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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 &' 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