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Home My WebLink AboutPermit Building 2000-12-11Job# 00-01699-01 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Page 1 ot2 TRANSS: 01-000400? DATE:DII 11 1000 AHT REID:X $ 3L?"0il IHAI',IGE: FAI:'UTtrEt, NtrCIUnUt lILl\. UJ I SPRINGFIELD h, 225 North Fifth Street Springfield, OR97477 Location Of Proposed Site: 2566 00021ST St Spr AssessorsMap#: 17032442 Lot: Block: Addition Job Number: 00-01 699-01 Office: 726-3759 lnspection Line: 726-3769 Tax Lot #: 00800 Subdivision: ctrY oF SPRINGFTELD, OREGON Owner: Loretta VanHooven Address: 2566 21st Street Scope Of Work: Fire Damage Phone Number: City/State/Zip: Repair Springfield, OR97477 Value: $40,000 Garage & Roof over Garage/H20 Heater in garage heavily arcing on arrival Contractor Type GeneralContr Electrical Contr Plumbing Contr Contractor Ehlers Construction lnc 2066112 Roosevelt Blvd, Eugene, OR 97402-2536 Crow Valley Electric lnc Po Box 22201, Eugene, OR 97402 Donn Merrick X, X, OR Registration # Expiration Date 4231 1111912000 9591 0 Phone 541 -689-61 77 541-729-5108 Quad Area: # Of Units: Constr. Type: Water Heater: Office Use - Land Use: Zoning Gode: Bedrooms: Range: # Of Buildings: Occupancy Group: Heat Source: Sq. Footage:; To request an inspection call the 24 hour recording at726-3769. All inspections 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 working day. Required lnspections Building I Ceiling lnsulation ShearWall Nailing Framing Walllnsulation Drywal! Final Building -Prior to cover. -Before covering sheathing with finish materials - Prior to cover. -Prior to Cover - Prior to taping. -When all required inspections have been approved and the building is complete. Electrical rU/7t 'Fo*?:! Special -See Plan Review and/or lnspectors Notes 1t6t2001 {f":e /6 u4).p, C ,uo Job# 00-01699-01 Page2 ot2 Required lnspections Final Plumbing Construction Types: Occupancy Groups: # Of Buildings: # Of Bedrooms: Handicap Access? Area (Sq Main: Plumbi -When allplumbing work is complete. Accessory: # Of Stories: Current Units: Census Code: Does not aPPIY Total: Height (feet): Proposed Units: Fee Paid On Receipt# Value/Quantity Fee Amount Buildi Building Permit State Surcharge For Building Permit Building Administrative Fee Total Building 12t1112000 1211112000 12t1112000 4009 4009 4009 40,000 $2s8.00 $16.66 $7.14 $261.80 Electrical Branch Circuits WO Feeder or Service State Surcharge - Electrical Administrative Fee - Electrical Total Electrical 12t1112000 12t11t2000 1211112000 4009 4009 4009 2 $37.00 $2.s9 $1.11 $40.70 Minimum Plumbing Permit Fee Number of Fixtures State Surcharge - Plumbing Administrative Fee - Plumbing Total Plumbing Plumbins 1211112000 12t11t2000 1211112000 12t11t2000 4009 4009 4009 4009 1 $5.00 $10.00 $1.05 $.45 $16.50 Grand Total By signature, I state and agree that I have carefully examined the completed application and do hereby certify that all information herein 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. I further state that only contractors and employees who are in 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 the project 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 construction Signature Date $319.00 \z - lr- 66 #o00tQqq-o/ 11 os z Lt^FD-16 ootoo FiRE DAMAGE REPORT OR ELECTRICAL HAZARD Building Department Springfield Fire Department Structural Damage to Building 1l-lt,hlt V6L Y6 TO: FROM: SUBJECT: N,t9Address or locat'ion of bu'ilding Name of o\./ner Type of bu'i 1d i ng Estimated value of bujlding Estimated loss to buildinq (Dwel 1 i ng , Store, I^larehouse, etc. ) 1) o0 00Date of fire Location of damage in building (Roof , l,la1l o Exterior, interior, etc. ) Structura'l weakness as a result of the fire 4{, Burned rafters, Beams, Joists, etc Additional pertinent information 0At"€ E'leCtri cal Hazard 'a 0C v6c cc:b1t-A{?C Siqned rl AUVRLN (1,/i ri nq , 0ut'lets , etc. ) DATE: Di"t tLcL,^/ L itr 6fiUb6 N(nvp< ffi.*&q ;.#3[ffir;L;tr"X*&L c0 _ r{ooDErr. ., .M No. E)cosuRE tr New INcrDEr.[r OCHANGEToREPoRT FORALL DTSTRICTOF OTTIER TYPE OFSITUATION FOUND: OFSITUATION FOUND: l6\-D COUNTY Lane DEpr. REspoNDTNG_S!Li-0.9-Li_e-ld_Li_fe__ Fir:ld 6: DISTRICT/ ZONE TELEPHONE 5.1 l, IN Irt Lll r Do llE typc of tirc) Decon Area Decon People@uip Monitor Hazrnat Evacuate TELEPHONE ztP MUTUAI AID I O GTVEN 20 nt'-t -(yoa 00 O tr NONE 0 zlP AKEN (CHECK AII-THAT APPLY ) aZjZkorciUte fntry l5;*f,ninguish 1@Ventilate Tl4PttvestiSate 3l trRescue 36 O Trarsport 42 D Haznat ID 32 O Extricate 4I tr Remove Hazard 33 tr EMS 44 O Esablish Safe 6 tr Class D 47tr 46E) 450 35 tr Search 53 B Standby 52 tr Move Up 34 tr Provide Personnel 74 O C:nceled at Scene 72DC-atrcr;ld En.oute COMPLETEFOR 8tr tr 7 B Water From Tanker/Icader Shucle 8 tr Ground Crews WEquip tud/OrAirSupport 4 tr Automatic Extiogrrishing Sptcm 5 Water Carried On lnitial Apparanrs J Portable DraftOr 9 tr Method Abovc 14 PRIMARY AGENT OF EXTINGUISIIMENT lE4tatcrOoty 3trClassAExring. 5DQassAIB/CExting. 7 O@2 9trCompressedAirFoam ll OClassBFoam/AFFF I tr Self-Extinguished 2 B Makeshift Aids 2 4 17 IGMTION FACTOR Water 13 BNone 14 tr OtherClass A Foam MOBILE PROPERTY INVOLVED IN IGNITION t20 liDcM) I OFDGD PORTABLE of Origi! ircL Y'E I 0 ^YWtAL,/\RM DATE/ /-lk-O o WEEK DA'>A (If a Eze PRIMARYTYPEOF ' :Fidd3:FieH 5:Frcld l:SPECIAL Ficld 2:. 97'*{77 zlP CENSUS TRACT 'Lo.o I 3 TNCIDENTADDRESS (tr /L{bL N, LlztT N,v OWNERNAME Fri( Mr) K (Lrq Fsq MI) E 6 BUSINESS OWNER ADDRESS DOB ?-/l-7L 7 0V( r/L€ OWNER NAME Clst, F6t MI) A BUILDINCI'{OBII lr PROPERTY bWT'ITN ADORESS 9An€ DOB c-17-tt4 ,,.,.H fi N(IL,^.^ ' /)\/6N N !J (L 9 INCIDENT REPORTED BY (kst,roq MI) 9anero u.rcroer,tT REPonrgp nv- eooffi #OFENGINES 7 RESPONDTNG / { OF AERIAL APPARATUS RESPONDING f OF OTIIER FIRE SERVICE - \EHICLESRESPONDING/- II *OFFIREPERSONNEL RESPONDINGaw f ?-*va*ro., (eU5E (,( GENERAL UCENSE*M YEAR MAKE d 16 R,OOIWAREA OF FIRE ORIGIN AZ-a 6( SERI.AL#POWER SOTJRCEE Multipb Pcrsons Iawhrcd O Nurnbcr of Jueailcs: Juwlilc O Put Agc.Dd GcDds iD REMARKS Eldcrly 1egce5+) tr Ptrysically Oisaduntaged tr lE ET'MANFACTORS INVOL\IED IN TCNITION Aslccp tr I OMab zBrcmt Uocooscious Unancodcd Pcrsoa tr FIRST IGNITED WAS MADE OF19 FORM OF HEAT OF IGNTTTON 3 O euorc Gmaa 4 O tD Fli8hr20 LEVELOFFIRE ORICIN I D Bclov Grurd d&andl*wl 2I ESTIMATED VALUE Buildine/Lb 0-0 0 *Cootos -//00 *and .00 OdEr .@ TOTAL/ZZ z-fD .oo 22 ESTIMATED LOSS / Sood */ot 0 .*8rD .oo .@ .@ ITEM FIRST Frc () ARR Frcld 4: DOBi-- {l DOB I tr STATE OF ORECON OFFIC ALLINCIDVi TYPE SITUATION ALL $r rE FIRE "^84,4 T REPoRTINGIT$mu- FIRE Af}ot{ No.D New lNcroerrr 1 1 OCH ITGETo REPoRT ff tla COUNTY Lane t}rc tYPc of fia) 47 B Dccon Area 46 D Decon PeoPle/EquiP r'5 O Monitor Hazrnat nrsrononc Spri ngf i el d Fi re Field 6: ZONE '9 DEPT. 35 O Search 53 B StandbY 52 tr Movc UP ,5rl l, 1 .b,{00 DTSTRICTOF 28 OTTIER OTHER xl or 3TffiorcibleEntrY l5fiPxtinguish l6Bar'entilate Tbdlnvestigate 3l O Rescue 32 O Extricate 36 trTransPort 42 B Hazrnat ID 4l B Rcmove Hazar<i IN ?6 {^ UP () ( ') () ztP I O GTVEN O O NONE 2 34 O Provide Personnel 74 tr Canceled at Scene 72DC-ateldEoroute OEMS 44 fd{faerOotY 3 DClassAF,xting'5 tr Class A/B/C Exting. 7 O@2 9 O ComPressed Air Foam I I tr Class B Foanr/AFFFl4AGENT 8tr l0 Class A t20 WWater 2 4 tr Ciass 60 D FRorsxrv lwou (Coqkrc ro Safe Area 43 13 O None 14 D Other s_0D o ALA I^nI YTYPEOF2LPRIMAR Frld4: Fi€ld 1:::Fidd3: zrP ADDRESS3 DOB 4 E. DOBU 1 1.i115t or ?€'b Field 5: CENSUS .0 I -5 1(lrL FiEt ,L NA}TE5 'An e Fust, 7 DOB FIRE( - V-EHICLESRESPONDINGt- #AERIAL RESPOI\'DING I 4 RESPONDING., Volut6r ll Carer RESPONDING *oF 7 tr Watcr From Tanker/Tender Shuule 8 O Ground Crcws W Equip And/Or Air Support J Ponable AbovcDraft 4 tr Automatic Extinguishing System 5 tr Watcr Carried Oa Initial ApparatusI tr Self-Extinguished 2 tr Makcshift Aids ,t!(e n(LA b€ USE t hM D YFARE IN -)n TAILf I BFDGD 20 Mutilc Pasou Iarohrcd E PhF caly Disadvaoaged E Eldaly (Agc6i+) E Nunbcr of Imilcs:Jul![ilc O hrtAgc eld Gcadaia REMARKS Pcfsoa o Asbcp D tDMah 2 E Fcalc 18 IIUMANFACTORS INVOLVED IN ICNTrION IGNTTEDTEMffiRr L nRsricxrrro wes UADE oF19 FORM OF AEAT OF IGNTTION I EatowGmua 4 E ID RiShr Floor of Gigia (Suucnrc Fucs Only) 20 LEVELOFFIRE ORIGIN t O Bclow Grcurd zdcr-rdt*t 2T ESTIMATED VALUE BuildiDg .00 Cootots .00 Mobilc Propaty ard Cootcas 7Y0 .oo OdEr .@ TOTAL?fb .00 22 ESTIMATED LOSS .oo .@ 7 5-0 .oo .@ '? rD oo ARR co.tt Frcld2: -sercrer- sruores arrcll U*) o Urconscious ,*#ffix[r*N';ffiI*&ftfl 0ffi DTSTRICTOF 2A PRIMARYTYPEOF 28 TTPE OF SITUA' 2C OTUERTYPEOFSITUA firc FORALL COUNTY Lane of firc) COMPLETE FOR ALL FIRES DEpr. RESpoNDTNG_Sp.f.i-0gtje_l_d_Li_fe_ Field 6: DISTRICil ,p, /G ,C,'tr ZONE j grl TELEPHONE TELEPHONE MUTUA.L AID I O GTVEN -bt/0 0 O tr NONE ztP 0- 110 01->ONEwINcDENT OG{ NcEToREPoRToN At ?D WtrNI t.-l 8 DA OF T>:1 I Ficld 2:: Fictd 3:Field 4:Field 5:SPECIALSTUDIES (kxitU*) Ficld 1: 3 INCIDENTADDRESS";-;'iL"; Lt$l ttt'tzlP CENSUS TRACT zo.ol s-t7'rlD084 OCCT,PANT NAME (hs( Frq MI) u COMPANY/BUSINESS NAME SU c.+1nN€ta. Dr,rpl r ?. DOB5 BUSINESS OWNER XAMS 0rl, Ers( IUI) DOB7 BUILDING^{OBILE PROPERTY OWNER NAME (Irt, Est, MD Srlne SAn e 9 INCIDENTREPORTED BY ({$t Fis( MI) 5 fr)tt DOB IO INCIDENT REPORTED BY ADDRESS 9nn ( tI *OFFIREPERSONNEL RESPONDING Carer l 2- l v"t*t c. #OFENGINES RESPONDINC>I 6 OF AERIAL APPARATUS RESPONDING ?- # OF OTHER FIRE SERVICE VEIIICLES RESPONDING rz rrrE or ecrroN TAKEN ( cHEcK ALL THAT Apply ) 37@Forcible Entry 7l EXlnvesdgate 36 D Transport lsdExtingrrish 3l ORescue 421HaznatD 16EWentilate 32!Ettricate 41 ORcmoveHazard 14 Atalvage 33 D EMS 44 O Establish Safe Area 47 tr Decon Area 46 O Decon People/Equip 45 O Monitor Ha:rnat 43 O Evacuate 35 O Search 53 O Standby 52 D Move Up 34 tr Provide Personnel 74 O Canceled at Scene 72 tr Canceled Enroute 4 D Automatic Extinguishing Slatem 5 tr Water Carried On Initial Apparatus 7 D Water From Tanker/Tcndcr Shurle 8 O Ground Crcws W Equip And/Or Air Support I:t PRIMARY METEOD OF EXTINGUTSIIMENT Method Not Oassified AbovcFromDraft Or I tr Sclf-Eminguishcd 2trMakchiftAids tEg/aterOnly 2trDirt 3 O Oass A Exting. 5 tr Class AIBIC Exting. '7 A@2 4trClassB/CExtine. 6trClassDExtine. 8OHalon 9 tr Compressed Air Foam I I O Class B Foarr/AFFF l0 E Class A Foam 12 O Wening Agcnt WWater 13 E None 14 tr Other 14 PRIMAR.Y AGENT OF EXTINGUISHMENT MOBIT F PROPERTY IIWOLYED (CoqIAc Iirc M)15 SPECMCPROPER,TYUSE Rs5ra€tce GENERAL PROPERTY USE tlcENsE fnt(It' GttG-STATE . -y'PNE:M YEAR.20 MAKE Npt)M.DELX LEDD t a> EQUFI|{EI{.r nWOLYED IN ICNmON (Corrytac Ljr D16 ROOM/AREA OF FIRE ORIGIN 6n4-nb e E YT4R POWERSOURCE T OFDGD 2 O PORTABLE MAKE MODEL SERIAL# 17 IGMTIONFACTOR T8 EI,,MANFACTORS INVOLVEDTN IGNIflON Jrcilc O Prt Agc rad Crcadct il Eld.dy 65+) tr Numbcr of Jumiics: PhftsicallY Disdrutaged E Multigb Pcrrcus Invokd E Aslccp tr t O Malc 2trFcmlc Umrcirru o Uunadcd Pcoo o 19 FORM OF EEAT OF IGNITION MATERIAL FTRST IGNITED WAS MADE OF ITEM FIRST IGNTTED 20 LEVELOFFIRE ORICIN r El Bclcw Goqd 2 tr Grould Lrrcl 3 OAborcGrDuDd 4 tr ID RiShr Floor ofOrigin (Strucnnc Frs Ouly) 2T ESTIMATED VALUE Building .00 Cootdts .@ Mobib PtoEw lrd Cou(tr'EO o .oo Ot}rr .@ TOTALr00 .00 22 ESTIMATED LOSS .@ .oo .ooi05 .oo /00 00 ) () ( .) () ARR t BUIIDING/MOBILE PROPERTY OWNER ADDRESS RATTT,(t l\