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Home My WebLink AboutPermit Building 1992-10-27RESID ENTIAL PERMIT APPLICATION lnspections: 726'3769 Of fice: 726'3759 s GFIELO e JoB NUMBE R ffA7z 7 225 Flfth Street Sprlngfleld, Oregon 97 477 LocAroN oF PRoPosED woBK: - /6a- ASSESS.FT. M^pt D€7 %: _t2- I r'\r' - BLOCK: SUBDIVISION: TAX LOT: ZIP:sSTATE: pHoNE: a,Az-Ort* CITY: ADDRESS: OWNER ADDITION DEMOLISH OTHER DESCRIBE WORK: NEW- BEMODEL PHONEEXPIRESADDRESS_fuy*CONTRACTOR'S NAME GENERAL: CONST, CONTRACTOR # ELECTRICAL: -----. Pt-UMBING:-- .. MECHANICAL: RANGE: r OF BDRMS: _ OFFICE USE - LAND USE: ZONING CODE: FLOOD PLAIN OCCY GROUP:. WATER HEATEFI: r OF STORIES: r OF UNITS: SECONDARY HEAI SQUARE FOOTAGE: OUAD AREA: , OF BLDGS CONSTR, TYPE: HEAT SOURCE: To request an lnspectlon, you must cail 726-3769. Thls ls a24hour recordlng. All lnspectlons requested before 7:00 a.m. wlll be made the same worklng day, lnspectlons requested after 7:00 a.m. wlll be made the lollowlng work day. REOUIRED TNSPECTTONS [--l Temporary Electric Rough Mechanlcal - Prlor to cover. Flnal Plumblng - When all plumblng work ls complete. Site lnspecllon - To be made after excavatlon, but prior to setting lorms. Rough Eleclrlcal - Prlor to Flnal Electrlcal - When all electrlcal work ls complete.cover. Underslab Plumbing/ Electrlcal / Mechanical - Prlor to oover. Eleclrlcal Servlce - Must be approved to obtain permanent electrical power. Final Mechanlcal - When all mechanical work ls complete. Foollng - After trenches are excavated.Flreplace - Prlor to faclng rnaterlals and framlng lnsp. w Flnal Bulldlng - When all requlred lnspectlons have been approved and building is completed.t_J Masonry - Steel locatlon, bond beams, groutlng.Framlng - Prior to cover. Foundatlon - After forms are erecled but prior to concrele placement. Other Wall/Celllng lnsulalion - Prlor to cover, Underground Plumblng - Prior to filling trench.Drywall - Prlor to taping. MOBILE HOME INSPECTIONSUnderlloor Plumblng/ Mechanical - Prior to insulatlon or deckln1l.Wood Slove - After lnstallatlon Post and Beam - Prlor to floor insulation or decking.lnsert - After flreplace approval and lnstallatlon of unlt. Blocklng and Set.Up - When atl blocklng ls complete. Floor lnsulatlon - Prlor to decki ng.Curbcut & Approach - After forms are erected but prlor to placement of concrete. Plumblng Connecllons - When home has been connected to water and sewer. Sanilary Sewer - Prior to filling trench.Eleclrlcal Connectlon - When blocklng, set.up, and plumbing lnspectlons have been approved and the home ls connected to the servlce panel. Storm Sewer - Prlor to fllling trench. Sldewalk & Drlveway - After excavatlon ls complete, forms and sub-base materlal ln place. Walsr Llne - Prlor to fllllng trench. Fonce - When compl€ted. Slreet Tleae * Whon all requlred trees are planted. Rough Plumblng - Prlor to cover. r E tl tl tl tl E [-i'flnat - After alt requtred '-J lnspoctlong.are approved andporchesr sklrtln!, dbcks, and ventlng have been lnstalled. tl fl tf i APPFIOVED BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT Thls permlt ls granted on the express condition that the said consiructlon shall, in all respects, conform to the Ordinance adopted by the City of Sprlngfleld, including the Development Code, regulatlng the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances' DatePlans Reviewed BY Plan Check Fee Date Pald FleceiPt Number Received BY w@ VALUE ,fru. -2 -?*- (A) BUILDTNG PERMI so.FT. X $/SQ. FT.ITEM Main Garage Carport Total Value Building Permit Fee State Surcharge Total Fee Systems Developtrtent Charge is due on all undeveloped properties within the City limits which are being improved'SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtu res Residential Bath(s) Sanltary Sewer Water Storm Sewer Mobile Home PLUMBING PERMIT FEE No FT. FT. (c) Plumblng Permlt State Surcharge Total Charge Wood Stove/ lnsert/ Flreplace Unlt Dryer Vent MECHANICAL PERMIT (D) No Mechanlcal Permit lssuance State Surcharge Total Permit Furnace Exhaust Hood Vent Fan By slgnature, I state and agree, that I have carefully examined the completed appllcation and <lo hereby certify that all lnformationhereonistrUeandcorrect,andl{urthercerti{y that any and all work perlormecJ shall be done ln accordance wlththeOrdlnan<;esoftheCltyofSpringfield'andtheLaws of tho State of Oregon pertalnlng to the work descrlbed hereln, ancl that NO OCCUPANCY wlll be made of any structure wlthout perrlission of the Builcling safety Division' lfurthercertllythatonlycontractorsandemployeeswho are ln compliance witlr ORS 701'055 will be used on this prolect. e to ensure that all required inspections are he proper tinre, that each address is readable Date e I lurther agre requested at t t card ls located at the f rontfrom the street, that t -z-qz set of plans will remainof the ProPe ng constructionon tlre site MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sicjewalk - ft Curbcut _=- ft Demolition State Surcharge Total Miscellaneous Permlts (E) DATE PAID AMOUNT RECEIVED - RECEIVED BY _ VALIDATION: RECEIPT NUMBETI TOTAL AMOUNT DUE (excludlng electrical) (A, B, C, D, and E Comblned) Lot laces Lot sq. ftg. ,..} Lot coverage TopographY Total height Lot Type -- lnterlor l -_ Cdrner - Panhandle - Cul-de-sac ks PL.HSE GAR ACC W E N s f i THE PROPOSED WORK lN THE YIISTORICAL DISTFIICI, OR ON THE HISTORICAL BEGISTER? _.- lf yes, thls appllcation must be slgned and apProved bY the Hlstorlcal Coordirrator prlor to permlt lssuance. FT. Slgnature €=- -7/52f Job No. q -7 JOB ESS t6o ^t -t?Plr /Ll CITY OF SPRINGFTELD Developmenl Servlces 225 North 5th Street *,t Building Division Date 9-?0.e2- TO: ( \\:- CALL FOR REINSPECTION - INSPECTOR { I ""CALL FOR: - INSPECTION 726'3769 - INFORMATION: 726-3759"" SPFlINGFIELE' RES!DENTIAL PERMIT APPLICATION I ns pecti ons: 726-3769 Office: 726-3759 JoB NUMBE a 9Zo=Z 7 225 Fifth Street Springfield, Oregon 97 477 d 4LOCATION OF PROPOSED WORK: ASSESSORS MAP:12:e3'34:uZ TAX LOT:26/b LOT: - BLOCK:SUBDIVISION PHONE: 4)aaz_ztP 6 STATE:*.CITY: ADDRESS: OWNER: NEW - REMODEL ADDITION DEMOLISH OTHER DESCRIBE WORK: EXPI RESADDRESS PHON ECONTRACTOR'S NAME MECHANICAL: ELECTRICAL: CONST. CONTRACTOR # G EN ERAL: PLUMBING RANGE: * OF BDRMS: - OFFICE USE - LAND USE: WATER HEATER: + OF UNITS: FLOOD PLAIN: ZONING CODE SECONDARY HEAT: SOUARE FOOTAGE: OUAD AREA: * OF ELDGS: OCCY GROUP: * OF STORIEST CONSTR, TYPE: HEAT SOURCE: To request an inspection, you must call726-3769. This ls a24hour recording. All inspections requested before 7:00 a.m. will be made the same working day, lnspections requested after 7:00 a.m. will be made the following work day. REQUIRED INSPECTIONS Rough Mechanical - Prior to cover. Final Plumbing - When all plumbing work is complete. Site lnspection - To be made after excavation, but prior to setting forms. Rough Eleclrical - Prior to Final Electrical - When all electrical work is complete.cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Eleclrical Service - Must be approved to obtain permanent electrical power. 8 Final Mechanical - When all mechanical work is complete, Footing - After trenches are excavated.Fireplace - Prlor to facing materials and framlng lnsp. Final Building - When all required inspections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prlor to cover. Foundation - After forms are erected but prior to concrete placement. Other Wall/Ceiling lnsulalion - Prior to cover. Underground Plumbing - Prior to filling trench.Drywall - Prior to taping MOBILE HOME INSPECTIONS Underf loor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation Post and Beam - Prlor to floor insulation or decking.lnsert - After fireplace approval and installation of unit. Blocking and Set.Up - When all blocking is complete. Floor lnsulation - Prior to decking.Curbcut &Approach - After forms are erected but prior to placement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling trench.Eleclrical Connection - When blocking, set-up, and plumbing inspections have been approved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & Driveway - After excavation is complete, forms and sub-base material in place. Water Line - Prlor to filling trench.l--l Fence - When completed Streel Trees - When all required trees are planted. Final - After all required inspections are approved and porches, skirting, decks, and venting have been installed. tl Rough Plumbing - Prior to cover. 18o-a/7-{ [l Temporary Electric ll tl E E tl E E tl Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner - Panhandle - Cul-de-sac Setbacks P.L.HSE GAR ACC N S E i -Ts rHe PRoPosED woRK tN THE HISTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? - lf yes, this application must be signed and approved by the Historical Coordinator prior to permit issuance. APPROVED: BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any provisions of said ordinances. Plans Reviewed By Date Recelpt Numbe Plan Check Fee: Date Paid Received By: BUILDING PERMIT ITEM SO. FT. X $/SQ. FT.VALUE (A) Total Value Building Permit Fee State Surcharge Total Fee Main Garage Carport Systems Development Charge is due on all undeveloped properties within the City limits which are being improved. SYSTEMS DEVELOPMENT CHARGE (SDC) (B) ADDITIONAL COMMENTS ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge Wood Stove/lnsert/Fireplace Unit Dryer Vent 4,ra /?4t/_/5: (D) N0 /2- to Vent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood 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 f urther 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 Building Safety Division. I further certify that only contractors and employees who are ln compliance with ORS 701.055 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 f ront of the property, and the approved set of plans will remain 9 on the site at all ti esd Signatu Date MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E)/z-6€DATE PAID AMOUNT RECEIVED BECEIVED BY VALIDATION: RECEIPT NUMBER TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) /-aa4' =-----J> -F2€,5 SPRINGFTELD RESIDENTIAL PERMIT APPLICATION lnspections:726'3769 Ol{ice: 726'3759 LOCATION OT: PRO ED RK: ASSESSORS MAP h,*n ) JOB NUMBER 225 Fifth Street Springfield, Oregon 97477 TAX LOT: SUBDIVISION: PHONE: zlPI STATE: OWNE ADDRE CITY: ?.| ADDITION DEMOLISH OTHER DESCRIBE WORK NEW-- REMODEL PHONEEXPIRESADDBESS ELECTRICAL: CONTRACTOR'S NAME MECHANICAL: - -- G EN ERAL: PLUMBIN CONST. CONTRACTOR # RANGE: # OF BDRMS QUAD AREA _ OFFICE USE _ FLOOD PLAIN # OF STORIES OCCY GROUP: _-- SECONDARY HEAT: SOUARE FOOTAGE: LAND USE: ZONING CODE: WATER HEATER: CONSTR. TYPE: HEAT SOURCE: # OF BLDGS: - - To request an inspection, you must call 726-3769. This is a 24 hour recording. All inspections requested before made the same working day, inspections requested after 7:00 a.m. will be made the following work day 7:00 a.m. will be REOUIRED INSPECTIONS d',FinutPlumbins - When all H plumbing work is comPlete. ( l-I TemporarY Electric ll Rough Mechanical - Prior to cover. Sile lnspection - To be made after excavation, but Prior to setting forms. Rough Electrical - Prior to Final Electrical - When all etectrical work is comPlete.cover. Underslab Plumbing/ Electrical / Mechanical - Prior to cover. Electrical Service - Must be approved to obtain Permanent electrical Power. Final Mechanical - When all mechanical work is comPlete. Footing - Af ter trenches are excavated.[-l Fireplace - Prior to facingu materials and framlng lnsP. Final Building - When all required insPections have been approved and building is completed.Masonry - Steel location, bond beams, grouting.Framing - Prior to cover. Other Foundation - After forms are erected but Prior to concrete placement. Wall/Ceiling lnsulation - Prior to cover, Underground Plumbing - Prior to f illing trench.[-_] Drywatl - Prior to taoing. MOBILE HOME INSPECTIONS Underlloor Plumbing/ Mechanical - Prior to insulation or decking.Wood Stove - After installation Post and Beam - Prior to floor insulation or decking.lnsert - After firePlace aPProval and installation of unit. Blocking and Set'UP - When all blocking is comPlete. Floor lnsulalion - Prior to decki n g.Curbcut & APProach - After forms are erected but Prior to piacement of concrete. Plumbing Connections - When home has been connected to water and sewer. Sanitary Sewer - Prior to filling t ren ch.Electrical Connection - When blocking, set-up, and Plumbing inspections have been aPProved and the home is connected to the service panel. Storm Sewer - Prior to filling trench. Sidewalk & DrivewaY - After excavation is comPlete, forms and sub-hase material in Place. Water Line - Prior to filling t ren ch. Fence - When comPleted Street Trees - When all required trees are Planted. Final - After all required inspections are aPProved and porches, skirting, decks, and venting have been installed. ver. h Plumbing - Prior to n r tl E E E E E E tI EE Lot faces Lot sq. ftg. Lot coverage Topography Total height Lot Type - lnterior - Corner -- Panhandle -_ Cul-de-sac tb irslne PRoposED woRK lN THE HISTOFIICAL DISTRICT, OFI ON THE HISTORICAL REGISTER? - lf yes, this application must be signed antl approved by the Historical Coordinator prior to permit issuance. APPROVED: P.L.HSE GAR ACC N S E VALUE (A) X S/SO. FT. Total Value Building Permit Fee State Surcharge Total Fee BUILDING PERMIT ITEM SQ. FT. Main Garage Carport BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinance adopted by the City of Spring(ield, including the Development Code, regulating the construction and use of buildings, and may be suspended or revoked at any time upon violation of any i)rovisions of said ordrnances. Plan Check Fee: - - - Plans Reviewed By Date Date Paid Fleceipt Nurntrer:- Receivcd By: (B) Systcms Development Ch;rrge is due on all undeveloped properties within the City limits which are treing improved. ITEM Fixtures Residential Bath(s) Sanitary Sewer Water Storm Sewer Mobile Home FEE (c) N0 FT. FT. FT. PLUMBING PERMIT Plumbing Permit State Surcharge Total Charge ADDITIONAL COMMENTS Wood Stove/ lnsert/ Fireplace Unit Dryer Vent (D) NoVent Fan Mechanical Permit lssuance State Surcharge Total Permit MECHANICAL PERMIT Fu rnace Exhaust Hood By signature, I state an(l agree, that I have caref ully examined the completed applic:rtion and do hereby certify that all information hereon is true and correct, and I f urther certif y that any and all work pcrforrncd shall be done in accordance with the Ordinances of the City of Springf ield, 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 Building Safety Division. I further certify that orrly conlractors and employees who are in compliance with ORS 701.055 will be used on this proiect. I f urther agree to ensure that all required inspectio6rs are requested at the proper time, that each address is readable of the property, and the pp ES U Signat Date is located at the f rontfrom the street, that the permit set of plans will remain onstructionon the site at MISCELLANEOUS PERMITS Mobile Home State lssuance State Surcharge Sidewalk - ft Curbcut - ft Demolition State Surcharge Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrical) (A, B, C, D, and E Combined) DE DATE PAID VALIDATION: RECEIPT NUMBE AMOUNT R RECEIVED SYSTEMS DEVELOPMENT CHARGE (SDC) OREGO'UC'TY OF 225 ?TfrE STREBf, SPRINGPIBLD, ORBGON 97 INSPECTTON f,EQTIBST: 7 OPPICE: 726-3759 loa\ )_l 1 LOCATION OF IJGAL DBSCRTPTION Permits are non-transferable and expire if vork is not started vithin 180 days of issuance or lf vork is suspended for 180 days. 2. CO}ITRACTOR INSTALI,ATION ONLY aI#,l1l$Po3!tliff lf r$::xr's; z6mw(0 qp l'JlYil?crnrcer.PERilTT APPLICATION City Job Nuuber ?za 2,7 3. COHPI,ETB PBE SCffiDTIIJ BELOS SPlr!t\lcFIELD tial-Single ory per druelling unit. luded:Items Cost HuI t i-FamiI Service Inc $ 8s.00 Sum -* Electri trac r Ae'- Address $tv 24ry' PhoneVa-l.*r Supervisor Licen-se Number ? 7< > Expiration Date c Constr Contr. Number 7/72 Expiration Date 2?^9/ Signa of Supervising Electrician D Ovners Name Address ci Phone OSNER INSTALI,ATION The installation is being made on property I ovn rrrhich is not intended for sa1e, lease or rent. orners Signature: DATB: Temporary Services or Feeders Insiallation, Alteration or Relocarion 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or Hodular Dwelling Servlce or Feeder Services or Feeders InstaIIation, Alterations or Relocation: 200 amps or less 201 amps to 400 amPs - 401 amps to 600 amPs - 601 amps to 1000 amps- 0ver 1000 amps/volts - Reconnect OnIY SUBTOTAL OF ABOVE 5Z State Surcharge TOTAL B $ 1s.00 s 40.00 $ s0.00 $ 60.00 $100.00 $13o. oo $300.00 $ 40.00 200 amps or less $ q0.' 201 amps to 400 amps - $ 55. over 4b1 to 600 ambs - $ 80. 0ver 600 amps or 1000 voT[s see t' 00 00 aSoIE 00 BI' I Branch Circuits Nev, Alteration or Extension Per Panel one circuit $ 35'oo Each Additional Circuit or vith Service or Feeder Permit $ 2.00 E Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ 40.00 sign/outline Lighting- $ 40.00 t,iili tea Energy/Res -- $ 20.00 - Limited nner[yZcomm $ 36.00 RECEIVBD 5 CE JOB Permit No:qza7a2 Address:e_ 1 2 lssued te:r@Q 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 upon 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. OR 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. ! hereby certify that the above information is correct and that ! have read and understand the lnformation oti Property Owners about Construction Responsibilities on the reverse of is /o-zz -7 z Permit App icant Date R WHITE COPY TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT 3 0244J Bt91 natu N CONTRACTORS BOARD INFO*cIATION NOTICE TO PROPERTY M,NERS ABOUT CONSTRUCTION RESPONSIBILITIES NOTE: This lnfor:mation Notice to Property Owners About Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701OS5(5), passed by the 1989 Oregon Legislature. If you are actin$ as your owrt cintractor to construct a new home or make a substantial existing structure, you can prevent many problems by being aware of the following respon of concern. improvement to an sibilities and areas EMPLOYER RESPONSIBILITIES: lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an"employer" and the people you hire will be "employees". As the employer, you must comply with the following: on's Withholdi Tax Law: As an e mployer, you must withhold income taxes from em ployee wages at the time em oyees are paid. You wi ll be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390. Unemployment lnsurance Tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, callthe Oregon Employment Division DHR at 378-3224. nlqters' Compensatio As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. lf you fail to obtain workers' compensalion insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information. call the Workers' Compensation Division DIF at g7*74U. U"S. lnternal Revenue Service: As an employer, you must withhold federal income tax from employees'wages.-vou@ymentevenifyoudidn,tactuallywithholdthetax'Formoreinformation,call the lnternal Revenue Service at 221-3960. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: -ode Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet .ode requirements that may be brought to your attention through inspections. Liability and Property Damage lnsurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc- tures, fire, or work that must be re-done. Time to Supervise Employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contiactor, 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 503-378-4621 ozMJ fit24t89 ru-tL) SPRI}iGFIEI-} FIRE DEPARTMENT FIRE DA}IPGE REPOP'T OR ELECTRICAL HAZARD laaseq DATE E7 TO: FR0l'1: SUBJECT: Bujld'ing DePartment Springfield Fire DePartment Structural Damage to Bu'ii d'ing \1D3B*.^4zcr#,eoit fr Address or locatjon of bu'ilding Name of o\'/ner C) Type of bu i 1 d'i ng (Dwe ing'Store,I^larehouse 'etc. )CC, Estimated value of building Estimated I oss to bu'i1d'ing Date of fire 2- Locat'ion of damage i n buii di ng (Rcof , l'la ll,Exterior, I [terior, etc. Structural weakness as a result of the fire (Burned ra fters,geams, .loistS,etc. ) Add'i t'ional perti nent i nfornra ti on Electrical Hazard nq, 0utl ets ' e I $ o t, I t" i I I I s^"/4 /),)..c f'' L,-.'cc: I,t i S i qned tc. ) _."*. /)I 4.or)D 7