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Home My WebLink AboutPermit Building 2005-01-21Status Issued 225 Fifth Street, Springfield, OR 54l-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line Building/Combination Permit PERMIT NO: COM2004-01498ISSUED: 0112112005APPLIEDz 1210712004 EXPIREST 0712112005VALUE: $ 6,000.00 SITE ADDRESS: 4039 E 16TH AVE Eugene TYPE OF WORK: Manufactured Home on ASSESSOR'S pARCEL NO.: 1703344306100 Private Lot TYPE OF USE: New Residential PROJECT DESCRIPTION: Replacement manufactured home. Demo and sanitary cap - Manufactured Home Phone Number: 541-463-1985Owner: Address: JACK ALLEN 3946 DOVE LN EUGENE OR 97402 Contractor Type General Electrical Manuf Home Inst Plumbing Contractor License JACKALLEN 71284 MICHAEL A WHEELERS MOBILE HOME S 91504 MICHAEL A WHEELERS MOBILE HOME S 91504 JACKALLEN 71284 Expiration Date 02t04t200s 05fi4t2005 05n4t2005 02t041200s Phone 54r{63-1985 541-928-0995 541-928-099s 541-463-1985 # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: Floor: Ft 2nd Floor: Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: WORK REQUIRED PARIilNG Total: 2 Handicapped: Compact: t 4,792 924R-3 loltor VN opffh 1 0090. 33.00 20.00 6.00 21.00 0.00 Urban Fringe 25.00 \S Mat No ENCED ABAN 80 DAY pER\00. Downspouts/Drains: R OR IS Notes: AC ANY 1 Paee I of3 UUN INIUKTYTATTUN I F Building/C o mbination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01498ISSUED: 0112112005APPLIED: 1210712004 EXPIRESz 0712112005VALUE: $ 6,000.00 Description Tvpe of Construction Foundation Onlv Use Bid Amount Manuf Home Manufactured Home $ Per Sq Ft or multiplier $1.00 $1.00 Square Footage or Bid Amount 1,000.00 5,000.00 Value $1,000.00 $5,000.00 $6,000.00 Date Calculated 12t27t2004 01/18/2005 Fee Description Demolition Sanitary or Storm Sewer Cap Plan Review Residential + l0Yo Administrative Fee + 1Yo State Surcharge Foundation Permit Manuf Home State fssuance Manufactured Home Conn - Plmb Manufactured Home Feeder Manufactured Home Placement Plan Review Major - Planning Total Amount Paid Total Value of Project Date PaidAmount Paid $45.00 $4s.00 $29.2s $30.00 $21.00 $45.00 $30.00 $4s.00 $s0.00 $160.00 $103.00 $603.2s Receipt Number 3200400000000000360 3200400000000000360 1200400000000001793 1200500000000000096 1200500000000000096 1200s00000000000096 1200500000000000096 1200s00000000000096 1200500000000000096 1200s00000000000096 1200500000000000096 t2t7t04 t2l7t04 12t27t04 u2u05 u2u0s u2u05 U2u05 u2u0s 112y05 u2u0s u2U05 tr'pps Peid Plan Reviews Initial Review Planning Review Public Works Review Structural Review Structural Review 12128t2004 12t28t2004 12128t2004 01/18/2005 12t28t2004 0u17t2005 0110712005 0u15t2005 APP APP APP RJB DLM 12t28t2004 12t28t2004 APP CAS Single-wide allowed as a replacement of single-wide in Glenwood per SDC 5.050. Storm drainage retained on site t2l28t2004cAS Added notes for septic system requirements. OK To Request an inspection call the24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Demolition: After demolition is complete, sewer is capped or septic is pumped and filled and inspection is requested and approved, and all debris is removed from the site. Paee 2 of 3 Yaluation Description I SKG TAJ Keoulred lnsDections I Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01498ISSUED: 0112112005 APPLIEDz 1210712004 EXPIRESz 0712112005VALUE: $ 6,000.00 Sanitary Sewer Cap: Capped within five (5) feet of the property line and capped with an approved material as required by the code. Footing: After trenches are excavated. Manuf Home Set Up: When installation of all piers or stands is complete. Final Manuf Home Set Up: After all required inspections are requested and approved and porches, skirting, decks, venting, street address numbers, trees, driveway, etc. have been installed. Manuf Home Plumbing: After home has been connected to water and sewer. MH Electric: When blocking, setup and plumbing inspections have been approved and the home is connected to the panel. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. By signature,I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during (=, Signature Date Page 3 of3 _\ 225 Fifth Street Sprirgfield, Oregon 97 477 541-726-3759 Phone city of Springfield Oflicial Receipt -.-- velopment Services Department Public Works Department RECEIPT #: 1200500000000000096 Date: 0112112005 11:45:45AM Job/Journal Number coM2004-01498 coM2004-01498 coM2004-01498 coM2004-01498 coM2004-01498 coM2004-01498 coM2004-01498 coM2004-01498 Description Manufactured Home Placement Manuf Home State Issuance Manufactured Home Feeder Manufactured Home Conn - Plmb Plan Review Major - Planning Foundation Permit + 7Yo State Surcharge + l0% Administrative Fee Amount Due 160.00 30.00 50.00 45.00 103.00 45.00 21.00 30.00 Item Total:$484.00 Payments: Type ofPayment Paid By unecKNumDer Authonzatron Received By Batch Number Number How Received Amount Paid Check WHOLESALE HOMES djb 3679 In Person $484.00 Payment Totat: -$4-EATd' t/2U200s Page I of I *pxtHaFr*L9 City of Springlield 225 Fifth Street, Springfield, Ox_97477 541-726-3759 Phone 541-726-3676Ba,x September 20,2005 ALLEN JACK 3946 DOVE LN EUGENE oR 97402 Job Number: Location: coM2004-01498 4039 E I6TH AVE Project:Replacement manufactured home. Demo and sanitary cap - Manufactured Home Dear Permit Holder: The Springfield Building Safety Code Administrative Code provides that in order for a permit to remain valid, the work which has been authorized by the permit must begin within 180 days of the date of issuance, and an inspection must be requested at least every 180 days. According to our records, you obtained a permit for a project at 4039 E l6TH AVE which is set to expire on 10122/2005. Ow records indicate that you have not requested an inspection within the past five (5) months. This letter is written to notiff you that your permit(s) wilt be expiring shortly. If you are ready to request an inspection for your project, please phone the inspection line at 541-726-3769. If you do not request an inspection prior to the expiration date, your permit(s) will expire and additional permit fees will be required in order to complete your project. If you have any questions, please feel free to phone me at S4t-726-3790. Sincerely, Lisa Hopper Building S afety Sup ervisor s trgry { 3* t:; flJ gna*a} 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 r FAX: E LECTRI CAL P ERMIT AP P LI CATI ON Oere City JobNumber COn<ZoOLt -O lt4 ? Y Date 1. - Lto3?AV LEGAL 33 o r:$iliiti:l}? 3 JOB DES Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder Cr,"+f Permits are non-transferable and expire if work is ' not started within 180 days of issuance or if work is Suspended for 180 days. Contractor $ 19.00 r-$50.00 ., City Supervisor License Number Expiration Date Constr. Contr. Number Expiration Date Signature of (= 3),q Phone frt I Qz I tow, 4q'7 h OAR fu{a Y 200 Amps or less 201 Amps to 400 Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 or 1000 Volts see "B" above. New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit 7o/o Stzte Surcharge 10% Administrative Fee TOTAL D. $ 63.00 $ 7s.00 $12s.00 $163.00 $37s.00 $ s0.00 $ s0.00 $ 69.00 $100.00 $ 43.00 $ 3.00 ltrT lrst/i/c-t d Owners Name Address L City 4^.t ol,o Phone__T- OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners 3fo S-e('2 -'D,'O Ifispection Request: 726-37 69 s Shared Drive(T:)/Building Forms/Electrical Pennit Application l -03.doc t)o/ A. / B. Services o: Teeders - Installaiion, Alterations or Relocition: r::;..::::,:::,.:.:: i:'.r.:,.,::-i riiri : , i::11 '' ..:, :r'.r:,; $ / Ll Elecgieal IXM#Juy E. $ 45.00 Permit Inspection Fee is $45.00 * Surcharges ^i:., ff(_)t/ ssrSitsrGFtELa DEVELAPW EIIT SEff YiCES DEP,fiRTMET!.dT x MANUFACTURED HOME LAND USE AGREEMENT As required by the Ciry of Springfield Development Code, I agree that with the of the permits, one of the following manufactured homes will placed al Springfield, Oregon, City Job Number Type I Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch of 3 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thermal envelope meeting performance standards which reduce heat loss to levels equivalent to the performance standards required of single family dwellings constructed under the State Specialty Codes. Type II Manufactured Home. A unit of not less than 12 feet in width with an enclosed floor area of not less than 500 square feet, that has a nominal roof pitch of 2 feet in height for each 12 feet in width and that has no bare metal siding or roofing. The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6 percent slope within 10 feet of the perimeter enclosure. The perimeter foundation wall surrounding the home shall be constmcted of stone, brick or other masonry materials, and with no more than24 inches of the enclosing material exposed above grade. I further agree to meet all land use and City Code requirements of the above mentioned parcel within 60 days of the date of lssuance of the manufactured home set up permit. These requirements may include, but are not limited to the items listed below. Specific land use requirements regarding your parcel are noted on your approved set up plans and/or permit and your partition approval if applicable: o Street Trees. Paving Driveway o Minimum 32 square foot storage structure o Completion of partition approvalo Removal of any existing structures as noted on your partition approval. Signing and recording of any required partition, easement, improvement agreements, etc.. Final lot grading . City Sidewalk and curbcut installation. Any outside agency approval as required i.e., Division of State Land approval. Bymys below, I agree to the above mentioned land use requirements Date Contractor Signature Date 225 FIFTH SIEEET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (54.1) 726-3689 r />t los DISTRICT OF INCIDENT: 0347: SPRINGFIELD FIRE LIFE SFTY COUNTY: 20: IANE DEPI. R'ESPONDING: 0347: SPRINGFIELD FIRE LIFE SFTY ALART DATE: l0,19n0o4 TYPE OF SITUANONS FOUND: '121: Fire in mobile home used as fixed residenoe ALARU TllrE: 19:51:0O ARRIVAL DATE: 1O19,[20o/.ARRNAL ntE: 19:56:00 BAGK rN DATE: 'tot9r20o4 BAC]IN trlrElj r!!9 TNoDENTADDRESS; 4039 E 16TH AVE ctTYtztPi SPRINGFIELD, OR 97477-CENSUSTRACT: 36 ZONE: 4 OCCUPANT,@TPANY: WENDY MCCOY DoB: 1213011961 TELEPHONE;1 1-1056 DOB:TELEPHONE:BUSINESS OVI'NER: AODRESS: BUILDINGilIOELE PRoPERTY OvtNER: BUD BARTZAT ADDRESS: 3525 OXBOWWY EUGENE OR 9740'l- DOB:TELEpHoNE: (541) 686-8692 REFORTED BY: ADDRESS: CAREERF,F: 16 DOB;TELEPHONE: 1 OTHERVEHICLES: 3 f,UTUALAID: 2: Received ACTIONS TAKEI{: '12: VENTILATE, EXTINGUISH, SALVAGE & OVERHAUL 98: NO ACTION TAKEN 98: NO ACTION TAKEN TETHOD OF EXTINGUISHIENT: 6: WATER FROM HYDRANT,DRAFT,STANDPIPE AGENT OF EXTINGUISHMENT: ii[?'Ef;rr r"r, 4'r1: oNE-FAMrLy DWELLTNG, vEAR RoUND usE GENERAL PROPERTY USE:41: 1 OR 2 FAMILY RESIDENCE toBlLE PRoPERTY ltflrolvEo: 1 7' MOBI LE HOME/BU I LD I NG ROOiilAREA OF ORIGIN:EQUIPMENT INVOLVED: 21: SLEEPING ROOMS; LESS THAN 5 PEOPLE JUVENILE: COUNT: No0 lGNlnON FACTOR: 71: COLLISION, OVERTURN, KNOCKDOWN ( INCLUDING MVA) FORil OF HEAT IATERI.AL FIRST IGNITED WAS MADE OF: 9800: NO EQUIPMENT INVOLVED FINI ITET FIRST IGN]TED; 34: CLOTHING NOT ON A PERSON46: HEAT FROM PROPERLY OPERATING EQUIP 7'l : lvlAN-lvlADE ESTIMATED VALUE BUILDING: $0.00 CONTENTS $s00.00 UOBILE PROPERTY AND CONTENTS: $6,000.00 OTHER: $0.00 $0.00 REASON FOR DETECTOR FAILURE: 8: NO AIARM FAILURE REASON FOR SPRINKLER FAILURE: 8: NO EXTING. SYSTEM FAILURE ESTIMATEO LOSS $0.00 DETECTOR TYPE: 8: NO AI-ARM PRESENT DETECTOR POWER SUPPLY: 8: NO ATARM PRESENT SPRINKLER SYSTEM TYPE: 8: NO SPRINKLERS PRESENT FOLLOW-UP INVESTIGA]]ON REqUESTED: DETECTOR PERFORMANCE: 8: NO ALARM PRESENT lF YEs,l ,Ho u,lLL lNvEsnGArE: Y: LOCAL FD PERSONNEL OR TEAM $6,000.00$500.00 # OF HEADS OPENED: 0 NUMBER OF INJURIES FIRE sERvlcE: O oTHER: 0 NUMBER OF FATALITIES FIRE SERVICE: 0 OTHER: 0 ADDITIONAL INFORi|ATION BY: MEmBER tAKlt{G REFORT: Cox, DOUglaS rrTLE: Q6plsln DArE: 1OI9DOO4 DATE; \4 TITLE: State of Oregon Office of State Firt @l Ar-A*rNo'T EXPOSURE il0: fiil)'c3 COIIPLETE FOR ALL STRUCTURE FIRES SPRINKLER PERFORMANCE: 8: NO SPRINKLER PROTECTION COMPLETE FOR ALL INCIDENTS ENGINES; 3 u a Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01498ISSUED: 1210712004APPLIED: 1210712004EXPIRES: 0610712005 VALUE: SITE ADDRESS: 4039 E 16TH AVE ASSESSOR'S PARCEL NO.: 1703344306100 PROJECT DESCRIPTION: Demo and sanitary cap Owner: JACK ALLEN Address: 3946 DOVE LN EUGENE OR 97402 Eugene TYPE OF WORK: Site Work Only TYPE OF USE: Demolition Residential PhoneNumber: 541-463-1985 Contractor Type General Plumbing Contractor JACKALLEN JACKALLEN Expiration Date 0210412005 02t04t2005 Phone 541463-1985 541-463-198s License 71284 71284 CONTRACTOR INFORMATION v TION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: R-3 VN # ofStories: Height of Structure Type of Heat: Water Type: Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: %o oflot Coverage: follor rules adopted by Notification Center. Those rul Downspouts/Drains: ln OAR 952-001-0010 through OAR 952-001' 0090. You maY obtain coPres I calling the center. (Note: th REQURED PARI(NG Total: Handicapped: Compact: IF THE WORK IISNO nla of the rules bY re telePhone 2344). $ Per Sq Ft or multiplier Square Footage or Bid Amount Description Type of Construction Pase 1 of2 Value Date Calculated S PERMIT S IHORIZED U F Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 54l-726-3753 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO: COM2004-01498ISSUED: 1210712004APPLIEDz 1210712004 EXPIRESz 0610712005 VALUE: Fee Description + l0Yo Administrative Fee + 7Yo State Surcharge Demolition Sanitary or Storm Sewer Cap Total Amount Paid Amount Paid $9.00 $6.30 $45.00 $45.00 $10s.30 Total Value of Project Date Paid t2t7l04 t2l7l04 t2l7t04 t2t7t04 Receipt Number 3200400000000000360 3200400000000000360 3200400000000000360 3200400000000000360 Fees Paid Plan Reviews To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. Demolition: After demolition is complete, sewer is capped or septic is pumped and filled and inspection is requested and approved, and all debris is removed from the site. Sanitary Sewer Cap: Capped within five (5) feet of the property line and capped with an approved material as required by the code. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during Owner or Signature Pase2 of2 Date t>7 Y Keourreo InsDectrons I 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone ^!ty of Springfield Official Receipt . evelopment Services Department Public Works Department RECEIPT#: 3200400000000000360 Date: 1210712004 2:58:31PM Job/Journal Number coM2004-01498 coM2004-01498 coM2004-01498 coM2004-01498 Description Demolition Sanitary or Storm Sewer Cap + 7oh State Surcharge + l0% Administrative Fee Amount Due 45.00 45.00 6.30 9.00 Item Total:$10s.30 Payments: Type of Payment Paid By CheckNumber Authorization Received By Batch Number Number How Received Amount Paid Check WHOLESALE HOMES djb 3666 In Person $105.30 Payment Total: -5imo- t2/7t2004 Page I of I *&taaxrafr*l! COt/VZc.) L(- O lL.t 7 t D,d!a: SPRIHGFIELD DA4ELOPMFj|{T SEFYICES PUBUC I44oRKS M ETR O PO I/TAN WASTEWATER M AN AG EM EM DEMOLITION PERMiT APPLICATIONS Thank You for Your Patience' ant the CitY of SPt'itito ngfi e 'ld permi quested . ssl Your demolition permit is currently b?ing 'processed' There-.may be a slight delay, of up to I-woifing days ior'small itructures, due to the time required to review the history_of th.e structuie io determjne ii it needs to be documented before demol ition. 'f[is-ao..unteii.tion- ji for irchival purposes on'ly and uill llr jffi',::i*tutll*l;:t;{i;';l*:"1'{{i}i.'i,it:tp',l[,i]ti?,lilii o.vi. ' ,o'cur.nl.iirn ;i'ii- .ii'!'i -Ji prrotographing tiif -i,T'SJ'fl;o.lilllflmeiiur.m.nts and making scaled drawings'. J.t'' by the City at'-no iitito you. -'OoCuri'entation is being done on all structures aited prior to riiollr.,it ,i.i-t *. ii;ioi;;importance to the ci!v's devetopmgnt.' ., IHrs DSSUHE1{TATIoN 1{ILL NoT IHPEDE THE DEHSLITI9N PRocEsS' on.n.cut-offoflg40waschosenbecausethisisthedatethattheNationa.lparks Service and the Springfiefi O.uefopr.nt Code use to determine potential historical significance . .t. Ifyou riould prefer to complete this documentation yourselfygu must provide the City with tne'?olt*i.g lnfot*iii;.;- Ii -bfaCf ana white photosraphs of each elevation, a fl;;;'iiin=wiin #;r;;.ni",-ini a set of e'levation drawings with measurements. . N5 FETH SIBEEI SP8'NGF/ELD, OR 97477 (503)726-s7s3 PropertY S1 ature: on.to enter mY' ProPe rty to ete on of the structure Io at ATTENTION : Oregon law requires you to follow rules adop ted:by the Oregon Utiti Igr compl cated :UI '7 ty NOTICE: i' THIS PERMIT SHALL EXPIRE IF THE WORK l!]11-0!riED UNDER THts pEBMrirs r,ror COfu1IVIENCED Ofi IS ABANDOTViO rON" ANY 1BO DAY PERIOD. Notification Gen ter, Those rules are set fonn in OAR 952-001 -0010 through OAR 952-00 't- 0090. You may obtain copies of the rules by calling the center. (Note: the telephone number.for the Oregon Utitity Notificaticn' Center is 1-800-33 2-2344). Date: /,1wlao<:L4,- OlLt 1 K -!t SPRINGFIELD DEVELOPMENT SERVI CES D EPARTMENT 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 725-s75s FlX(541) 726-s689 Address:L{3?tr(& Q Strueture to be Demolished: Job Number:Co*ntzg O t-{- ol\n r The appiicant is hereby notified that any redevelopme,nt of the subject site must comply Jtt Ai of tUe applicable laws, codes, ordinances, policies and plq,s in 9ffect aJ the time . the redevelopment proposal is-acceptd as compleig f9r prtl review. P* *".'l1inblude conection oisubstandard conditions associated with the presen! devel-oP3Tl Examples of such corrections may inclu,ile mod.ification of inadequate drainage facilities; ;;6il* with building set-backs'from proper-ty lines; correctiol gf subqtandard sidewatks and sfeet impiovements, ineluding driveway width aod ptagemen! ldgther;;r.ti.* which -u16" Dgcessary to comqly with existing development standads' ' Fr;rthermore, if an existing use is demolished or otherwise removed prior to thq il;;pdi of the propo!"a use, then the system dwelopment charge "t:SJ fgr the ;ffi.rliy-;G"g *r rUaf expire-two-years afterthe !{e.of issuance of the demolition ;;dt, orith., removal of the previousiy existing qse. (Springfield Municiphl Code My siguatr:re ielow indicates that I have read and uoderstand the above coodidors ;r1i,[i; the demolition of the above mentioned stnrcttue. NOT!CE: THIS PERMIT SHALL EXPIRE IF THE WORK 1!lf0lrzED UNDER THIS pEhMrirs nroi COMMENOED,OR IS ABANDONiD FOR. ANY 1B(J DAY PERIOD, Date ATIENTION:'Oregon law requires you.to .follow rules adopted by the Oregon'Utility Notification.Center. Those rulos are set forth in OAR 952-001-0010 through OAR 952-001: 0090. You may obtdin copies of the rules by calling the center: (Note: the telephone number for the Oregort Utility Notification center is 1 -800-332-2344). Page I of I ITWORDFILE\PERI'IITS\Demosdc.doc DISTRICT OF INCIOENT:COUNTY:DEPT. RESPONDING: 0347: SPRINGFIELD FIRE LIFE SFTY 20: IANE 0347: SPRINGFIELD FIRE LIFE SFTY Al-ARt DATE; IOE/|2004.ALARil ImE: 19:51:00 ARRML DATE: lOEnOO4 ARRIVAL TIME: '19:55:(E BACK lN DATE: 1Ol9D@4 BACK lN TIME: 0:16:00 TYPE OF SITUATIONS FOUND: 121'. Fire in mobile home used as fixed residence NqDENTAITDRESS: 4039 E l6THAVE ctTYIztP2 SPRINGFIELD, OR 97 477 -CENSUSTRACT: 36 ZONE: 4 occUPANTrcorPAilY: WENDY MCCOY DoB: 1A30n961 TELEPHONE:1-1 056 DOB:TELEPHONE:BUSINESS OYI'NER: ADDRESS: BUrLrxNGrroBrLE PROPERTY OUTNER: BUD BARTZAT ADDRESS: 3525 OXBOWWY EUGENE OR 97401- DOB:TELEpHoNE: (541) 686-8692 L ooe,TELEPHONE:REPORTED BY: ADDRESS: CAREERFTF: 16 VOLUNTEERFTF: 0 3 J AERIALAPPARATUS:1 OTHERVEHICLES: 3 TUTUALAID: 2'RegeivedENGINES: ACNONS TAKEN: 12: VENTIIATE, EXTINGUISH, SALVAGE & OVERHAUL 98: NO ACTION TAKEN 98: NOACTION TAKEN f,ErHoD oF ExnNGUlsHtlENr: 6: WATER FROM HYDRANT,DRAFT,STANDPIPE AGENT OF EXTINGUISHI ENT: ilto!'Ef- r"., 411: oNE-FAMtLy DWELLING, vEAR RoUND usE toBlLE PRoPERTY lt{voLvED: 1 7' MOBILE HOME/BUILDING GENERAL PROPERTY USE:41: 1 OR 2 FAMILY RESIDENCE ROOf,'AREA OF ORIGIN: 21: SLEEPING ROOMS; LESS THAN 5 PEOPLE JUVENILE: COUNT: No0 lGN]nOilFACTOR: 71: COLLISION, OVERTURN, KNOCKDOWN ( INCLUDING tvIVA) EQUIPTENT INVOLVED: 9800: NO EQUIPMENT INVOLVED FORT OF HEAT 46: HEAT FROM PROPERLY OPERATING EQUIP 71 : trilAN-[rlADE BUILDING:CONTENTS ESTIMATED VALUE $0.00 $500.00 ESTIMATED LOSS $0.00 $500.00 8: NO ALARM PRESENT SPRINKLER SYSTEiI TYPE:# OF HEADS OPENED: 08: NO SPRINKLERS PRESENT FOLLOryV.UPII{VESNGATIONREQUESTED: Y IIATERIAL FIRST IGNITED WAS MADE OF: ;1EM FTRST tcNtTED: FINI 34: CLOTHING NOT ON A PERSON MOBILE PROPERW AND CONTENTS:OTHER: $0.00$6,000-00 $6,000.00 $0.00 SPRINKLER PERFORTANCE: 8: NO SPRINKLER PROTECTION REASON FOR DETECTOR FAILURE: 8: NO ATARM FAILURE REASON FOR SPRINKLER FAILURE: 8: NO EXTING. SYSTEM FAILURE lF YEs, vl,Ho u,lLL lNvEsrlGArE: Y: LOCAL FD PERSONNEL OR TEAM DETECTOR POVYER SUPPLY: 8: NO ATARM PRESENT DETECTOR PERFORMANCE: 8: NO ALARM PRESENT NUMBER OF INJURIES FIRE sERvlcE: O OrHER: O NUMBER OF FATALITIES FIRE SERVICE: 0 OTHER: 0 ] 'lrILE: Qsptsin DATE:'tot9t2004ilEtBER ilAKING REFORT: COX, DOuglaS ADDI]]ONAL INFORiIATION BY:TITLE:DATE: of Oregon Office of State Firc hal lncident Report ALARJII NO: 04' i3 EXPOSURENO:00fi! FORALLSTRUCTURE FIRES COMPLETE FOR ALL INCIDENTS ALARTDATE: 1OI€,|2cn4 AtARI{TlfE:19:51:00 ARRMLDATE:'lO/9l2OO4 ARRIVALTIIE: 19:56:00 tnCXlNDATE: 1O/9|20o4.BACK lN TIUE: 0:16:00 803 Bunryell, Dana Narrative for #803 - Battalion Chief - Dana Bunrell Dispatch on this fire was two Eugene engines and a chief officer, one Springfield engine, one truck mmpany and one medic with *Afjg as command. #841 anived first and reported a fully involved mobile home. They ask Engine #3 to bring in a hydrant line when they came. I arrived second after ffi41 and assumed command. I confirmed the hydrant line and requested Engine #1 to pull a se6nd preconnect off of #841 to protect exposures on the B side. I ask C-1 to come to the scene and be safety officer and has+ to report to the front of the structure to become the RIT team. I called dispatch for SUB, fire investigators, Red Cross and police. I instructed Safety to locate the main power and see if he could disconnect it, which he did within a couple of minutes. Wnie *g+t was aftacking the front of the fire, Engine #1 took a line down the B side and made entry into the rear of the trailer. I cautioned both companiels about apposing hose itreams and had #841 pump set up the fan when it was called for. The main fire was controlled within several minutes and the interior crew reported that the primary search was completed. I instructed C-1 to see if he could locate the occupant, which he did and reported minor smoke inhalation. I instructed #859 to check the patient and to also set up rehab in front of engine #841. After the first air bottle I instructed Engine #3 to relieve #841 and #854 to relieve Engine #1 for overhaul. After this was completed I had all the crews come out of the building and tumed it over to the Fire Maishals on soene when the crews broke down the hydrant line. All engines and medics were release from the fire and Truck #854 stood by to assist the investigators. Damage was estimated at $35,000 and Red Cross was taking care of the occupant. No injuries or damaged equipment on this fire. Dana Burwell - Battalion Chief - "B" shift Page 3 of3 SFLS Supplemental Fire'\ - tnt Report AljRIS NO: 0, 63 EXPOSURENO:0000 ALART DATE: 1OI9DOO4 ALARIf,TIME: 19:51:00 ARRIVAI-DATE: |Of,DcrJ! ARRIVAITIilE: 19:56:00 EACKINDATE: 1O|gDM BACK lN TlfE: 0:16:00 Personnel Apparatus 1 1 1 3 3 3 803 841 u1 84'l 854 854 854 8s9 8s9 Position Company Officer Engineer Firefighter Company Officer Engineer Firefighter BCO Company Officer Engineer Firefighter Company Officer Engineer Firefighter Firefighter Firefighter Name Bunrell, Dana Cox, Douglas Allen, Mark Evans, Jason SchwarE, Todd Kimball, Clifford St Sauver, Donald Starkey, Paul Archer, James Narratives Name Cox, Douglas At 1g51 hrs, 841 was dispatched with a full first alarm assignment to 4039 E. 16th Ave. 841 was first in. On anival I notified Dispatch that we had a mobile home that was fully invoved, and 841 was making an exterior attack. Eugene Engine 3, arrived avised me he was laying a supply line to 841 . I first used the deck gun to knock down the fire, with good results, and then switched lo a 1 3l4" pre-connea. FF Evans and myself, hit the fire through a window and knocked down the fire in the kitchen area, then advanced to the front door and knocked down the fire in the entry and a bedroom. We achieved good knockdown so we kept advancing, to the back of the structure. 803 anived and took command. Engine 3 took care of the exposure on the "B" side and assisted 841. After the fire was completely knocked down, we began a Primary search. Engine 3 took the rear of the structure and my crew took the front. We found noining and I advised Command we had an "All Clea/' on the primary search. I asked Commani to have ppV fans set up to clear the smoke, and then began a thorough secondary search. Nothing was found and Command was notified. We then began hitting hot spots but didn't begin overhaul until lnvestigators could get a look. 841 was then released to go to Station 3 for air and hoie, while 854 remained on-scene to help investigators. After restoring 841 , we returned to the scene and released 854. lnvestigators completed their work and 841's crew finished the overhaul. 841 returned to quarters to clean up, and then retumed for a finll look for hot spots. No hot spots or signs of smoke were found, and 841 retumed to quarters. Respectfu lly Submitted, Captain Cox 854 Scnrrart , toaA Structure fire 4039 16th street Glenwood 10togt0/. At 1951 hours on Saturday, October 09 2004 854 with crew of Schwartz Kimball St- Sauver was dispatched from FS4 to a structure fire at 4039 16th Street in Glenwood. Upon anival and order from lC 854 crew cleared an area and set up the RIT equipment. After approximately 15 minutes 854 crew relieved Engine 1 in the rear of the subject structure. 854 crew used an entirb air botle eac'h'while performing overhaul. All apparatus left and 854 assisted dfm with investigation and overhaul. When 841 retumed 854 went to FS3 to restock air and Bottles.854 was clear in Quarters at 2356hrs Respectfully, Todd Schwartz Page2 of3 SFLS Supdemental Fire 'ent RePo*A|ARHNO: 0 163 EXPOSURE NO: ff100