HomeMy WebLinkAboutPermit Building 2000-12-20Job# 00-01724-01
RESIDENTIAL PERMIT
City Of Springfield
Community Services Division
Building Safety
Page 1 of 2
SPRINGFIELD
h,
225 North Fifth Street
Springfield, OR97477
Location Of Proposed Site: 515 00040th St Spr
AssessorsMap#: 17023114
Lot: Block: Addition
Job Number: 00-01724-01
Office:726-3759
lnspection Line: 726-3769
Tax Lot #: 04003
Subdivision:
ctTY oF SPRTNGFIELD, OREGON
Owner: Buzz Steele
Address: 515 40th Street
Scope Of Work: Fire Damage
fire damage
Phone Number:
City/State/Zip:
Repair
541-747-5190
Springfield, OR 97478
Value: $17,000
Contractor Type
GeneralContr
Contractor
Ehlers Construction lnc
2066112 Roosevelt Blvd, Eugene, OR
97402-2536
Registration #
4231
Expiration Date
1111912000
Phone
541-689-6177
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 at
a.m. will be made the same working day, inspections
working day.
All inspections requested before 7:00
after 7:00 a.m. will be made the following
726-3769
requested
Ceiling lnsulation
Framing
Walllnsulation
Drywall
Fireplace
Fire Damage
FinalBuilding
Temporary Power
Rough Electrical
Special
Final Electrical
Required lnspections
Buildi
-Prior to cover.
- Prior to cover.
-Prior to Cover
- Prior to taping.
- Prior to facing meterials and framing inspection.
-When all required inspections have been approved and the building is complete.
Etectrical I
-Approval required prior to SUB energizing pole.
- Prior to cover.
-See Plan Review and/or lnspectors Notes.
-When all electricalwork is complete.
lation
Job# 00-01724-01
# Of Stories: Height (feet):
Current Units: Proposed Units:
Census Code: Does not apply
Total:
Page2 of 2
Construction Types
Occupancy Groups
# Of Buildings:
# Of Bedrooms:
Handicap Access?
Area (Sq.
Main:Accessory:
Fee Paid On Receipt# Value/Quantity Fee Amount
Buil
Building Permit
State Surcharge For Building Permit
Building Administrative Fee
Total Building
12t20t2000
1212012000
12t20t2000
4090
4090
4090
17,000 $122.50
$8.58
$3.68
$134.76
Electrical
Temporary: 200 Amps or Less
Branch Circuits With Feeder or Service
State Surcharge - Electrical
Administrative Fee - Electrical
Total Electrical
1212012000
12t20t2000
1212012000
12t20t2000
4090
4090
4090
4090
I
2
$40.00
$4.00
$3.08
$1.32
$48.40
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
$183.16
Lz- z-P 'ooa_z_
CITY OF 0,REGCfC
SPF. jF.ELE,
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Eome or
Modular Dvelling
Service or Feeder
B. Services or Feeders
Installation, Alterations
or Relocation:
D.
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-375s
FAX (541) 726-s689
DEVELOPMENT SERVICES
225 PIFIH STREBT
SPRTNGPTELD, OREGON 974
INSPECII0N REQIIESTz 726-3769
OFFICE: 726-3759
1. LOCATION OF INSTALI.ATION
SI f qorL\
I,EGAL
Z q-1Q-<_tt-
JOB DESCRTPTION
t-7 7=/ (q o"(oo_<
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONItsACTOR INSTALI.A:TION ONLY
Electrical Contractor Q,.r9-1.e | | Bart
Address
L 1L
Zoning )-,_o-eo
Signature
-
-b1.. , -P,I#ICTTJCAL PERHIT APPLICATION
City Job Number c>e ' a | -7 Z'( -O I
3. COI{PLETE FEE SCEEDTILB BELOS
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:Items Cost
Date
Authorized
77
A
Sum
$ 8s.00
$ 1s.00
$ 40.00
$
$s0
60
100$Ci ty Phone
Supervisor License Number
200 amps or less
20L amps to 400 amps
-401 amps to 600 amps _
601 amps to 1000 amps_
Over 1000 amps/volts
Reconnect Only
Temporary Services or Feeders
Installation, Alteration or Relocation
6 "tLtl -ZtlLt
q)Ll5 $130
s300
$40
00
00
00
00
00
00
Expiration oate iO -0 I -Ol
Constr Contr. Number 7 0 'q L{?(
Expiration Date t-o
ture of Elect clan
rs Name 'l3
Address j ti 16*l^
Ci 1ft'o Phone 17 T-6tzo
OVNER INSTALI,ATION
The installation is being made on
property I ovn which j.s not intended
for sale, lease or rent.
0rners Signature:
DATE:
2oo amps or ress i' $ 4o.oo
201 amps to 400 amps
-
$ 55.00
over 4b1 to 6oo amps
-
$ 80.00
0ver 600 amps or 1000 vofTs see rrB,
Branch Circuits
c
Nev, Alteration or Bxtension Per Panel
One Circuit $ 35.00
Each A<idi t ional
Circuit or vith Service /or Feeder Permit Z $ 2.00 Lt
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/0ut1ine Lighting_
Limited Energy/Res
Limited Energy/Comn
SUBTOTAL OF ABOVE
7%, state Surcharge
3% Administrative Fee
TOTAL
c)
c7,..l-r
Yo
a6ove-
.*{
$ 40.00
$ 40.@
$ 20.00
$ ro.Erl
W
P
Cra
Ll5
E' :T-I-DI>
m Crl.. {+
(3P
I
OGF.(}
O
ZZ.=e <2
*/--/u
RECEIPT_T
RECEIVED B
CITY OF SPRINT IELD
Fire & Life Safety
TO:
FR0l'1:
SUBJECT:
FIRE DAI'IAGE REPORT
OR
ELECTRICAL HAZARD
DATE: //-)?- Oo
Building Department
Springfield Fire Department
Structura'l Damage to Building
Address or location of building -f /5 4o * s4.
Name of or./ner R, ,z z -\/., /.
Type of building
(lling,tore, l,larehouse, etc.
Estimated value of building 6 OQ
Estimated'loss to building $d"
Date of fire _J
Location of damage 'in buil di ng
.62, F/,*.
J
{
(Roof, Wail, Exterior, Interior, etc.)
Structural weakness as a result of the fire
(Burned rafters, Beams, Joists, etc.
Additional pertinent information
Electrical Hazard
cc:
Signed
f,, A nr//"rf ,rfle /"*-i, etc. )
STATE OF OREGON OFFICL S|ATE FIRE UARS'IAL
2OM OREGON ALL INCIDET.IT REPORIING
o
ExposunsNo.-qo83
DEpr.REspoNDrNG Spri ngfi el d FireLaneDISTRICTOFCOI,,NTY
I AI.ARM//- A
DATEq -oo AL/\RMTIME2>7./"r,iJr?'rn ARRIYALDATE ARRIVALTIME2)3-?DATEBACK IN TIMEBACKINn.aa <
ze PRIMARY TYPE Ol. SITUATION FOUND: Of r fin b irrolvc4 c'i6 oE ryF of fE)
28
rc OTHER TYPE OF SITUATTON FOUND:
Eirid 5:.Frcld1:Frld2:Frldl:Fir:ld 6:
97q79
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DISTRICT/
ZONE5/s qo a sl.3 INCIDE!{TADDRESS
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TELEPEONEa OCCITPANT NAME (r <. Eirsq MD c COMPANY/BUSINESS NAMEHn,e/nn,ffi)Le .5'.
5 BUSTNESS-OWNER NAMSCIS( ErS( MI)DOB TELEPIIONE
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AP6 BUSINESS OWNER ADDRESS
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TELEPHONE7 BUILDINGyMOBILEPROPERTYOWNERNAME (L.st, ftrt MD
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I OF AERI L APPARATI,S
RESBOT{DING
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MUTUALAID
IO GTIEN
20 RECEII/ED
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36 trTransport
a2trHaznatID
4l E Rqnovc Hazard
47trDccon Arca
46 tr Dccon Pcople/Equip
{J I t1,{eai161 }lamat
35 tr Scarch
53 O Standby
52 OMovc Up
34 O Povidc FctsoDDd
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COMPLETEFORALLFIRES
q Il
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5lwatcr Carricd On Initial Apparanrs
7 tr Water From Taokcr/IcDdcr Sbudc
8 B Ground Cre*s W Equip &d/OrAir Support
9 tr Mcttrod Not0assificd Abore6WaterFrom3 trPortablc Draft Or
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r. PRIMAN,YAGEITIT OTETTINOUISHMENT
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CENERALPROPERIAUSE
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EQUIPMENT INYOLYE) IN ICNmoN (Cmpk c tiE D
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17 IGMTIONFACTOR
IE EI,|MANFACTORS
INVOLVEDIN
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hnAgceadccadcria Jrcilcs:
Eldsly
(Aee65t) tr
of
tr
r$taUy
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Mu&ipb Fcrsoos
Iffohrcd B
Aslccp l QMah
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Uocoasciors'
tr
19 FORM OF IIEATOF IGNTTION
,1<e,o/nce
MATERIAL FIRST IGNTTED WAS MA.DE OF()JooJ
rTEM FIRSTIGNITED
5'luJs
20 LEVELOFFIR'
ORIGIN I D Bclo* G@Dd z[c*-ar.*r 3 OetorcGsroa 4 B I! FliShr Floor of Origir
(SmrcrrcEsOolv)
2I ESrIMATED
VAI-T,,E a Buildiogq,/ aS ooG .oo
ComtJ.ooo .@
Mobilc Prcp<ty erd Coac*s
.@
OdE
.@
( , J\*ooo w
22 ESTIMATED
LOSS d .sr.',o.*6.*.o0 .@ 5ooc.*d
s"1
37 BForciblcEotry
, CffY OF SPRINGT-IELD
Fire & Life Safety
-)r"b tr Aqyl)f o/
,-7O> 3l tq oAoo3
DATE: /l-2{-Oo
FIRE DMAGE REPORT
OR
ELECTRICAL HAZARD
TO:
FROM:
SUBJECT:
Bu'ilding Department
Sprf ngfield Fire Department
Structural Damage to Buiiding
Address or location of bui'lding -f/5 9o* sl .
Name of or.Jner R,,zz S/eo /e
Type of building
, Warehouse, etc. )
tr oQ
'lling,
Estimated value of bu'i1d'ing
Est'imated I oss to bui ldi ng
a
$
,/{oo.?oo f
Date of fire //-JL/- OO
Location of damage in building
(Roof, l,'lalI, Exterior, Interior, etc.
Structural weakness as a result of the fire
(Burned rafters, Beams, Joists, etc.
Additional pertinent information
Electrica'l Hazard
t{i ri ng , 0utl ets , etc.
cc
Signed
sr,f,rE oF oRrcoN OFFTCE OF;rAtE ttRE UAnSflAL
2(rcO OREGON ALL INCXDE{T REBORTING SYSTEM
,!
FIREDEST. AIJRI{r{O.
E ooSuRENo-
ONgr[rlNctDEr.rr
trGrexczloRgoer
COMPLETE FOR ALL
DEpr. REsnoNDrNclpfi-Ogtie_ld_Eife_LaneDISTRICTOFCOT'NTY
2a PRIMARY TYPE OF SITUATION FOUND: Grrr.ttb intdvG4.d.rrbct F o(fir)
AARIYALTIME TIMEBACKINDAYOF
28 OTHERTYPEOF
DATE-oo
2C OTHER TYPE OF SITUATTON FOUND:
''.' EHd5:'Frddt.Fidd2:-:Fidd3:Frcld4:FkldG
CEITSUSTRACT/9,o2.'/ts </O $ ,.r1.
3 INCIDENTADDRESS
97</ ? IztP
S/rl,# 7
DISTRICT/
ZONE
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DOBa OCGJPANT NAME (bs.. EI:r. MI) a COMPANY/BUSTNESS NAME
/{n,elqn . ffi)te .S''sg/ 7qg- 2181
TELEPHONE
DOB TET.E.PHONE
()
s ruswesS owrteR NArt{fc-rs( EI!( Mr)
6 BUSINESS OWNER ADDRESS AP
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DOB (.s,r'l'zq? -5/? a
TEI.EPHONE7 BUILDING/I!(OBILEPROPERrr OTf,NERNAME Grsq Ertq lvtr)
S{ee./e , R,t?z P.
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10 INCIDENT RETORXEO BY ADDRESS
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'OFENGINESXESPTONDINC
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{ OFo!EER,NRESERVICE
- \ VEIIICIIS RESPTONDINGJ OO NONE
MUTUALAID
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20 RECETVED
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32OEricatc
33trEMS
TTI^TA'ILY)
36 trTransport
42trHazmaID
4l trRcoovc Hazard
gXEaablistr SafcArea
47trDccon Arca
46 tr DeconPcoplc@uip
45 tr Mooitor H"-'qat
43 trEvacuate
35trScarctt
53 B Standby
52trMovcUp
BOhcr
34 tr ProvidcPcrsonncl
T4trGocclcd atscrc
72 B CanelcdEnroutc
14tr[Salvage
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U TTPEOFACIION
37 tr'ForciblcEotry
13 PRIM,,TRIMEISOD
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7 O Watcr RomTaokcdlcodcr Shutdc
8 tr Ground Gews sr/ Eqlip Aod/GAir Sup,port
9 B Mcdtod Not0assificd6tr$tatcrFrom Draft Or
t. IRIMANYAGEITTOFErIING{'ISEME{r :i
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15 SPECIFICTROPERTTUSE'Residu,,,.
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GENERALPROPEETT USE
Duo le><
MOBILE PROPERIT II.IVOLVED (Coqlcc Er M)
M YEAR MAKE MODEL SERHL I/AIRCRAFTTAIL
'
IICENSE'STATE
EQUIPMENT DWOLVED tN IGMTION (Coqlcc rt E)16 ROOWAIEA OFFIREORICIN
lrbtn, Poor---. - fiaeb/ee<
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20FORTABLE
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17 IGMTIONFACTOR
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Mutflcncrsoc
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It ET'MANFACTORS
INVOLVEDIN
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fi<e,o/'qce
20 I,EVELOFFIR'
ORIGIN 3 EAboraGmrod 4 tr ro Fuslx Flu ofOrigi!
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Coorans*
.@J,oc
22 ESTIMATED
LOSS 6.*-@ .@
{ S.oo.*4 .s*o.*
o
FIRES
23 APPROXTMATE
BUU,DINCAbEc!Y6)a5
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4 E ro.ooo - 19.999 se FT
5tr 2o,ooo-t9,!99qIrr
Oh tocbdotB.ssH)
2' STR(rcTI'RETYPEpdr"a*asm,o-
3 tr Qca Srururr (t{o Walls)
4B Airssppodod Structurc
5B Tcsrt
6 B Opca Plsdorrn ( tlo Roo0
7tr UndcrgouodStrucorc
9 B Tlpc of Strucorrc Not Class'd AboG
@II8STRUCIIONTYPE
I OStcct & Concrae- 3a tlr
2BProrccedlv{asaryEr. & Wood hL
3OUnprotcctcd MasooryFrL &Wood hL
.f OProcacd. StcdBldg.
5O Uoprotcacd Stccl Bld&
6 O Hcavy Tirnbcr
7 O Protcacd Wood Frarnc
SlUnprotcctcd wood Erarnc
9 BTrrpc Not Classcd Aborrc
I B Class A Or B (Non Combustible; Mca! 1aa 6o-nosiCoaj
!cl<s C C-ocrpositiooorPrcFre4 Mar'l (Aspbatt Sbinglcs)
3 O Class CGEarcd atd Listcd Wood Shi"Clcs)
4O Untrtaad Wood Shirylcs
5 B Nonratcd RoofCovcring ( Canvas, Plastic, HotTar.)
8 OSt-uctur Without Roof
9 O RoofNot Classcd Abovc
ROOFCOI/ERING
)t'TLJTME TRA\1EL25 PRIMARY PRIMARY AVENUE OF SMOKE TRAVEL
7o .A#r2
EfrENT OF DAIilAGE CAUSM BY2t FIRE SAPPRESSION EFFORTS CONFINfr TO
FI,AIVTE
I-OObjcaof Origin
?}frn of Rooderea of Origin
3trRoomofOtigia
4 B Ffuc-rlatcd Comp. of Oigin
5 O Floor of Origin (Multi-Roor BlG.)
6 O Structuc of Odgin
7 B Bcyood Strucarlc of Odgin
8 0 Non-fire DarnascRcDtrt
SMOKE
I BObjcctof Origin
?)&n of Roonr/Arca of Origin
3 B Room of Origin
4 O Ercatcd C.omp- of Origin
5 O Floc of Origin (Multi-rloo( Bldd)
6 O Stuctnrc of Origin
7 O Bclond Srucorc of Origir
9ONoDamagcof ThhTlpc
ETTINGUISEINCACENT
I OObjcdof Oigio
2&n of RooE/&ca of Origin
3 tr Room of G.igin
4 O Fuc-ratcd Camp. of Origia
5 O Floo of Origin (Mutti-Roo( Bldt)
6 tr Structuc of OrigiD
7 tr Bqond Sructurc of Origin
9 tr No Dama* ofThis Ttpc
FIRE@NTROL
f BObjccrofOrigin
aFPart of Rood&Ea of origr"
3 O Roomof Origia
4 B Fuerarcd Comp of Origia
5 OFloc of Otigia (Multi-BoorBtdg)
6OStrucorcof Odgin
7 O Bclrood StuctrrE ofOdgin
9ONoDamagcofThisTypc l
REISON FOR AI.ARIU FAILURE
I O Hards,ircd Pourcr Supply Failcd
2 O Impropcr lrtalladoo or Placcrncnt
3ODcfcaiwAlarm
4 tr Ioadcquetc Meintcoaaoc
5 O Bat&ry Missing or Discoanecrcd
6 B BattcryDschargcd
8tsNoAlarmRilurc
0BFailurc Un&tcrmiacd
27 AIARMTYPE
rXsmokc
2gHcat
3 tr Codioation Smokc/Ilcat
4 O SpriDldclnila&r Flo,f,, Alarm
5 O Spcdal lf.zrd Sp Rdcasc Dcvicc
6 B Morc Than Onc Tlpe Prscot
TBGrboa MonoxidcAlero
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I O 06cr T)Dc of ALE Plcscat
O O rorlarm Unloodoot rcoortcd
AII,RMFOWER,ST'PPLY
ll8accryOtrly
2OHardwircOaly
3OPtugin
4B Hardwirc dBancry
5OPtuginw/Baacry
60 Mcchdtical
7 O MultiplcAlaro& Powr&rpplics
AI.ARM PERFORI{,{NCE
I O In Room of Origin/Alcrtcd Ocarpaals
2ENot in Room /Alcrtcd Occupans
3 tr In Rooro of Odginr,Did Not Opcaa
4 O Not in RoorD/Did Not Opc{atc
5 tr Prcscot iB RoorD/ErE Too Srnall
6 O Opcratcd/l.lot Eaorin Discovtry
7 O Opaatcdoccupaats Failcd ro Act
*RINI(I.ER PERT1ORMAITCE
I tr Opcatcd & CootolkdlExting'd ErE
2 O Opcr.ed & Not Cotol/Extiag ftc
3 O Shoold hate Opcalod/ D&l Not
4 O S)@ ItEscot/Fic Too Sraall
t tr f.so Eqdp io Rooo of Origin
OOFcrfornccUucportcd
REASOS{ NOR SPRII{Iq.ER, FAIII'RE
IOslsshotOff
2 O i{otEmotb fteot o Ooor,ol Eile
3 O AgEt Coold No( Rac.h Fte
4BS,@PipirgOamgea
5 O No llads h Rooo of Otigir
8trI.IoSymhilure
0 O Rcasd fo( hiht€ tncpctca
U SPRINKITR,SYSTEMTYPE
I OWaPipcs,ffi
2BDryPipcSptcm
3trDdugpSlaco
aOke-aaioo Sy*co
5 B Comb. Dry Pipc & Praecdm Sy:tcra
6 tr rco0f Sprinldcr lfcadr
7 tr Opco Hcad Sysuq l{anust Cootrol
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