HomeMy WebLinkAboutPermit Mechanical 1993-09-22crrY oT OREGO'V
WOOD STOVE/INSERT INSPECTION APPLICATTONCITY OF SPRINGFIELD
BUILDTNG SAFETY DIVISION
225 Fifth StreetSpringfield, Oregon 97417
Job Location:
Assessors H"p *t /t oe )r
0vner:
Address t 4 I
Ci ty:
Tax Lot #: C oSalt
S--.IHGFtELD
0ffice:
INSPECTTON LINE:
726-3759
726-3769
Value of llood Stove
(please clrcle
State: OQ
/rnsert, 3 )
approp ate appli ance
OC
Phone #: -l ')L-lY')1
zip:Ql ct 7-)
state surcharge.
Preriminary rnspection is $15.00 (prior to instalration of insert)wood stove/perret/rnsert permit is'$15.00-+-$ioloo rssuance + $.15
Type of Inspection Requested:
IIet St
Con t rac tor:
Address:Phone #:
Ci ty:
-
state:zi p:
Construction Contractors Registration *:Expires:
By signing this permit/application, I agree to call for an inspection (s) as required(726-3769). r s tate that all informat lon on this application/permi t is correct andthat I vas provi ded vith the llood Stove Safe ty infornation for vood burn ingappliances and preliminary inspection standa rds. f further state that t he appliancef am installing meets smoke emission stand ards as set by the Oregon Department ofEnvironmentalQuality or the Federal Envi ronmental Protection Agency and I agree toprovide the te sting approval number to t he inspector at the ti me of inspection. falso underst and that if I am requesting a preliminary inspecti orrr the vaII coveringbe required to removed
q
gnature Date
FOR OFFTCE USE
REQUIRED INSPECTION(S): yo0DST0vE INSERT PRELTMINARY
Date of Application: t)Job*, a3lr.-l 1n
Total Amount CoIIected: 9
Receipt $:rD Issued By:B
J
Checked for Delinquencies 2 )..-Checked for Historical Status, u
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Qn l, t,S-r*vq-
Permit No:Q'z)L-tsb
Address:t-ttt 0*u- SL
rssued oy, Dt 1^t", ?/-/r\
1
2
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 applicable blanks, and initial boxes 1 and 2, and either box 3A or 38:
I own, reside in, or will reside in the completed structure.
! understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
A My general contractor is ,
Contractor reqistration number-.
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3.8 I will be my own general contractor.
lf I hire subcontractors, lwill 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.
! hereby certify that the above information is correct and that ! have read and understand
the lnlormation Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
q tL13
nat of rmit cant Dtte
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
3
OR
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
INFORTIATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
lf you are acting as your own contractor to construct a new home or make a substantial improroment to an
existing structure, you can prevent many problems by being aware ol the following responsibilities and areas
of concern.
ETIPLOYER RESPONSIBILITIES:
lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the construction or improvementof a residential'structure, y.ou will, in most instances,'bE ruled to be an
"employer" and tne peopie you hire will be "employees" As the'employpr, yo,, 5nrit comply wlth tne following:
- e,
Oregon's Withholding Tdx Law: As an employer, you must withhold income taxps f"rom employee wages at
the time employees are paid. You willbe liable for the tax paymen$i .even if you donlt actually withhold the
tax from your employees. For more information, call the Oregon Departryent of FeyeRue at 378-3390.
: i.- , _,:,.tfil
Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance
r,nployees'Formoreinformation,calltheoIegonEmploymentDivisionDHR
at 578-3224
i.- "J ii. | ';,
Workers' Compensation lnsurance: As an €mployer;'you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers'
compensation insurance, you may be subject to penalties and'will tle liable for all cfaim costs if one of your
employees is injured on the job. For more information, callthe Workers' Compensation Division DIF at 373-7434.
U.S. lnternal Revenue Se.rvice: As. an employer, you must withhold federal income tax from employees' wages.
ment.eVenify9!didn'tactual1ywithholdthetax'.Fbrmoreinformation,call
the lnternal Revenue Service at 221-3960.
OTHEH RESPONSIBILITIES AND AREAS OF CONQERN: -, , j :
Code Conpliance: As the pernait, holder for this projeot,, you'are responsiicle for-.resolving any failure to meet
code requirelnents that mqy be,brought to your:attentbh through'lnepections.
- : , ', 1,,
Liability hndProperty Damage lhsurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidents and omissions such as falling tools, paint overspray,,Waterdamage from pipe punc-
tures, fire, or work that must be re-done.
i.!;!: r!iii;r';i,i ? r.'..irlt: lr : I , rlrJ::.!.-r -,ft l, ;..;rl' '.., , -i;3 .; r,i,;f1rfi .
Time to Supervise Employees Make sure you have sufficient time to supervise your employees.
. :r. ,. "1 .s. , .:
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. ;- , ii -. .-; .il
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-S/&4621
NOTE: This lnformation Notice to Property Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.o55(5),
passed by the 1989 Oregon Legislature. ri'
o244J 10t24t89