HomeMy WebLinkAboutPermit Mechanical 1994-11-15:??? s;'liiiil:?lT'i::::::"*
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225 Fifth Street
l'r"ri,iii;ra, o"eon el 471
APPLICATION
State:
SPRII{GFIELD
0ffice:
INSPECTION LINE:
126-3759
726-3769 -
Job Location:
Assessors M
!.tt.
Ovner:
Add rESS:
Ci tY:tor"t@
Tax Lot *:
Phone: *:
Zip Code:
OO
installation of inser
*-'d. zs state surcharge
t]
s.45 administrative
Val-ue of V od Stov
PreliminarY InsPe ction is $15 .00 (P rior
Vo od Stove/Pelle t /Insert Perm it is $1s.
i.ssuance s26.zo taI
p rovide the
to
00
fee
Type of InsP ection Requested:
Contractor:Phone *:
Address:Zip Code:State:
Ci tY:Expires:
Construction Con r ac t ors Registration *:
By s igning this Pe rmi t /aPP lication,I agree to caII for insP ect ion( s )as required
(7 26-3169).I stat e that all the i nformation o n this Permi t/apP lication is correct
and tha t I vas Prov ided vith the Vood Stove SafetY informa tion for vood burning
app liance s and Prelim inarY inspe ction standards'I further st ate that the aPP liance
Iam
Environmen
installing meets
tal QualitY or the
smoke em1
Federal Environmen
ision standards as set by the Oregon DePartmen tof
+ S10.00
also unders
and I
inspec
val1
agree
tion.
to
I
covering
tal Protection AgencY
time of
testing aPP roval nunber to the insPec tor at the
tand that if I am reques ting a PreliminarY inspec tion, the
ruay be requ ired to be remov ed.
ate
gna ur
=======--===========================--====================FOR OFFICE USE
PRELIMINARYL/''
REQUIRED INSPECTION(S) :VOODS
Date of APPIication:
INSERT
Job #:q
C
Total Amount Collected:
Receipt -, \qAt 3 Issued BY
ell-e t
Checked for Deliquencies z
-
Checked for Historical Status:
CITY OF
o \\t
+
I
of permit applicant)
5F
lt tsqt
Permit #:
Address:
Issued by:Date
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note: Oregon l-aw, 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 I and2, and either box 3A or 38:
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3A.. My general contractor is a S ul_LLt(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.
38. I will be my own general contractor,
If I hire subcontractors, I will hire only subcontractors registered with the Construction ContractorsBoard' If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notiff the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correctand thatr have read and do understand the InformationNotice to Owners about Construction Responsibilities on the reverse side of this form,
OR
(
(White copy to issuit
p ink copy :: :rr;;:l:; rmit fi te'
(Date)
/Wr/
w
Information' Notice to property Owners
Note: Thls lryform.ation Notice to Property. Qwn-ers,about Construction Re,'wai deiveiope'd by-the crii.struitibn canrractors Bo*rd in accrtrdance with
sponsibilities
oRS 70t.ass$).
lf ycru iire acting iis ysilv {.1w:} 'Jofl]{ractor t$ {snstruct a *fw h**ti: *r" rni&* a subst*n{.ia} imprcvement to an existing structure,
you cafi g:rcven| rnauey problems by being aware r":f the f*ilowing responsibitities and areas of concem.
EM PLOYER HESPONSI BI LITIES:
If you hire persons xox registered with the Construction Ccntract*rs Board to do lat:or ir constructing or assisting in the
coltstnrctinn err irnproveinent of a residential structure, you will, in mi:st instances, be mled to be an empioyer and the people
you hire will be ernployees. As the employer, you rnust conrpiy wittr the following:
Oregon's withtrolding tax law: As an employer, you must withhold income Llxes f,r*m employee wages at the time employees
are paid. Ycu will be liable fcrr the tax payments even if you don't actualiy rvithhold the tax from ycur employees. Fcr more
inforrnation, call the Oregon Dept. of Revenue at 945-809I .
tlnemployment insurance tax: As an employer, you are required to pay a tax for unemploymsnt insurance purposes on tle
wages of all employees. For rnors information, call the Oregon Ernpl,oyment Division at the Department of lluman Besourileb
Workers'cornpensation insuranee: As an employer, you are subject to the Oregon Workers'Compensation Law, and *tust
obtain wr:rkers' con-rpensation insurance for ycur employees. If you fail to obtain workers' compensation insurance, youmay
be subject to penalties and will be iiatrle for all claim costs if one of your employees is injured on the job. For more inform4lip,ti
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S.Internal Revenue Seryiee: As an employer, you must withhold federal income tax from employees'wages. You will be
liable forthe tax payment even if you dicln't actualiy withhold the tax. For more information, call the Intemal Revenue Service
at 1-800-829-1040.
OTHEN 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 10 your attention through inspections.
Liability and properff damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidenis and omiisi,:ns such is falling tools, paint overspray, water damage frorn pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: I!{ake sure you have sufficient tirne to supervis* your empioyees.
Expertise: Makesureyouhavetheexpertise toactasyourowngeneraicontractor,tocoordinatetheworkcrfrough-inandfinish
traies, and to notify Ugit6ipg officials at the appropriate tirnes so they can perform the required inspections'
If you have additional quesiions, write or cail the Constmction Contraetors Board (Po Box l4l40, Salem, oR 97309-5052,
SAyX*-q*21). The Board is iacated at 700 Suinmer St. NII Suite 3ffi, in Salem'
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