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HomeMy WebLinkAboutPermit Mechanical 1992-10-07SPRIrl.GFIELE, 0f,f ice r INSPECTION LINE: QfrUOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Job Location: Assessors H"p *t 0vner: Address: Ci ty:State! ?26-3759 726-3769 Tax Lot *: Phone *: .zip: Preliminary Ins pection is 915.00 (prior to installation of inser t )Vood Stove/ Type of Ins Con t rac tor : Pe1let/Insert per is 515.00 +s10.00 Value of (pl ,t--'::tove/Pelle0 Strcle\ffiriaease ci u1 to ere e+state surcharge. pection Requeste Address Phone *: Ci ty:State:Zipz Construction Contractors Registration #:Expires: inspee t By signing this permi t/application , I agree to caII for an ion(s) as required(726-3769). r s tate that all inf ormation on this applicat ion/pe rmit is correct andthat f vas provi ded vith the Vood Stove Safety inf ormation for vood burn ingappliances and p reliminary inspect ion standards.f further state that t he applianceIam installing meets smoke emission st andards as set by the oregon De partment ofEnvi ronmen taI Quality or the Federal En vi ronmental Protection Agency and I agree toprovide the t esting approval number t o the inspect or at the time of i nspection. Ialso underst and that if f am r equesting a prelimi nary inspection, the vall covering te $tds,1q +t3X may ed.b C-,-7-7 LtuDate POR OFFICE USE REQUIRED INSPECTION( S) : Date of Application: Total Amount Co lected: Receipt #: PRELTMINARY Job #: t ,-rd'r c,ry OF SPR OREG ON fnsert 3 \ 'ELLET/ Checked for Delinquencies: I ed Ch'ecked for Historical Status: Permit No: Address Date: R OFFICE USE ON 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 1 2 3.A plicable blanks, and initial boxes 1 and 2, and either box 3A or 38 I own, reside in, or will reside in the completed structure. I understand that I must reg ister as a construction contractor if the structure is sold or offered for sale before or upon com letion My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work ture must be registered with the Construction Contractors Board. +u5C ni fiMlqI- gv OR the WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 3.8 I will be my own general contractor. lf I hire subcontractors, I will hire only subcontractors registered with the Construc- tion Contractors Board. lf 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 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 form. /0 -- - 7L- gn re Perm pp Date CONSTRUCTION CONTRACTORS BOARD 0244J 8t91 t t lssued INFO*ffiATION NOTICE TO PROPERTY CMNERS ABOUT CONSTRUCTION RESPONSIBII.ITIES NOTE: This lniormation Notice to Property Owners About Construction Responsibilities _was developed by the Construction Contractors Board in accordance with ORS 70{-055(5}, 'passed by the 1989 Oregon Legislature. :' lf you are acting as your own contractor to construct a new home or make a substantial improrement to an existing structure, you can prevent many problems by being aware of the following responsibilitfes and areas of concern. EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the conslruction 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: 9regon's Withholding Tax Law: As an employer, you must withhold income taxes from emptoyee 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 Department o{ Flevenue at 378-33g0. Unemployrnent lnsurance Tax: As an em ployer, you are required to pay a tax for unemployment insurance For more information, call the Oregon Employment Division DHRpurposes on the wages of all employees. at 378-3224. Workers'Com nsation lnsurance As an employer, you are subject to the Oregon Workers' Compensation Law, and must workers'compensation insurance for your employees. lf you fail.to obtain workers' compensation insurance,yo u may bb su bject to pen information, alties and will be liable for all claim costs lf one of your employees is injured on the job. For more callthe Workers' Compensation Division DIF at 373-7434. U.S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages. ymentevenifyoudidn,tactuallywithholdthetox.Formoreinformation,iall the lnternal Revenue Service at 221-3960. OTHER BESPONSIBILITIES AND AREAS OF CONCEHN 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 lnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure you have sufficient time to supervise your 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 buildinE officials at the appropriate times so they can perform the required inspections. lf you have additional questions, write to Construction Contractors Board 700 Summer St. NE, Suite 300 Salem, OR 97310-0151 Phone 503-378-4621 a24U 10t24t89