractors Board in accordance with ORS 701.055(5). If you are acting lIS your own contractor to eonstruct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insuranee purposes on the wages of all employees. For more infonnation, call the Oregon Employment Department at 378-3524. Worker's compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obt.1in workers' compensation insurance for your employees. If you fail to obtain workers' eompensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured ou the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. u.s. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, eall the Internal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contaet your insuranee agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punetures. fire. or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise our employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309-5052, 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem prop-own.pm4 1/94 ~ $P-OO,