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RV & Manufactured Structure Inspector Certification Application Mail application with payment to: DCBS Fiscal Services P.O. Box 14610 Salem, OR 97309-0445 • Manufactured Structure Installation • Manufactured Structure Construction • Recreational Vehicle • Park and Camp Department of Consumer and Business Services Building Codes Division • 1535 Edgewater St. NW, Salem, Oregon Phone: 503-373-1268 • Fax: 503-378-2322 Web: bcd.oregon.gov STEP 1 APPLICANT INFORMATION (please print) Last First Middle initial Name: Phone: Address (street or P.O. box): Fax: City: State: ZIP: Social Security number (Required, ORS 25.785): – – E-mail: STEP 2 OREGON INSPECTOR CERTIFICATION (OIC) REQUIREMENTS Every person who performs building official duties, building code inspections, or plan reviews must possess a valid Oregon Inspector Certification (OIC) and a valid appropriate Oregon Code Certification for the work being performed. Before you may be approved for any certification listed in step 3, you must have an active OIC number. Please mark the box which applies to you: No, I do not have an active OIC. Please mark the status of your OIC application. I have a pending OIC application. I am applying for, and have included my payment for the Oregon Inspector Certification (OIC). Yes, I have an active Oregon Inspector Certification (OIC). My number is: OIC STEP 3 CHOOSE APPLICATION TYPE Application fees are nonrefundable Oregon inspector certification (OIC) ............................................................ $125 70711 Each certifications below is............................................................................................ $80 70411 Manufactured structure installation inspector (On-site MHI) Park and camp inspector (PCI) Manufactured structure construction inspector (In-plant MCI) Recreational vehicle inspector (RVI) STEP 4 TEST LOCATION Upon approval of your application, BCD will send a letter to you authorizing you to sit for this examination. Choose one examination location from the list below. Bend Klamath Falls Pendleton Salem Coquille Lincoln City Portland White City Eugene Ontario Roseburg DEPARTMENT USE ONLY Approved Signature: Date: Denied Signature: Date: Comments: Secure fax for credit card payments: 503-947-2333 If paying by credit card, applicant must sign credit card information box. Visa MasterCard Applicant must sign Page 2 of application Make check or money order payable to Department of Consumer and Business Services (DCBS). Do not send cash. DCBS Fiscal use only: 12104/0600 Discover Phone: / Credit card number Expiration date Name of cardholder as shown on credit card $ Cardholder signature Amount Page 1 440-2520 (10/10/COM) STEP 5 REQUIRED TRAINING (MHI & MCI Only) An applicant for certification as a manufactured structures installation inspector must attach proof of completion of 2010 Manufactured Dwelling Installation Specialty Code study guide. STEP 6 EMPLOYMENT HISTORY List your experience consecutively, beginning with your present or most recent position. Describe in detail your related duties and responsibilities, technical areas, type of buildings, occupancies, etc. If more space is needed to list experience, please attach additional sheets. Please print Employer’s name: Period of employment: Address: From: To: Hours worked per week: - Phone: - Position/title: Describe work performed: Employer’s name: Period of employment: Address: From: To: Hours worked per week: - Phone: - Position/title: Describe work performed: STEP 7 VERIFICATION OF WORK EXPERIENCE All applicants must submit a separate verification, filled out and signed by the employer, for each work experience used to qualify for a certification. To provide proof of your work experience, submit an experience verification form (page 5). If you are Step 6A verifying work from more than one employer please use a separate verification form for each. Step 6B If using education as part or all of your experience, please attach a copy of your college transcript or diploma Step 6C If using your experience as an installer or inspector, please list license and/or certification number. Type: No.: Type: No.: STEP 8 APPLICANT AFFIDAVIT 1. I hereby certify that, to the best of my knowledge, the information on this application is complete and correct. 2. I understand that my license may be suspended, conditioned, or revoked if I have deliberately falsified my application. ORS 455.129 3. I understand that, if I provide false information on this application or cheat on a licensing examination, my application will be denied and I may not apply for any license or be allowed to take any division- related examination for one year from the date of denial. OAR 918-001-0040 4. I certify that I have read these statements and understand the terms of my license. Applicant name (print): Applicant signature: 440-2520 (10/10/COM) Date: Page 2 Application for Certification CHECKLIST FOR APPLICANTS Complete application form completed Choose application type and test location Complete work history Training certificate of completion for manufactured structure installation inspector only Experience verification forms for each employer and/or proof of related education Application signed by applicant Payment of fee is enclosed MANUFACTURED STRUCTURE INSTALLATION INSPECTOR (MHI) OAR 918-089-1305 A manufactured structure installation inspector (MHI) conducts field inspections of manufactured dwellings and park trailer installations. Requirements 1. Must have an active Oregon inspector’s certification (OIC). 2. Any one of the following meets minimum experience requirements: • Two years of experience as a supervisor in the building construction industry • Two years in design work related to building construction • Two years of experience as a quality-assurance inspector in a manufactured structure plant • Two years of experience as an Oregon-licensed manufactured dwelling installer • A current Oregon state certification as a building inspector or plans examiner • A one-year certificate of completion in building inspection technology from a division-approved education program and completion of a 180-hour division-approved inspector-in-training program • An associate degree or equivalent from a division-approved education program in a construction-related field • Any combination of experience and education allowed above, totaling two years 3. Applicant must take and pass an exam. The examination covers current editions of the Oregon Manufactured Dwelling Installation Specialty Code, ORS Chapter 446, and OAR Chapter 918, Divisions 500, 515, and 530. 4. Training is required for manufactured home installation inspectors. Go to http://www.bcd.oregon.gov, code program Manufactured Dwelling to access the study guide. MANUFACTURED STRUCTURE CONSTRUCTION INSPECTOR (MCI) OAR 918-098-1315 A manufactured structure construction inspector (MCI) conducts field and manufactured structure plant inspections, reviews plans, and provides technical services for manufactured dwelling manufacturers, dealers, and owners. Requirements 1. Must have an active Oregon inspector’s certification (OIC). 2. Any one of the following meets minimum experience requirements: • Two years of experience as a supervisor in the on-site or factory building construction industry • Two years of experience in design work related to on-site or factory building construction • Two years of experience as a division-certified construction inspector or plans examiner • Two years of experience as a quality control inspector in a manufactured structures plant • An associate degree or equivalent from a division-approved education program in a construction-related field • A one-year certificate of completion in building inspection technology from a division-approved education program and completion of an 800-hour division-approved inspector-in-training program • Any combination of experience and education allowed in the above-listed requirements totaling two years 3. Applicant must take and pass an exam. The examination covers the current editions of NFPA 70, 24 CFR 3280, 24 CFR 3282, PL 93-383 Title VI, ORS Chapter 446, OAR Chapter 918, Division 500, and the Oregon Manufactured Dwelling Installation Specialty Code. 440-2520 (10/10/COM) Page 3 Application for Certification RECREATIONAL VEHICLE INSPECTOR (RVI) OAR 918-098-1310 A recreational vehicle inspector (RVI) conducts field and manufacturing plant inspections, reviews plans, and provides other technical services for recreational vehicle manufacturers, dealers, and owners. Requirements 1. Must have an active Oregon Inspectors Certification (OIC). 2. Any one of the following meets minimum experience requirements: • Two years of experience as a supervisor in the building or recreational vehicle construction industry • Two years of experience in design work related to building or recreational vehicle construction • Two years of experience as a division-certified building inspector or plans examiner • Two years of experience as a quality-assurance inspector in a manufactured-structure plant • Two years of experience as a division-certified RV quality-assurance technician • Two years of code-related experience as an RV technician • An associate degree or equivalent from a division-approved education program in a construction-related field • A one-year certificate of completion in building inspection technology from a division-approved education program and completion of an 800-hour division-approved inspector-in-training program • Any combination of the experience and education allowed in the above-listed requirements totaling two years 3. Applicant must take and pass an exam. The examination covers the current edition of NFPA 1192, ANSI 119.5, NFPA 70, ORS Chapter 446, and OAR Chapter 918 Division 525 & 530. PARK AND CAMP INSPECTOR (PCI) OAR 918-098-1320 A park and camp inspector (PCI) conducts field inspections, reviews plans, and provides other technical services for manufactured dwelling parks, recreational parks, organizational camps, and picnic parks. Requirements 1. Must have an active Oregon inspector’s certification (OIC). 2. Any one of the following meets minimum experience requirements: • Two years of experience as a supervisor in the building or road construction industry • Two years of experience in design work related to building or road construction • Two years of experience as a building or road construction inspector • Two years of experience as a surveyor or landscape architect • Two years of experience as registered sanitarian • Two years of experience as an Oregon-licensed manufactured structure inspector • An associate degree or equivalent from a division-approved education program in a construction-related field • Any combination of experience and education allowed in the above-listed requirements totaling two years • A one-year certificate of completion in building inspection technology from a division-approved education program and completion of a 180-hour division-approved inspector-in-training program 3. Applicant must take and pass an exam. The examination covers the current editions of ORS Chapter 446, OAR Chapter 918 Divisions 530, 600 and 650, and the 2002 Oregon Manufactured Dwelling and Park Specialty Code. 440-2520 (10/10/COM) Page 4 Application for Certification Certification Experience Verification Mail verification to: • • • • Building Codes Division P.O. Box 14470 Salem, OR 97309-0404 Manufactured Structure Installation Inspector Manufactured Structure Construction Inspector Recreational Vehicle Inspector Park and Camp Inspector Department of Consumer and Business Services Building Codes Division • 1535 Edgewater St. NW, Salem, Oregon Phone: 503-373-1268 • Fax: 503-378-2322 Web: bcd.oregon.gov STEP 1 APPLICANT INFORMATION (please print) Name (applicant): Address: City: State: Phone: Fax: ZIP: E-mail: Verification of experience is required for certification with the State of Oregon. This application to the Oregon Building Codes Division is for certification as a: Manufactured structure installation inspector (MHI) Park and camp inspector (PCI) Manufactured structure construction inspector (MCI) Recreational vehicle inspector (RVI) STEP 2 VERIFIER INFORMATION Name of verifier: Address: City: State: Phone: Fax: STEP 3 ZIP: E-mail: VERIFIED EXPERIENCE Describe your knowledge of the applicant’s experience. Fill in the name of employer and dates of employment. Describe applicant’s position and type of work performed. Describe the types of buildings, structures, or projects on which the applicant worked. Give any other details that will aid in evaluating experience. Additional pages may be attached. I certify that I know the applicant and have direct knowledge that the applicant was employed from to Month/year as a: Month/year Applicant’s position/title: Company name: Duties and responsibilities: How was your knowledge of the applicant’s experience acquired? I certify that the foregoing statements are true and correct. Signature of verifier: 440-2520 (10/10/COM) Date: Page 5 Application for Certification