HomeMy WebLinkAboutPermit Mechanical 1993-09-07CffY OF OREGO'V
1JOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFTELD
BUILDING SAFETY DIVISION
225 Fifth StreetSpringfield, Oregon 97 477
Job Location:
Assessors llap *:
"3
0vner:
Address:
Tax Lot #:
Phone *:
installation of insert
ST T'{GFIELD
0ffice:
INSPECTION LINE:
zip:
726-3759
726-3769
)
Ci ty:
Value of d Stov
(please circle
Prelimlnary Inspection i
Ilood Stove/Pellet/Insert
State:
t Stov rt:
pliance
s $15.00 (prior tois $15.00 +0-00 Is )
$5 state surcharge.
Type of Ins
Contractor:
d re
Requ ted:
FOR OFFICE USE
c
Address:Phone *:
Ci ty:State:zi p:
Constructi Contrac rs Registration *:.Expires:
By signing this permit/applieationl I agree to caII for an ins pection(s) as required(726-3769). I state that all information on this applicat ion/permit is correct andthat I vas provided v ith the Vood Stove Safet v information for vood burningappliances and preliminary ins pection standards I further state that the applianceI am installing meets smoke em ission standards as set by the 0regon Department ofEnvironmental Quality or the Federal Environmental Protection Agency and I agree toprovide the testing app roval number to the inspecto r at the time of inspection. Ialso understand that if I am requesting a prelimi nary inspection, the valI coveringmay be required to
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Datd
\\cr
REQUIRED INSPECTION( S) :
Date of Application:
Total Amount Collected:
Receipt *:
PRELIHINARY
Job S:
Checked for Delinquencies:
Issued By:
Checked for Histori I Status:
ton
1
2
Permit No:
Address:
lssued Date:
OR OFFICE USE ONLY
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
underORS 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
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or completion
A My general contractor is
Contractor registration 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, 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 ! have read and understand
the lnformation Notice to Propedy Owners about Construction Responsibilities on the
reverse side of this form.
Si gn of rmit Applicant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
3
OR
WHITE @PY TO ISSUING AGENCY PERMIT FILE
PiNK COPY TO APPLICANT
rNFoRfrnoN NoncE ro pRopERrt oilnens
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This lnformation Notice to Propefi Owners About Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
passed by the 1989 Oregon Legislature.
lf you are acting as your own contractor to construct a new home or make
existing structure, you can prevent many problems by being aware of the fo
of concern
EMPLOYER RESPONSIBILITIES:
ll you hire persons not registered with the Construction Contractors Board to do labor in constructiqg or assisting
in the construction or improvement-of a re$identia-l structtiie, you witl,'in most instahiesr.OeilteO to be an
"emplover" and the people you hiie will be "employees". A's lhe employ6( you musl cgmply with the following:
Oregon's Withholding Tax Layv: As an employer, you must withhold income taxes froni,emoloyee wages at
uwitlbcliableforihetaxpaymentsevenifyoudon'tacttialtywithholdthe
tax from your employees. For more information, call the Oregon Departrrlgnt of Flevenue at 378-3390.
' i .: .: , - l;
Unemployment lnsurance Tax: As an employer, you ar'e required to pay a tax for unemployment insurance
purposes on the wages of all ernployees. For more rnformation, call the Oregon Employment Division DHR
at 378-3224.
Workers' Compensation lnsurance: As an ernployer, yotl are subiect to the Oregon \,Vorkers' Compensation
Law, and must obtain workers' compensation insurance for your employees. lf you fhil to obtain workers'
compensation insurance, you may be subjeet to.penalties and will be liable for allClaim cgsts if one of your
employees is injured on the job. For more information, callthe Workers'Compensation Divisiop DIF at gf*74A.
,, ,t,' ,"i'-,
U.S. lnternal Revenue Service: As an er.nployer, you mus,t withhpld federal income tax from employees'wages.
yment","nifyoioiontactua!iYwiinrrcilo.th6.tax.Formoreinformation,call
the lnternal Revenue Service at'221-3960.
._.i .
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 brou$ht to your attention through inspections-
Liability ahd Property Damage lnburance: Contact your htsr-lfanee agent to See if you harre adequate insurance
coverage for accidents and omissions such as falling tools, palnt overspray, whEr damage from pipe punc-
tures, fire, or work that must be re-done.
Irme,to'Yervbe' : Make:sure you,have suff.icient tirne tb 1.**,"",ryr_nrY_..f,
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. . . * .. -, .;;. _ _
lf you have additional questions, write to:Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
Phone 503-tr/8-4621
o24N 10t24t89