HomeMy WebLinkAboutPermit Building 1989-03-10APPLI CitrtON /PERI4IT
225 North |th Street
Springfield, )regon 97477
Building Diuision
coLr ?nE?I du-u I oo
SPF|INGFIELOI" RESI; :NT|AL"
Job Locaticn: f,.
I'az Lot llAssessore llap #
Sttbdiuision:
Otmer:
: Phone:Addtess
City:
r
Describe Nork
.ldditicn
ilobile Hone
f
-1
on,oon,
Val.ue
Ned
n &
tr C
Date of Applicaticn
General
P lurnb ing
Uleccrica
DEI.IOLITIO!] OR
Receipt i
6,)
3
SITE INSPECIION: To be nade aftez"
es;aD;tl;h-5ut prior tc set up of
forme.
WEEF tLB ?L!!Dl!!, xLEgl4!l!_L_ x
lvtECHLllICAL: To be made before any
cooered.
F)O?INC & F)UNDATICN: ?o be naCe
iVtZF-tFencG{ai7 erc au a t e d and
forns are erected, but prior to
poul*iltg ccncrete.
UND1RGROUND PLUMSrNC, SEWP. tl.qrUR,
DR!I\\! !: To be naCe priot to fil-Tfi-li6n.hes.
UNDERFLOOR PLUI,EING & I4ECITANICAL:
o1
fToor insulation or decking.
P1Sf AND BEAI|: ?o be rnade prior to
I.I
d
required oapor batriers dte in place
but before any Lath, gApsun boarC'or'
unLL cooering is applied, and before
any insulation is concealed.
DRYHALL INSPECAI1N: lc be nw.de
afie"-itT-6yuatt-ts in place,
but prior to any taping.
MAS)NRY: Steel Location, bond
Gffiilgrouting or oerttcals in
accotdance Ltith U.B.C. Section
24L5.
\10ODSTO'|E: After installation is
cctnpleted.
D
Date:
Scnilar! eas*. !!.pp4 7.t ylopetty Lire
Septic totk p;.nped and. fi.Lled vtth gra:sel
Final - l{hen abcoe itens are ecnoleted
and uhen Cenalition is conrplete or stn^r-
tute moued and prenrLses cleaneC up.
IIcnes
Blocking otd. Set-up
Plunbittg connections -- aaie! anC uater
Electrical Ccmnection - Blocking, set-u:
and plwnbing connections rrust be appncu-el
before requeating eleclrtcal inspec:iot.
I
Accessory* BuiLCiry
"$
S uperv i-s i Ele<'t r'( !.lln
It ie the reaponaibility of tle permit hoder to aee that aLf, inapectiona at,e nade at the prope" ti,me, that ecch cddress is t'eadab)e
fron the st?eet, aruC that the permtt eatd is Loeated at the front of the property.tBuilding D.luiciot ap;t'otetl p'L,tn shcll remain on the Buildinq :-!Lt at all tines.
26-3769 (recorder,) state yout, city lesignated job nwnber, job aC&,ess, type of inspec=ict;
inspection, Contractors oi Asners-nsne and plone nunbet,. Requests teceited befcre 7:0C ctPROCEDURE FoR INSPECTIOTT R\QUEST :CALL 7
@tbereadyfot,'-'iLL be nade the sane dcy, reqxiests nade after, ?:00 an uyill be nade the ncat uorking dag
Ioun City Desigr,ated Job Nunber Is:
I
I
iistiTlii-c" o7
decking,
No
these i
nade ard approued
FIPEPLACE:
materiaLs
CURB & APPROACII APPON:
a". "r.ett;A-b;rw;ot,
After formsto pouringLOn Ot'
haue been
Ptiot, to plceirq facittg
and before fratning inspec-
eoncrete.
SIDEIIALX & DRI"'EI,IAY: For al?, can-
crer;nal)W ,rlti6 st?eet right-
of-tt:!, to be maCe aften al.L erca-
oating complete & forn wrk & sub-
base material in Place.
Final - After
etc. are conp
pcnchea, ekirting, decks,
leted.
tion.
d71 mu':tltc: tutust be nequested aften
lxj "pp"rr"L of rough ptwrbing, tiectri---.r cal & neclanical, AL! roofing
bracing t chinmcys, etc. rntst be
eompleted. llo ucrk i,s to be con-
cealed until this inspecticn has
'been nade anC appro'"^ed.
FII|AL PLU!,!BIIIG
I4E!HAN ICAI,
IENCE: ta\ten complete -- Pt'ottiCe
gates on nouable sectians through
P. U. E.
ALL pno;jcat aondi.t'i.ons, su,:h us the i.nstallation of street toees'conpletian of the
ned LanCsccp'ing, ctr:', tmtst be satisfied before the BUILDINC FINAL can be requested
FINAL BUII,DINC: The llinol Buildt-ng fnspection rmtst be requested after the Final Plwnbtn3
Electr,tcal, aru| Mecharical Inspections hgoc been nade ard approoeC.
P.rf:e 1oJ't
FTNAL ET,ECTfi'ICAI,
*AI,I, I4AII\ICI,ES AND CLIIANOUTS III]S,T RD AC(,"ESSIBL[:, ADJUSTIIEN! TO BE I'IADE AT NO COST TO EIIY
r
iltJOB NO.
/Corst:
cSOLAR ACCESS REQ.-L-CO
B,ztlroons
LCT TWE
_ fntericr
_ Corner
_ Panlnnd.Le
Cul-de-sac
Lot Faces -So;o,eesIot Sq. Ftg.
7, cf Lct Cooerage
Set !tea
Df House C.Access
! of Stories
Total Height
Topography
,kia
Fi 1r)crt
TTEI.I FTG x Va Building Volue & Permit
this permit is granted on the exptless eondition ttnt the said.eonsttaction
jii.ff', L, all rZspects,- eonfornt'to th-e crd'ina,ice adopte'1 6y the city 2f
iprtrgT;nU, inc!ludtn17' l,L" \oning Crdtna.trc.e, ra'julcLi.ttg .thn ":'::t-\:l:"t:.r^i"d "'iL of Luildiryls,- and mey be, suspende'd or reuokec at ctty tlme upon olc-
Lation of any prcuisions of said ordinances'
t
TOTAL VALUE
uc
S.D.C 1.5 a
Building PenrLt PLan Fee
Date Pa:-d
State
?otal Changes q)*Signed:
ITEM N0.FEE CHARGE Plumbing Permit
No pereon slall constrttct, install-,- altet or ctange -ctlll net)).cr ecisting
;ir;bia "; it'airage systLn in ahoie or. in part, unLess such person is the
i"-gir p"o""nr"o, o7"o iltii pt-i"r,s L.tcense, eaceptt that a pe"son ma! dg
plhtlig uork to proprity ,hi"h i" oumed, Leased or operated by the appli-
cant.
Fi*tut es
Residential (1 bath)
Seuer
Waten
Plwnbing Pernit
State
lotal
Electricol Permit
Hlpt'e State Lau requiles tt^,at the electt'ical aork be done by -an Eleetrical
Conttaetor, the elictrical portion of this -pemit shall not be oaliC until
the Label'has been signed by the ElectrieaL i:otttt'd'ctor'
State
lotal
+iNeu/Efierd Circuits
Seroiee
FEE CIIARCEITSM
I
State
Mechonicol Permit
Eslwnst llood
I'lcodsto;le
Vent Fol
Permit Issuance
Mechanical Penntt
-- ENCROACHMENT --
sea'u'itu Deposit
Stot,d.ge
Maintenance
Permit
Curbcu!
Sida,salk
lence
Electyical Inbel
Receipt ll:
TATA-Planr Eaamirter
IHA\EcARgFULLyExA],llNEDthecompletedapplicationfo.rpermit,anddatni"ty ii"ll.fy tnot otl infonnation heneoi- is true an'd cortect, amc r
fu,tk"er centZiy that ang ard aLL uo.r'k pe-rfotned elnll be done in accot-
Enee tith th'e" Ordinanc"es of the Ctty of bpringfield, and th-z Lc:;s of the
xitL ,r oregon pertainina to the uork cescribed herein, cnd tlnt No occu-
peicy ,itt b"e ,a1e of any" struetut,e uithout permissi-on of the Bui.Lding Di-
oision. I further eertifil thd; only contracto"s a;id enpLcYees t'ho are Ln
canpliance uith cRS 701.05s uiLL be used on this proiect
Total
I"lobile Hone
)TOTAL AMOUNT DUE:,
Date
t\)N1'r:ol,
NO.
D() NO't'WRl tE IN I'iltS SI'ACfl S l'.r\ I'E Of,' OItDUOi\ r"lRE l(UPLr, t'l'
STATE FIRE M,\RSHALtixP
N()
' !)EPT.
t ...(l\l NO.JFg'j -
District of Incident
2 INCIDENT ADDRI'SS
6
NAME (tast. Firet, Ml)
4 BUSINESS NAME (Last, Pint, MI)
5 OWNER NAME (Last, Fint, MI)
6 FIRE REPORTED BY (Last, First, MI)
E NoAlarmRec'd D NotCtrsifiedAbove
I)ept. Responding
E HandJaidho*/hy&ant,standpipe D Undetermined
D Master Stream Device
E Not Clrosified Above
Below level Undetermined
Not CIassi6ed
50 storix or more
CouIly
'7 Telephone Direct
D MunicipalAtarmsystem
E PrivateAlarmsyst€m
Radio
E verbal
n v"hi"l"Fir"
E Brush, Grass, Iaava
E Trash, Rubbish
I
9l I (Tie Line)
Voice Signal Muni Alarm
70 feet
ln
oEz
a:
'lLF:jIt ItEJEa=
APr.t.
c)
EP
a:Ji!
b r,,,t \1
,i>t.l.
o
7
"0
.l5
4,
rr
t-t
o
U),J
|.
-l
U)
a.l
Co
'J
frl
rrl(t)
z-
fInn
tr
n
D
D
ALARM
8 #OFPIRESERVICEPERSONNEL
RESPONDED
9 TI'PEOFSITUATIONFOUND
Structure Fire
Other Prop. w/value
TO METHODOF
EXTINGUISHMENT
II FIXEDPROPERTYUSE
D Self-Extinsuished
E Make-shift aids
E PortableExtinguisher
E Other(Liso
Automatic Ext, Sy6t€m
Pre-connect hose/tank only
Pre-connect hos/hydrant, standpipe
E
]\,t MOBII-E
PROPERTY
l2 ROOM/AREA ORIGIN
vED
IN IGNITION
r3
l4 OF
t7
l8 UILDh"C AGE (In Yean)
19 CONS'fRUC1'ION TYPE
E Steel&
Heavy Unprotrct. St€€l Bldg
E Protect. Steel Bldg I Protect. Masonry Ext. & Wmd Int.
Unprotect, Masonry Ext. & Wood Int.
Protected Wod Frame
I5 LEVEI. OF FIRE ORIGIN
E/Grade letel to 9 feet
l0 to 19 feet
20 tn 29 feet
30 to 49 feet
50 to 70 fet
16 VAI,UE
LOSS
2 stolies
3 to 4 st ties
5 to 6 stories
7 to 12 stories
13 to 24 storiG
25 to 49 storiG
3 {hr.
Unprotected Wmd Frame
Not Classilied Above
EXTENT OT DAMAGE CONFINED TO:
I The object oforigin
2 Part of room or area oforigin
20 3 Roomoforigin
4 Fire-rated comp. oforigin
5 Flooroforigin
6 Structureoforigin
7 Extended beyond structure oforigin
Flame Smoke
9 No damage of the tlpe (N/A)
2t
z2 Follow Up Investigation Requested ]Z If ym, who * ill investigate
I
2
3
4
5
6
't
I
2
3
4
5
6
7
D!
D!
E
D
I
Y N
23 Numberoflnjuries
Fire Senice
2{ Mcmlrr Ma}ring llelrrrt
25 r\ddittrnal Information bY
t\10
1-
DAY
./
YI]AR
e1
Tues
\\'ed
n rr,,
! r'i
ALAR)\T TI]\'E
n lr,,n o6
Sun Satur
I
I)AY Ot'
\1'UUK
ATTRIVAI,'IIi'E
/lo9
1'IME IJACK IN
SDltvICE
/,f / 2-
CENSUS TRACT
/?,or
IS() CI,.ASS
3
DOB (optional)TELEPHONE
1q6 - qe qq
ADDRESS DOB (optional)TELI'PHONE
ADDRESS DOB (optional)TELEPHONE
ADDRESS DOB (optional)TELI'PHONE
E Received D ciu"r E NZe
o! investigate only)
# OF ENGINES RESPONDEDL # OF AERIAL APPARATUS RESPONDED # OTHER VEHICLES RESPONDED
(do not include PA's) -A
! Extinguish
E Inr*tigation
fl s"lu"g"
D NotClassified
TYPE OF ACTION TAKEN
! Removed Haard
! Stnd
PROPERTY COMPLEX (lf applioble)MOBILE PROPERTY (Complete line M)
SERIAL #LICEr*SE #\.EAR MAKE ]\lODEL
EQUIPMENT INVOLVED IN IGi:ITION (Complete Line
hent lnno ;ru \ttrtt
E)
lro,,
YEIR I MAKE I\IODEL SERIAL# /VOLTAGE
FIRST lGn*ITED \vAS N{ADE OF ITEM FIRST IGNITED:
Contents
.00 .00
Other
.00
,AI,
.00
Building
.00
.00 .00 .00 .00 .00
50,000-99,999 sq ft
100,000-499,999 sq ft
BU
I o-ssg
500,000 sq ftFlr
tr trft5000.9999 ft 20,000,49,999 ft
1000.4999 sq ft 10,000-19,999 sq ft
SPRt NK I,ER PERFORMA n"CE
t I Equipmentoperated
2 [ Equip.shouldhaveoper.-didnot
3 D Equip.presentfiretoosmalltooper.
9 D Notclassifiedabove
0 E Undeterminedornotreported
8 E Noequip-entpresent(N/A)
Sprinkleru Controlled Fire: YES fl NO !
I of Heads Opened
DE'f ECTOIT PERFOR]\,IANCI:
n!
trE
U!!!!
I In roomof origin-oper.
2 Not in room oforigin-oper,
3 [n rm of origin-not oper-fire too small
4 Not in rm oforigin-not oper. fire too small
5 In room oforigin-not oper. powet disconn6t
6 Not in rm of origin.- not oper. power di*on.
7 In room of origin - not oper. dead battery
8 Not in rom of origin-not oper. dead battery
9 Nodettctorpresent D lO Untleter-ined
Fire Service Ot her
Date'l irle
Dal t,'l'ille
814-440-10 (R-86)
Other
D cont. on back
I-t
L, ,,"
3
!
fI
ZIP
?1t78
I
l-,J- Qq(^ r, ,,r'{ ,, i u I
FIRE DA}4A.GE REPORT
OR
ELECTRICAL HAZARD
Yq$q^)
\ll I
UV
TO:
FR0r'1:
SUBJECT:
Building Department
Springfield Fire Oepartnent
Structural Damage to Building
0tto,
DATE: ;''.{- 81
4
^
AAddress or location of building
Name of ot,ner F[ *u.*(;rh
Type of building
Dwel I i ng, Store, llarehouse, etc.)
Estimated value of building
Estimated loss to bui'lding
Date of fire ,. - .{- 89
t ?-s-oo . a o
$ 4o,oo ,Oo
Location or damage in bu'ilding
f, l,.Ja1 1 , Exterior, Interjor, etc. )
Structural weakness as a result of the fire f\ntte -
(Burned raf ters , Beams , .lo i s ts , etc . )
Addi tr'onal oerti nent i nforr:la tion
Electrical llazard [h^,r-nt"'.{.^rY,o\ "rl I [,Prt t )e te
2
Siqned (ru,.u R. ll*rolrL
olorllr;r ,l
(tr.li r i ng , 0u tl ets , etc . )
cfi,r e. Ili ru q
\-,rtl^ r,to L[ + tosr n.l e f,{,i^e p+,rf
(
8q MQ ?-'
FiRE DA}4A.GE REPORT
OR
ELECTRICAL HAZARD
lqo ,, \lt {
(r)
DATE: 2'1- e q
TO
FRCI'1:
SUBJECT:
Bui'lding Department
Springfield Fire 0epartment
Structural Damage to Building
4
4
AAddress or location of bu'i'lding
I'lame of or.Jner
Type of bui'lding c(we t/iNq
se , arc]
$_ \g,ooo r ooEs timated va I ue of bu'i 1di ng
Es tima ted I os s to bu'i I d i ng
Date of fire L -.{- A9
$?-(oo . a o
Location of damage jn bui'lding
, r,./al I , Exterior, interior, etc. )
(Burned raf ters, Beams, ")9ists, etc. )
Addjtional oertinent information i(?Trr.atel y'ztae/rft>, rF ro
Electricai Hazard No^,r-rt^,,',f ,^rY , -{( o\.,1 lLert t^)(-re- e)or)r;c
LL.J
Siqned / u u ,,u R [\1 u,< o[..."r
,l
6
(t/irinq, 0utl ets, etc. )
\^u,tl r re [f + to.rr n..l ef,{,'re pg,rf
Structural weakness as a result of the fire Anate -
(' - )'l ,fl * - (t ,eF ',,c, 7 *
I