HomeMy WebLinkAboutPermit Building 1993-04-14SPFlII\lGFIELE,
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726'3769
O{f ice: 726-3759
LOCATION OF PROPO
ASSESSORS MAP:
JOB NUMBER
225 Fitth Street
Springfield, Oregon 97 477
TAX LOT:
SUBDIVISION:LOI:BLOCK:
PHONE:
ztPSTATE
OWNE
CITY:
ADD
DEMOLISH OTHERNEW -- FIEMODEL ADDI
DESCRIBE WORK:
EXPIRES PHONEADDRESSNAME
A
PLUMBING
MECHANICAL
ELECTRICAL:
CONST.
CONTRACTOR #CONTR
CENER
_ OFFICE USE _
r OF BDRMS:
OUAD AREA
CONSTR. TYPE: .-
- -
RANGE:
HEAT SOURCE:
ZONING CODE:
FLOOD PLAIN:
WATEFI HEATER:
-
LAND USE:
# OF UNITS
SECONDARY HEAT
SOUARE FOOTAGE:
s OF BLDGS: -
OCCY GROUP:
g OF STORIES:
To request an inspection, you must call 726-3769. This is a 24 hour recording. All inspeclions requested before 7:00 a.m. will be
macJe the same working day, inspections requested after 7:00 a.m. will be made the following work day.
REQUIRED INSPECTIONS
Temporary Electric Rough Mechanical - Prior to
cover.
Final Plumbing - When all
plumbing work !s complete.
Sile lnspection - To be made
after excavation, but Prior to
setting forms.
Rough Electrical - Prior to Final Electrical - When all
electrical work is complete.cover.
Underslab Plumbing / Electrical /
Mechanical - Prior to cover.
Electrical Service - Must be
approved to obtain Permanent
electrical power.
Final Mechanical - Wlten all
mechanical work is complete.
Footing - After trenches are
excavaled.
Building - When all
Fireplace - Prior to facing
materials and framing lnsP.
required inspections have been
approved and building is
completeC.Masonry - Steel location, bond
beams, grouting.ffiraming - Prior to cover
Other
Foundalion - After forms are
erected but prior to concrete
placement.Wall/Ceiling lnsulation - Prior to
cover.
Underground Plumbing - Prior
to filling trench.Drywall - Prior to taping
MOBILE HOME INSPECTIONS
Underlloor Plumbing / Mechanical
- Prior to insulation or decking.Wood Stove - After installation
Post and Beam - Prior to floor
insulation or decki ng.lnserl - After iireplace aPProval
arrd installation of unit.
Blocking and Set-Up - When all
blocking is complete.
Floor lnsulalion - Prior to
decki ng.Curbcut & Approach - After
forms are erected but Prior tc
placement of concrete.
Plumbing Connections - When
home has been connected to
water and sewer.
Sanitary Sewer - Prior to f illing
trench.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, torms
and sub-base fi]aterial in Place.
Water Line - Prior to fiiling
trench.
Fence - When comPleted
Street Trees -- When a!l required
trees are pianted.
Final - After all required
inspections are approved and
porches, sklrting, decks, and
venting have been installed.Rough Plumbing - Prior to
cover.
l
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Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total height
Lot Type
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
Setbac ks
PL.
N
J
E
HSE GAR ACC
i5-t HE r)nOPOSED WORK llv Tl"lE
rJrsroRrcAl DtsTntoT, oR oN
THtr HISTORICAL RL,GISTER?
-
lf yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
APPROVED
VALUE
tl9,43
(A)
X $/SQ. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
BUILDING PERMIT
ITEM SQ. FT.
Main
Garage
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This perrnit is granted on the express condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Developlnent Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said o
Plans Rcviewed By Date
Plan Clreck Fee
Date Paid
Flecei pt Number:
Fleceived
ances.
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtu res
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Mobile Home
FEE
(c)
N0
FT.
FT.
PLUMBING PERMIT
Plumbing Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Fireplace Unit
Dryer Vent
(D)
N0Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rnace
Exhaust Hood By signature, I state and agree, that I have caref ully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I f urther certif y
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springf ield, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify that only contractors and employees who
are in compliance with OFIS 701.055 will be used on this
proiect.
I further agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from the street, that the permit card is located at the front
of the property, and the approved set of plans will remain
on the site at all times during construction.
sisnature lL^ h" ^ ,l.z 't\.$
,
Datc
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electricat)
(A, B, C, D, and E Combined)
lFI
D
DATE PAID
VALiDATION:
RECEIPT NUMB
AMOUNT R
RECEIVED ]
FT.
" lt,.t ln\ _
Fill in the
Permit No:
Address:
lssued Date:
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
under ORS 701.010(7), need not submit this statement. This statement will be
filed with the permit.
licable 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.
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.
1
3.A
2
OR
3.B 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.
I hereby certily that the above information is correct and that ! have read and understand
the lnl6rmation Notice to Property Owners about Construction Responsibilities on the
reverse side ol this form.
I h,t^^,1'r-rl- -Ag17
nt
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
rNFoR,A;roN NorcE ro pRopER* o*ir*a
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This lnformation Notice to Property Owners About Construction Responsibilitps
was deVeloped by th-e Construction Contractors Board in accordance with ORS 701.055(fl,
passed by the 1989-Oregon Legislature. :"
lf you are acting as your own contractor to construct a new home or make a substantial imprwement to an
existing structure, you can prevent.many problems by being aware of the following responsibilities and areas
of concern.
,,
EMPLOYER RESPONSIBILITIES
lf you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting
in the constructioh or iriprovement,of a residential structuie';'yogwill,'in most instances, be- luled to be an
"employer" a.nd the people yori hiie will be "employeeS". Ag.[he erhployer, you muglcomply with the following:
Oregon's Withhqldilg Tax l.aw: ,As an,gmployer, you mpst withhold income taxes from,enployee wages at
the time employees ape paid. Yoy wjfl.be liab{e for the taxrpayments even if ygu.doh't Bclually withhold the
tax from your employees. For more information, call the Oregon Depafi,rne-ntgfuReWnUe,at 378-3i190.
Unemployment lnsurance Tax
, :" IAs an employer, you are required to pay a tax for unemployment insurance
purposes on the wages of all emplo/€€s; For more inficrmation, call the Oregon Enlployment Division DHR
at 378-3224.
Workers' Compensation lnsurance: As an employer, you are subject to the Oregon Workers' bompensation
Law, and must obtain workers' compensation insurance for your employees. lf yoy fail to obtain workers'
compensation insurance, you may be subject to penalties and will be liable fordl claim costs if"one of your
employees is injured on the iob. For more information, call th9 Workers' Compensalion Division DIF at gT3-7434.
U.S. lnternal Revenue,Service: .4s an employer, you must withhold federal income tax fr:om employees'wages.
menteveriityoLdidnltaciualIywithholdIhetax...Fo,,o,"infoimation,call
the lnternal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Complidnce: As the permit holder for this pfoject, you are responsible lor resolving any failure to meet
code 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, wabr damage from pipe punc-
tures, fire, or work that must be re-done.
Time to Su Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, 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
o24N 10t24t89
C'TY OF OFEGON'
SPrlt,{GFtELO
ELECTRTCAL PERHIT APPLICATION225 PIFTE STREBT
SPRINGFIEID, ORBGoN 97477
INSPECTION REQTIEST:
0PPICB: 72,6-3759
726-3769
4lr"
ALT,ATIoI:,
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Ir' $r
B
City Job Nunber
1. LOCATION OP INSTfl^
LEGAL DESCRIPTION
Permits are non-transferable and expireif vork is not started vithin 180 daysof issuance or if vork is suspended for
180 days.
2. COIITRACTOR INSTALI,ATION ONLY
COXPI^BTB PEE SCEEDTILE BELOS
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
1000 sq.ft. or less
Each additional 500sq. ft or portion
thereo f
Each Manuf'd Home or
-Hodular Dvelling
Service or Feeder
s 8s.00
s 1s.00
s 40.00
Services or Feeders
InstalIation, Alterations
or Relocation:
A
Sum
Electricar contractorCbr.^.n$ €Gi*Z
Address Bt-l 200 amps or less
201 amps to 400 amps
-401 amps to 600 amps
-601 amps to 1000 amps-
0ver 1000 amps/volts
-Reconnect 0nIy
O, O,)-G{ [
city LtA(ftArlU phone ){Y-oro5-
Supervisor Licen-se Number 3A"FS
Expiration Date
Constr Contr. Number 1-01%:1aqq6
Expiration Date
S
C. Temporary Services or FeedersInstallation, Alteration or Relocation
200 amps or less S 40.00
201 amps to 400 amps
-
S 55.00
over 401 to 600 amps
-
$ 80.00
0ver 600 amps or 1000 voITs see ttgrt .ffii-
Nev, Alteration or Extension Per Panel
one ci rcui t I $ ls . oo (\5.4'
Each Additional
-FCircuit or vlth Service
or Feeder Permi t $ 2.00
E. Hiscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation SSign/0utline Lighting- SLimited Energy/Res
-
SLimited Energy/Comm $
STIBTOTAL OP ABOVB5f State Surcharge
TOTAL
s s0.00
s 60.00
s100. 00
$130.00
s300.00
$ 40.00
o
':lt:;"*rvising BIec rrcran
gl rt-, $
D. Branch Circuits
Ovners Name
Address 'to i fu 0"4; 1L
Ci ty s,&trtJ Phone QLI-5q61F
OVNER INSTALI..ATION
The installation is being made on
property I ovn vhich is not intended
for sa1e, lease or rent.
0rners Signature:
40.00
40. 00
20. 00
36.00
5
RBCEIVED
ta)
4,\c
DATB:
Is
CMY OF SPRhiGFIELD
Fire & Life Safetv
F]Pi DA]/IPGi RtPOP.;
OR
ELECTR]CAL HAZARD
DA.TE:7lz+ tq >
TO:
FR0l.1:
SUBJECT:
Bujlding Department
Spri ngfi el d Fi re Department
Structural Daniage to Bu'i'ld'ing
\1 0 b35A+/D5co
Address or location of buildino 4A .AJ. 4+a
Name of o\rner L 214- lt?(q
Type of bu i 1d'ing
Estimated I oss to bu'ild'inc 5
Date of fire
= lz4 [qs
Location of damaoe in buildinq [,,Jalls )o,qf| c.iIi.rq .,oio)o,"rt, (ara.t
ro
(Roof, I^lal 1 ,terior, Interior, etc. )
Structural weakness as a resul t of the f ire N)o,-,<_ nDkA
I
(Burned rafters, Beams, "1oi sts, etc. )
Add'i t'ional perti nent i nforma t'ion
CC
c,<; l;
ord<.)
Sjqned
,{
0A. 4/,.
qElectrical Hazard E bu,coJcr
(l,l'iri nq , 0utl ets , etc . )
q
4oor+.run+ 11,,ih
(Dwe1 1in-0, Store, l.larehouse, etc. )
Estimated va I ue of bui I di nc S [.b. n, tr-t
' W//A ( Ya,/rtott4Y >Z/4#
"%*-<gg *vt//rtz hrr+o
"ruap1pQ
al OH/?"*a7Z
' (2Zya,gq sNil IsatruQ 7-rarxtat/-"'aryry .Swaqoilfi
/ vd?a teurD zqnsrfilr a/- 4*n au#u-ve 7mtr
CMry- OF SPRINIGFIELD
Fire & Life Safetv
FIRt DAI{PGE P.EPORT
OR
iLECTRICAL HAZARD
DATE:lzafi>
TO:
FROM:
SUBJECT:
Building Department
Springfield Fire Department
Structural Damage to Bu'i 1 di ng
\1 0 b35A4 ID5N
Address or location of buildinq 4a N. 4+a
Name of o\.Iner |la^ Brr*iln-{.U, 244- 1t?1 (?.r+to,',1\
Type of buiiding
(Dwel 1ing, Store, I^larehouse, etc. )
Est'imated val ue of bui I di nq
Estimated loss to build'inq
Date of fire Z
Location of damage 'in buil di ng [,Oalls )o,oft c<i(inq .,oio)o*), (ara.f
i^ b<droon- a+,l { ir'inq CYQtt
-(noor -
Structural weakness as a result of the fire
^)orr<_
11D E4
(Burned rafters, Beams, .1oi sts , etc. )
Addjtjonal pertinent information
Electr-ical Hazard E b,,CDV<T
C<; l;
Sjqned 0/4. 4/4
(l,Ji ri nq , 0utl ets , etc . )
4o" rluurtl r t,.its
CC
FAX TRANSMISSION
TO: ATTN: NEWS ROOM FROM: John Garitz, Deputy Chief
DATE: March 1992
Springfield Fire and Life Safety
225 North Fifth Street
Springfield OR 97477
726-3737
FAX 726-2297
INCIDENTT FACT SHEET
lncident Type: Structure Fire
Incident Date: March 24,1993
Incident Address: 406 North Fourth Street, Apartrnent 2, Springfield
Response: 2fire engines, l medic uniL 1 incident commander
Number of Personnel: 9 fuefighters
Condition upon Arrival: Smoke and flames visible from a front corner bedroom of the
two-story, wood framed building. The building contained five apartrnent units.
Occupants had evacuated prior to fire crerry's arrival.
Action Taken: Fire crews made a direct interior attack and were able to control the fue
fairly quickly. A search was conducted to insure that no one remained inside the affect'ed
aparfrnent unit or in adjacent units. A ventilation fan was set-up to remove smoke.
Damage was conlined to the aparfinent of origin.
Times:
Dispatched:
Arrived:
Under Control:
Cleared Scene:
l2:34
l2,36
12:50
13:32
[m3unies: No injuries reported
Fire Cause/Origin: Fire investigators have determined that a five-year-old occupant of
tlie apartnent was playing with matches. The fue started in a bedroom closet.
Occupants: The aparftnent is rented by Arcadio and Maria Gonzales. Seven people
were in the aparnnent at the time the fre was discovered.
***CONTTNUED***
INCIDENT FACT SHE -' -- Page 2
Owner Information: The apartrnent building is owned by Alan Brandenfels of Portland
It is managed locally by Gloria Hernadez,406 North Fourth Sheet, Apartrnent 14.
Damage Estimate: Struchre: $8,000 Contents: $2,000
fnsurance Coverage: The building was insured. The occupants did not have renter's
insurance.
Working Smoke Detector Present? There was no baffery in the smoke detector
Comments: Occupants were in the living room when they noticed smoke coming from
the bedroom. Upon opening the door to the bedroonr, they noticed fire coming from the
closet area. They all evacuated the building. A neighbor also noticed the smoke and
reported the fire to 9-1-1.
The occupants willbe displaced until repairs can be made to the apartrnent. They are
staying with locat relatives. Occupants of the other four apartrnents in the building were
allowed to refurn.
***END***
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