HomeMy WebLinkAboutPermit Building 1994-11-08SPFlINGFIELD
RESID ENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726-3759
LOCATION OF PROPOSED WOBK:
JOB NUMBER
225 Fif th Street
Springlleld, Oregon 97477
,4). /rb
ASSESSORS MAP:
LOX
-
BLOCK:
TAX LOT:,/z-A
SUBDIVISION:
-PHONE:
ZIP:7- -'STATE:%CITY:
ADDRESS:
OWNER:
DESCRIBE WORK:
NEW- REMODEL DEMOLISH OTHEBADDITION
ADDRESS EXPIRES PHONE
aScv
MECHANICAL:,t
CONTRACTOR'S NAME
GENERAL:
PLUMBING
ELECTFICAL:
coNsT,
CONTRACTOR '
_ OFFICE USE _
LAND USE:
# OF UNITS
QUAD AREA:
r OF BLDGS:
SECONDARY HEAT:
SOUARE FOOTAGE:
, OF BDRMS: --_
CONSTR. TYPE:
HEAT SOURCE:
OCCY GROUP:
r OF STORIES:
ZONING CODE:
FLOOD PLAIN:
WATER HEATER;-FIANGE:
To request an lnspectlon, you must call 726-3769. Thlsmade the sante worklng day, lnspections requested af
ls a 24 hour recording. All lnspections requested before 7:00 a.m. wlll beter 7:0O a.m. wlll be made the following work day.
REQUIRED INSPECIIOruS
Temporary Eleclrlc
Slte lnspectlon - To be madeafter excavatlon, but prlor tosettlng forms.
l--l Underslab ptumblngrEt€crrical/
-
Mechanlcat - prloi lo cover.
Footlng - After trenches are
excavated.
Foundallon - After forms areerected but prlor to concreteplacement.
Undertloor plumblng/ Mechanlcat
- Prior to lnsulatlon or decklng.
Posl and Boam - prlor to floorlnsulatlon or decklng.
Floor lnsulatlon - prlor todecklng.
[-l Sanitary Sewer - prior to filting.J lrench.
Slorm Sewer - prlor to fillin strench.
-t)4ll Rough Mechanlcat - prlor to/--acover-
( fX: Erectricar - Prior to
Eleclrical Service - Must beapproved to obtaln permanent
electrlcal power.
[-l Flreplace - prtor ro factng.J materlals and framlng lnspl
fftu-lng - Prlor to cover.
!]f WrlllCeiling tnsutarton - prtor ro.---1cover.
[--l Wood Stovo - Afrer tnsraltarton.
|_l lnsert - After flreptace approval
-
and lnstallailon of unlt.
Curbcut & Approach - Afterforms are erecled bUt prior toplacemcnt of concrete.
Fence - When completed
|}{ rinat ptumbing - When ail
-plumblng
work is completc.
f$finat Elecrricat - When ailqelectrical work is complete.
R
K
Flnal Mechanical - When allmechanical work ls complete.
Final Building - When ailrequired lnspections have beenapproved and building iscompleted.I--l Masonry - Steet locailon, bond
-
beams, grouilng.
Underground ptumblnrr.'flti;;;;;;h'.-"'""'n - Prior
ff.r*rn - prtor to taptns
Other
MOBILE HOME INSPECTIONS
Bloc&,ing.and Set.Up - Whcn altblocklng ts comptete.
i
Plumbing Connections a Whenhome has been connected towater and sewer.
Sidewalk & Drlveway - Afterexcavation ls complete, formsand sub-base material in place.
Eleclrical Connection - Whenblocking, set-up, and plumbinginspections have been approvedand the home is connected tothe service panel.l-_| Water Llne - prtor ro fiiling|J lrench.
re#?: Prumbing - Prror to [-l Street Trees - When ail requlred.J trees are planted.
Final - After all requiredrnspections are approved andporches, sklrilng, decks, and'ventlng have been lnstalled.
?/0/
E
lri' i i.
t,i I
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typ _
-
lnterior
-
Corner
-
Panhandle
-
Cul-de-sac
IS THE PROPOSED WORK TN THE .
HISTORICAL DISTRICT, OR ON
THE HISTORICAL REGISTER?
-
ll yes, thls appllcatlon must be slgned
and approved by the Historlcal
Coordinator prlor to permit issuance.
APPROVED:
PL.HSE GAR ACC
N
S
W
E
BUTLDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the sald
construction shall, in all respects, conform to the Ordlnance
adopted by the City of Springfleld, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any tlme
upon violation of any provisions of sald ordinances.
Plan Check Fee:
-
Beceipt Number:-
N,/,+Ptan;E GWed B,Date
Date Paid
Received By:
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
Total Value
Building Permit Fee
State Surcharge €,{3+ 3,3L
Total Feo (A)
VALUE
' 3,8f
/t2.3 r
/5aoaFr (llarz
Main
Garage
Carport
Systems Development Charge is due on all undeveloped
properties withln the City limits which are being improved'
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
ADDITIONAL COMMENTS
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
/5:0
Za,7f r, /f
FEE
.rZ/<) t
/r; ?^(c)
N0
FT.
FT.
PLUMBING PERMIT
Plumblng Permlt
State Surcharge
Total Charge
. FT.
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
19"o
/o ao
z a?"(D)
No
,7ft,y'f 20
Vent Fan
Mechanical Permit
lssuance
State Surcharge
Total Permit
MECHANICAL PERMIT
Fu rn ace
Exhaust Hood By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certlfy that all
lnformation hereon is true and correct, and I f urther certlfy
that any and all work performed shall be done in accordance
with the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made of any
structure without permission of the Bulldlng Safety Divislon.
I further certify that only contractors and employees who
are ln compllance with OFtS 701.O55 wlll be used on thls
proiect.
I further agree to ensure that all required lnspections are
requested at the proper tlme, that each address ls readable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans will remain
-7Date,tr4r77
on the site at all times durl ructlon.
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk
-
ft
Curbcut
-
ft
Demolition
State Surcharge
Total Mlscellaneous Permlts (E)
VALIDATION:
REcETPTNUMBER /1 37D
?-rAMOUNT RECEIVED
RECEIVED BY
DATE PAID
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, Q and E Comblned)/4/ZT
<4a' i' tz!^ i* y'' 't-t'
, ,.
11033*\2_corO
sr qt 3 r7l
3tt5S(ql
FIRE DAPIA.GE REPORT
OR
ELECTRICAL HAZARD
DATE:ir-/t-Q /q4l1l
(
TO:
FR0f*1:
SUBJECT:
Bujlding Department
Springfield Fire Deparbnent
Structural Damage to Bui'l di ng
Address or location of bu'ilding ?,{1 Al. l7 L
Name of oune
Type of building (<-ci nt t-
s
(Dwel 'li ng, Store, I^larehouse, etc. )
s ?0,00C-Estinrated val ue of bui 1 di ng
Estimated loss to building yJo
Date of fire 1t- 2- - 1q
Location of damage in building ( Nr.J o
(Rcof , l,.lal I , Exterior , Interior, etc. )
Structural weakness as a resul t of the fire n tn"a ft
(Burned raf ters , Beams , .1oi sts , etc. )
Add'i ti onal perti nent j nforma ti on
Electrical Hazard N O
(l.iirinq, 0utiets, etc.
ll-21.q,+ (-L Pu,l
0
Sjqned
ONC'TY OF SPR,,VG
SPR'NGFIELO
approval.
225 FIFTS, STREET
SPRTNGFTELD, oREGoN 97
INSPECTION REQUEST: 7
oFFICE: 726-3759
1.IH;TAtLA TION
{i JOB{<DtsgrPrroN
Permits are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspented for
180 days.
Ovners Name
Address
ci ty-Phone
OVNER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
t
0wners Signature:
DATE:
RECEIP'T
ELECTRTCAL PERHTT APPLICATTON
city Job N*b", €//71/
3. COHPLETE FEE SCffiDTIl^E BBLOS
A Nev Residential-Single or
Hulti-Family per dvelling unit.
Service fncluded:
I tems Cos t
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home or
Modular Dwelling
Service or Feeder
s 8s.00
$ 1s.00
$ 40.00
Sum
Address
Services or Feeders
Installation, Alterations
or Relocation:
B.
fl"c{r,'<
2. CO}ITRACTOR INSTALI..ATTON ONLY
Electricar contractor CP&J U:. /
o"" 6X3 A3?3
Temporary Services or Feeders
Installation, Alteration or Relocati
C
otR
supervisor License Number 3a)L/ 5
constr contr. Number 75'//O
o.
Expiration Date
Expiration Date
ofturegnasi
?
5
ingsperviSu
I 200 amps or less $ 50.00
201 amps to 400 amps
-
S 60.00
40L amps to 600 amps
-
$100.00
601 amps to 1000 amps- $130.00
over 1000 amps/volts $300.00
Reconnect Only $ 40.00
200 amps or less $ 40.00
20L amps to 4oo amps
-
$ 55.00
over 40L to 600 amps
-
$ 80.00
0ver 600 amps or 1000 voTts see "8"
Branch Circuits
ac.4<Ci ty
/4
EIec t.rtclErn
One Circui t l-
Each Additional
Circuit or vith Service
or Feeder Permi t 7
on
aE6E
$ 3s.oo v.\ n
s 2.oo '{
D
Nev, Alteration or Extension Per Panel
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/ou tline Ligh t ing-
Limi ted Energy/Res
Limi ted Energy/Comm
SUBTOTAL OF ABOVE
5Z State Surcharge
32 Administrative Fee
TOTAL
$40
s40
s20
s36
00
00
00
00
5
RECEIVED B
@
LEGAL DESCRTPTION
,^ =*?2i.4?r2a
it
q1
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NO.NO.
srArE oF oREGoN FIRE @;r)
STATE FIRE MARSHA\/DO NOT WRITE IN THIS SPACE
EXP.
lN6 uP
IRE DEPT.
ALARMNO.
Dept.
ST 3 xCONTROL
District of Incident
2 INCIDENTADDRESS
L n*e E NL€tk-D
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3
UCHi tr ul RNAME (last, firct,
4 BUSINESSOWNER (Last, Firet, MI)
s owNeRNalrar(Last,First, Ml)
rl OW rJ
6 FIREREPORTED BY (Irst, FiEt" Ml)
L( aCR (ck
OF Telephone Dirct Radio
\/
I
D Municipal Alarm SYstem
E PrivateAlarmSYstem
I verbal
f] No Alarm Re'd
9ll (Tie Line)
Voie Signal Muni AIam
Objets in
ALARM
OF TIRE SERVICE
RESPONDED
9 TYPEOFSITUATIONFOUND
=4Strtctr*Fit"D OtherProp.w/vdue
IO ME"IHOD OF
EXTINGUISHMENT
11 PROPERTY
15 LEVELOFFIREORIGIN
l€vel to 9 fet
tu veluB
LOSS
l',?
l8
€{/O6'/J r (
M MOBILE
PROPERTY
E EQUIPMENT
INVOLVED
IN IGNITION
IGNITION FACTOR
d
14 FORMOFHEATOFIGNITION
()v(N
E Notct *iri"dAbot"
E other(List)
Ext. System
ho*/tank only
fl Pre-connect ho*/hydrant, etandpipe
TJO QTOV €
l0 t! 19 feet
20 t! 29 feet
Over ?0 fet
E Hand-laidho*/hydrant,standpipe
fl Mmter Stum De'ie
E Notct"*ifi"dAbor"
Below gd. level
Not Clasifred
Proteted Wood Frame
BUTLENtcE
n Self-Extinguished
E Make-shiftaids
D PortableExtinguisher
il v"hi"l" Fi""
fl Brush, Grass, lsves
! Trmh, Rubbish
Heavy Timber
Prctet. Stel Bldg
Undettmined
UndetBmined
Wod Frame
Not Clsified Above
(!n Yqn)
19 CONSTRUCTIONTYPE
stel &3-4 hr
EXTENT OF DAMAGE CONFINED TO;
I Th€objectoforigin
2 Part of mm or am of origin
m 3 Rom of origin
,l Fire-Et€d comp. of origin
5 Flor of origin
6 Structureoforigin
7 Extanded beyond structure oforigin
9 No&mageof thetype (N,/A)
2t (optional):
22 Follow Up Invctigation Requested
30 to 19 fet
E sotozof*t
If y6, who will investigate
Unprct&t. St€el Bldg
Prot4t.ExL & Wmd lnt.
Int.
l-lame
IEzJ
3ErE
sE
Smoke
r!2E3E4EsE&=7n 7D
sE
Y- N
23 Numberoflnjurie
Fire Service
2,1 Membet R"po.t
25 Additionsl Itrformation by
o
TIMEBACK IN
0
TIME
7.yLJTIMEALABM/b! Mon -F **
D 'rr,r, E s"tt.
E r'i
TtesSunDAY OF
WEEKq/tMO DAYz lSO CLASS
3
DOB
-t
DOB (optional)ADDRESS
DOB (optional)TELEPHONE
ADDRESS
1 7
DOB (optional)ADDRESS
fl Ro"ir"d E cit". E r'l/e
or investiSat€
>/# OTHER VEHICLES RESPONDED
(do not include PA's)* OF AERIAL APPARATUS RESPONDED# OF ENGINES RESPONDED")l--' '
TYPE OF ACTION TAKEN
! Extinguish
E Invetigation
! Removed Haard
D St"na gy
El s"k"g"
E Notcluifi€d
MOBILE PROPERTY (Complete line M)PROPERTY COMPLEX (If aPPlieble)
LICENSE #SERIAL #MODELYEARMAKE
EQUIPMENT INVOLVED IN IC .ITION (Complete Line E)
tfCr:(r-t'OF FIRE
VOLTAGEMODELSERIAL #YEAR MAKE
ITEM FIRST ICNITED:
LL
MATERIAL FIRST IGNITED WAS MADE OF
60_(At (
.00o .00
Vehicle and Contents
.00 .00.00
.00 .00 4 40 0 *00 'w 000 .@
trtr
2 stories
3 to 4 storie
5 to 6 stories
7 to 12 stories
13 to 2{ 6tori6
25 to 49 stlrie
I S0storiaormore
50,000-99,999 sq ft 500,000 sq ft1000-4999 sq ft
sq ft,5000-9999 ft frftE
10,0O0-19,999 sq ft
DETECTOR PERFORMANCE
3
4
5
6
7
8
9
In rcom of origin-oper.
Not in mm of origin-ope!,
In m of origin-not oper-fire to smll
Not in rm of origin-not oper. irre too smll
In room oforigin-notoper. power dixonnect
Not in rm oforigin-not oper. power discon.
In rom of orig:in-not op€r. d€d battrry
Not in rmm of origin -not oper. dead battery
No dekto. presnt E t0 Undetermined
tr
tr
tr
tr
tr
tr
!r
SPRINKLER PERFORMANCE
Equip. should have ofEr,-did not
Equip. pIwnt fire te smll to oper.
Not classified above
Undetermined or not reported
0E-41 o ewto ent pr6€nt (N/A)
SprinktereControlledFire: YESE NOD
n
tr
tr!
E Equipmentoperated
# ofHeads Opened
OtherFire Senie
ofFataliti6
( -rt ( ,-tr/u '"* 6,q ?Tn iN o^" /tZ' 7 /
Title Date
Ql/ /rn-ln /o_ea\
Other
E cont. on back
\\-t
"ry'cr*"'c,i\it
TELEPHONE
I
2
r:-'
AP} 1
l\
ril
DO NOT WRITE IN TIIIS SP ACE
EXP.
srArE oF oREGoN FrRE "{8#STATE FIRE MARSHAL -FTREDEPT. <rq{-ALARMNO. "' '
I 3tts
CONTROL
District of Incident
2 INCIDENT ADDRESS
NO.NO.
F
2'1
Eo(r)rl
t.tta
Frt
U)
f
Eoarl
rr
15
41
15a
3 OCCUPANT NAME Fint, MI)
OWNER (L6t,
c-\
1
5 OWNERNAME (tast, Fint, MI)
6 BY (lrst, Fint, MI)
7
ALARM
e loF
RESPONDED
ll
M
PROPERTY
D Private Alam SYstem
Telephone Dirct
Municipal Alarm S1retem
10t 19
20 to 29 fftt
RadioE v""urt
E Nol"-n""d
911 (Tie Line)
E Voice Sigul Muni Alarm
El NotClasiliedAbove
Over 70 fet
n
(
(
rI
r
(
I
I
o
z
rrE
'-ltd
o
lrrr
rurl
tIt4
t5
U)
arl
F
rl
t5
U)
zt.
9 fiPEOF SITUATION FOUND
EF. Structure Fire
E oth".
rO METHOD OF tr Self-Ertinguished
Make-shift aids
Portable Ertinguisher
EXTINCUISHMENT E.tr
USE
a!+.. I t2r,:.t
OF ORICIN
tC-{ /tu,,/<lc ,r\
E EQUIPMENT
INVOLVED
IN IGNITION
I v"hi"te Fire
D Brueh, Grass, lavq
E Trash,Rubbish
E Other (List)
Auto@tic Elt. Syst€m
E Pre-onnethe/tankonlY
tr
<v<
t).t Ou\
30 to 49
50 to ?0 fet
Hud-taid ho*/hYdrut, standpipe Undetermined
E Master Strem Devie
n NotClasfiedAbove
-t2
, - :) Stao )de
h
r ^5K ls.-{ ror.*- *rur..N,*13
14 FORMOFHEAT
o.5\_
15 LEVELOFFIREORIGIN
Gmde level to I feet
" ,nLU,
LOSS
17
l8 BUILDINGACE(InYqn)
19 CONSTRUCTIONTYPE! st*tc
Th€ obj(t of origin
Part of mm or m of origin
Rom of origin
Fire-rated rcmp. of origin
Flor of origin
Structure of origin
Ertended beyond structure of otigin
to 6 stori6
to 12 8tori6
13 to 24 8tori6
25 to 49 8tori6
50 storiG or more
Unprotet. Mmnry Ext. & Wmd Int-Unprctected Wmd Frame
Not Clasified Above
F
Below grd. level
NotClsified
Undetermined
2 etoti*
3 to ,18tori6
Hqvy
3-4 hr.E P-t".t. St*t sldg Protet. Masnry Ext. & Wood Int.Protect€d Wood Frsme
EXTEN'T IJAMACE CONFINED TO: Flame Smoke
1
2
203
1
5
6
7
trEFtr
ntr
tr
tr
tr
trtr
trtr
tr
1
3
4
5
6
7
9 No &mge of the rype (N,/A)9EI
2I REMARKS (optional):
22 Follow Up Invetigation Requested \.Y- N /\
23
Fire Seruice
24
If y6, who will invGtigate
//
25 Additionallnformation
l^<CounE TIMEBACK INARRIVALTIME
2zI Mon B.wa E r'i
SaturThurTESuDAYOF
WEEK?'j
YEARDAY
Lt\
MO
ISO CLASSzrPCENSUSTRACT
3
TELEPHONE
L-t
DOB (oPtional)
TELEPHONEDOB (optional)
TELEPHONEDOB (optional)
ADDRESS
TELEPHONE(optional)
ADDRESS
E R"*i,"a fl ci,"n ,El alo
or inv6tigate
RESPONDED
(do Dot include PA'?-\RESPONDED# OF AERIAL APPARATUS
o# OF ENGINES
/
B-ooi.*i"tt
E Invetigatiou
E RemovedHaand
E St"nanv
TYPEOF tr
tr
TAKEN
Salvage
Not Ctassifred
MOBILEPROPERTY (Complete line M)
COMPLEX (If appliqble)
LICENSE #SERIAL #MODEL
Line E)IG .ITIONINVOLVED
VOLTAGESERIAL #MODELYEAR
ITEM FIRST IGNITED:
r-c-,Lk- u-.roci ln5t4-t- [...^rlr,t 5,** \.- 1 .-\.MATERIAL FIRST IGNITED WAS MADEOF
Other
.00 .00taQ<)
Vehicle and
.00Building
.00L
Contents
.00
.00 .00,6.00 .00.00
500,000 sq ft
E zo,ooo-lg,sssI o-eee ftft5000-9999 ft
10,000-19,999 sq ftBUILDING SIZE (Gmd 1000-4999 sq ft 50,0O0-99,999 aq ft
ft ! roo,ooo-499,999
DRTECTOR PERFORMANCE
tr
tr
trAutr
tr
D
tr
I In rum of origin-oper.
2 Not in mD of origin-oper.
3 Inmof origin-notoper-firetmsmll
4 Notin moforigin-notoper. luetoosmall
5 In rcom oforigin-not op€.. power disonnect
6 Not in m of origin-not oper. power dircon.
? In mm of origin-not oper. ded battery
8 Not in room of origin-not op€r. dead batt€ry
9 No detetor pre*nt fl to Undetermined
SPRINKLER PERFORMANCE
Equip. should have oper,-did not
Equip. prerent fire tm smll to oper.
Not classified above
Undetemined or not report€d
No equipmentpwnt (N/A)
Spriaklere Controlled Fire: YES E NO E
tr
Dn!
tr
2
3
0
8
# of Heads Opened
I I Equipmentoperated
o Other
Number of Fataliti6
Fire Servie
)-ilt lo h i.S,t+\
Title
Title
//./ 3 / >,/
Dah
Date
1//-z
x#
Q1A-AAO-1i lA-9A\
iJ
(i Other C)
E ont. on back
ALARMTIME
a41
Captain Michael G' HackeLt
Engineer Dennis Laub
Flreflgtrter WaYne Peargon
on trJednesday Ll-2-g4 841 responded Lo a flre aL 244 N 19th street' upon arrival
treerereorderedtoasgLgts2lcre$'wlthextlnguighment'l'Iycrev'asgigtedvrith
overheul of, the attic rernoving ingulation that wag snoldering' IJe al'eo cut a
hole in the roof to look for extengion of the flre'
Narrative for structure fire 244 North 19th Street
At L623 hrs on November 2, 1994 B2L, 84I, 849, and 803 were
dispatched to 244 Nnrth 19 street to a structure fire. Upon arrival
I assumed command and gave dispatch and enroute engines a report of
a working fire in a single family single story wood structure. The
fire was in the attic. I radioed 82L and assigned them to pull an 1
3/4" line to the kitchen area and attack the fire. 841 was assigned
to assist 821s crew with extinguishment. 849 was assigned to
medical standby at level 2. The fire was extinguished and apparalus
returned to service as appropriate.
Daniel I'1. Stucky
Deputy Chi ef of operati ons rrcrr shi f t