HomeMy WebLinkAboutPermit Fire Damage Report 1996-8-8
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COMMERCIALIINDUSTRI.
PERMIT APPLICATION
5P~R'NCFIELO . JOB NUMBER U \nl ) \...\l\ ~
~ "" INSPECTION LINE: 726.3769
flt OFFICE: 726.3759
( (\ Y (\rliL *\\,q
TAX LOT: ~(,;()I
225 Fifth Street, Springfield, Oregon 97477
LOCATION OF PROPOSED WORK: ~ ~ ~
ASSESSORS MAP: \ \D.~'34-
OWNER' ~ ~l ~,M\ Q F~0 \l{\) .
ADD~E?S: - -^;~ ~~ ~ I \ \ )10.( 1. ) ~
CITY: ~~~ - C'j. STATE:~~.f\01\
ffi l\ CJ- 0
ADDITION DEMO~SH
. PHONF'
ZIP'
ct 1411
NEW
REMODEL
VALUE:
DESCRIPTION OF WORK'
NAME
ADDRESS
PHONE
ARCHITECT:
CONTRACT~'S N~ .... L
GENERAL,- . ~ l"l )10 _ \..' ll{\_
PLUMBING: ~
MECHANICAl'
CONST.
ADDR~~ ~/^ yONTRACTOR ' EXPIRES
n~1 \ ,ur ~DZL. 3?z.Q]
,
1u~HcrqQ5
ELECTRICAl'
NO.
PLUMBING
I FEE I CHARGE
"'n I
MECHANI~AL
Backflow Device
I
I
!
I
\7:f:U I
I
I
Furnace/burner & vent
< 100.000 BTUs
Furnace/burner & vent
>100.000 BTUs
Floor furnace and vent
Suspended wall or IIoor
mounted unit heater
Appliance Vent
separate
Statlonary evap.
cooler
Vent Fan/SIngle
duct
Vent System apart
from AC or htg.
MeChanical exhaust
hood and duct
~I=E:' I t""....o.a/".lC'
Single Fixture
Relocated Bldg.
(new fix. addlll
Water ServIce
II.
SanItary Sewer
ft.
Storm Sewer
fl.
I
I . I
\ 110 l\2L~lH.QS\ I
~ -& I
I I
PermIt Issuance
$10.00
TOTAL PERMIT
TOTAL PERMIT
QUAD AREA'
· OF BLDGS'
- OFFICE USE _
LAND USE:
HANDICAP ACCESS:
FLOOD PLAIN:
, OF UNITS'
ZONING:
LIGHTING POWER BUDGET:
WATER HEATER:
OCCY GROUP:
CONSTR. TYPF'
. OF STORIE'"
HEAT SOURCE:_
SQ. FT.
$/SQ. FT.
VALUE
SQ. FTG MAIN
SQ, FTG ACCES<:
SQ. FTG OTHER
X
X
X
PLAN CHECK FE!'
TOTAL VALUE OF PROJECT
.3~JlfO~
RCPT' .
DATF
BY
I BUILDING PERMIT fjA-a.. ~ I PLUM81NG I <DCO DEMOLITION
\ : L::,
15% Slate \ \'111 5% Stale I
Surcharpe Surchar e .<\-~
I MECHANICAL I ~. FENCE I
VALUE $
15% State I SIDEWALK SUBTOTAL
Surcharoe FT. PERMITS
I PAVING I CURB CUT SYSTEMS
FT. DEVELOPMENT
TOTAL PERMIT FEES
EXCLUDING ELECTRICAL
c1lo3 ,::)L.
It Is the responsibIlity of the permit holder to see that all Inspections are made at the proper time. To request an Inspection. call
726.3769 (recorder). state your City designated job number, lob address, type of inspection requested and when you will be ready
for Inspection. Requests received before 7:00 a.m. will be made the sa king day, requests made after 7:00 a.m. will be made
the following work day. V'
SITE INSPECTION: To be .ROUGH PLUMBIN
made after excavation, but ELECTR
prior to setup of forms. MECHANICAL: No work Is to
be covered until these
Inspections have been made
and approved.
UNDERSLAB PLUMBING,
ELECTRICAL &
MECHANICAL: To be made
before any work Is covered.
FOOTINGS & FOUNDATIONS:
To be made after trenches are
excavated and forms are
erected, all steel in place, but
prior to placing concrete.
CONCRETE SLAB: To be
made after all Inslab building
service equipment, conduit,
piping, accessories and other
ancillary equipment items are
In place but before any
concrete Is placed.
UNDERGROUND: Plumbing,
electrical, gas, sanitary sewer,
storm sewer, water and
drainage lines. To be made
prior to coverlng or filling
trenches.
UNDERFLOOR: Plumbing,
electrical, mechanical. To be
made prior to Installation of
floor Insulation, decking or
floor sheathing.
POST & BEAM: To be made
prior to Installation of floor
Insulation, decking or floor
sheathing.
FLOOR INSULATION &
VAPOR BARRIERS: To be
made prior to Installation of
decking or floor sheathing.
MASONRY: Steel location,
bond beams grouting or
vertlcals In accordance wIth
UBC 2415.
ROOF SHEATHING AND
NAILING: Prior to Installing
any roof coverl ng.
-REQUIRED INSPECTIONS
"
~
PAVING: After grpvel Is In
place but prior to placing
asphalt or concrete.
ATTIC DRAFT STOPS &
CURTAIN WALLS
SPECIAL INSPECTIONS: In accordance
Section 306 of the State Specialty Code
a special Inspector shall be employed
by the Ownerl Contractor during
construction of the following work. A
copy of the special testing reports shall
be furnished to the Building Division.
FIREPLACE: Prior to placing
facing materials and before
framing Inspection. .
STRUCTURAL CONCRETE: In
excess of 2500 P.S.1. (306 a.1)
FRAMING: To be made after
the roof, all framing, fire
blocking and bracing are In
place and all pipes, chimneys
and vents are complete and
the rough electrical, plumbing
and mechanical are approved.
VINSULATION & VAPOR
BARRIER: To be made after all
Insulation and required vapor
barriers are In place but
before any lath or gypsum
board Interior wall covering Is
applied.
STRUCTURAL WELDS:
Performed on the iob. (2722 f)
HIGH STRENGTH BOLTING:
During all bolt Installation and
tightening operations. (306
a.6)
SPRAYED ON
FIREPROOFING: U.B.C.
Standards 43.8.
/)
SPECIAL GRADING,
EXCAVATION AND FILLING:
During earthwork. (306 a.11 &
Chapter 29)
FIRE & SEPARATION WALL:
Located and constructed
V"ccordlng to plans.
LATH AND/OR GYPSUM
BOARD: To be made after all
lathing and gypsum board,
InterIor and exterior, Is In
place but before any
plastering Is applied or before
gypsum board Joints and
fasteners are taped and
finished.
GLU.LAM BEAMS: Inspection
Certificate by an approved'
agency, furnished to the City's
Building Division before
beams are placed. (2501 U.B.C.
STDS. 25.10,11).
STRUCTURAL MASONRY: (306
a.7) .
SIDEWALK & DRIVEWAY:
Required for all concrete
paving within street right of
way, to be made after all
excavating complete and form
work and sub-base materIal In
place.
"In addition to the Inspec.
tlons specified, the Building
Official may make or require
other Inspections of any
construction work to ensure
compliance with the Building,
City or Development Code.
CURB AND APPROACH
APRONS: After forms are
erected but prior to placing
concrete.
FINAL PLUMBING
--~----------------------------------------------------
FINAL ELECTRICAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
ADDITIONAL COMMENTS'
SITE PLAN REVIEW BOARD: Must be requested 2 days In advance
of the date you wish Inspection. All project conditions such as
landscaping, parking lot striping, etc. must be completed before
v-requestlng this Inspection.
. FINAL BUILDING: Requested alter the final plumbing, electrical,
mechanical and Fire Department Inspections are made and
approved. No occupancy of the premises can be made until a
Certificate of Occupancy has been Issued by the Building Division
and posted on the premises.
PLANS REVIEWED BY
DAT~
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify th~t alllnformatlon
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 pertaining to the work described herein, and that NO OCCUPANCY
wlll be made of any structure without permission of the Bulldlng Safety DivisIon. I further certify 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 tlme, that project address Is readable from the
street, that thetermlt card Is located at the front of the property, and the approved set of plans w1l1 remaIn on the site at all
time durIng c structlon. /}01
SI naturo ;,/)))1 j _ (( )rVt-PA J V'"'.. --' Dato
/ /' .
VALlDATIO.l: ; U AMOUNT RECEIVED: .,0 1 03 .c:;:J2-
'V RECEIPT ': rJ.~-'Ef)J
DATE PAID: -t;::;j~'b' '.:f./.p..
RECEIVED BY: 0){.J)(\ ~
/
I ;,. CITYOFSPRING~
Fire & Life Safety
~'1
.\1b.'b~L'2?)~Dl ' tJ
qfpOo;rg
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DA TE : 7 - I q - 9 fa
TO: Building Department
FROM: Springfield.Fire Department
SUBJECT: Structure} Damage to Building
Address or location of building -.2 :5 7 OflJ\<:.DAG( :t:l) Ie 5
.Name of owner UA.)\(::I'J Il\N N ,~# ,V) ~ r.;r'/p ~I? 1JtJdv'/ V\tN0 .
Type of building f,PAft 'I?t Nfl I;L ~ Torty . V"V1{Cno/n
(Dwelling, Store, Warehouse, etc.)
Estimated value of building $ Z-o 0 () D 0
/
Estimated loss to building $ J(l i:'OD
Date of fire '7 - 1[- q (,.
Location of damage in building ':;"'Jl;ru. UN; (' .tt I/; r
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
(Burned rafters, Beams, Joists, etc.)
Additi ona 1 perti nent i nforma ti on
Electrical Hazard JHfLO()b/JDuj
(Wirin9, Outlets, etc.)
Si9ned
//'jl: J .
/I/;.~ .' //4"J~4 rAf'r,<')tJ
v /
cj;
cc:
STATE OF OREGON FIRE REPOR" .
STATE FIRE MARSHAL -r~~:: ~A ~- d J /10
Ll\rl~ DepLResponding ila.'N.(fi~o
~:~ 0 5ou. {~R~;ME l ':;~V~L~ME I TIMEBACKIN
ZIP I CENSUS TRACT
-z.. 1. /) 'L
dll 911(TieLine) ..futual Aid (extinauia....ol Inveatigateonlyj
-0- Voic:eSignalMuniAlann ~ ~ived 0 Gi~n 0 N/A
o No< C,""if"" Abov< e;. V , 13:r' f' R. ~ t.
I'or AERIAL/APPARATUS RESPONDED I' OTHER VEHICLES RESPONDED
(do not indude PA',) oz..,
o Other (List) ITYPEOFACTIONTAKEN
o EninIuhb 0 R.m,,,,ed HamnI 0 SeMp
o Investiption 0 Stand By 0 Not Claaifled
o Automatic FdL Syat.em 0 Hand-laid hose/bydJant, standpipe 0 Undetermined
9, ~nDed. tK.eItank only 0 Master Stram Device
~nDeCt hOle/hydrant, standpipe 0 Not Classified Above
I PROPERTY COMPLEX (If applicable) MOBILE PROPERTY (Complete line M)
(.lOV~~DAL~ AP-rS-
I ~ODEL
B 13 to 24 stories
25 to 49 stories
o IO,OOO-19,999aqCt 0 5O.000-99,999aqCt
o 2O,OOO.49,999aql't 0 IOO,OOO.499.999sql\
o Unprotect. Mll!IOnry Ell. & \\'000 lot. ~nprot<<k'd Wood Jo'rome
o ProtectedWoodFl'llme 0 NotClauiliedAbove
SPRINKLER PERFORMANCE
/l .,. DO NOT WRITE IN TffiS SPACE
/.- I CONTROL EXP.
NO. . NO.
DbtricLoflnddenL <;p{l..j]'l 6fJ(LO
1;0 jt;yt q{~ I ~~F
~
o Soo
o
County
D_
O Wed
Mo.
2 INCIDENT ADDRESS
~1bC;
...
{)fj~.!/ACC:
3 OCCUPANT NAME (Last, First, MI)
D 0 'tl~ :r~f'll')i~f'R.
of BUSINESS OWNER NAME (Last. Fi1'6t, Mil
~f'7
DOB(opllonall
A (L.PELLe
LIlGi
ADDRESS
10- s-/f,
nOB (optional)
5 OWNER NAME (Lalt, First, MI)
UrJ'KdbW.N
6 FIRE REPORTED BY (Last, Fil1lt, MI)
. ADDRESS
DOB (optional)
ADDRESS
DOD (optional)
VN'I(:r/OWpJ
o Telephone Dir<<t 0 Radio
o Municiplll Alarm System 0 Verbal
o Private Alarm System 0 No Alarm Rec'd
8 I OF FIRE SERVICE PERSONNEL , Ot ENGINES RESPONDED
RESPONDED ! ( - /
7 METHOD OF
ALARM
o Vehicle Fire
o Drum,Grass,Leaves
o Tnsh. Rubbish
o Selr.Estinguisbed
o MakNhift.ids
o Portable Extinguisher
9 TYPEOFSITUATI0NFOUND
..tz...S~Firl!
1J Other Prop. w/va1ue
10 METHOD OF
EXTlNGUlSHMENT
11 FIXED........................ USE
4 P19(tlll1t rJ'J 5
M MOBILE I YEAR
PROPERTY
'2 ROOM/AREAOFFIREORlGIN
) ,E.. g~P.~))M1
E EQUIPMENT I YEAR I MA~E
INVOLVED
IN IGNITION
13 IGNITION FACTOR
I MAKE
SERIAL I
EQUIPMENT INVOLVED IN IGNITION (Complete Line E)
MODEL
I SE~IAL I
IJVSoN r I Lf;v,;,f/crucJ1.'-1 s-e...f HV.-e_
I MATERIALFIRS't'IGNITEDWASMADEOF I rPtMFIRSTIGNITED;
/1lq.+riA..:'Ov-'>~19t.-b.", F/~/)1.l'tl"k L-tq'-\.'J 'ki4-So~'
15 u;;v.~Lot'f'IREORIGIN - 0 10tol9feet U 3Oto<f.9feet '1.] Qver70feet 0 Beklw grd. level
~Gradeleve]to9f~ 0 20 to 29 feet '0 5Oto70feet 0 ObjoctsinFlight 0 NotClassified
16 Building.~ r.(lntents Vehicle and Contents Other
VALUE d206 VilO.OO ~~'o.!).O ,.! .e, .00.00
, ,
LOSS 36001>.00 ,5; OP.O ..J .00
17 NUMBI-:ROFSTORIES ~25tories B 5to6atories
Dlalory U3to<f.stories 710 12atoriell
18 BUILDING AGE (In YelU~) I BUILDING SIZE (Gmd Fir Only) ~lOOO.<f.999aq ft
"Z.- 0 Q.999aqft 0 5OOO.9999aqCt
19 CONSTRUCTION TYPE [) Heavy Timber U Unprotect.St.eeIBldg
o SLee] & Concrete. 3.4 hr. prot. 0 Protect.. Steel BIdg 0 Protect. Masonry Est. & Wood Int.
EXTENT OF DAMAGE CONFINED TO: Flame Smoke DETECTOR PERI<'ORMANCE
I Theobj~oforigin 1 0 1 0 0 1 lnroomoforigin-oper.
2 Part o{roomorareu of origin 2 0 2 0 ifi!-2 Not in room oforigin-oper.
20 3 Room of ori~n 3 0 3 0 0 3 In rm of origin-not oper-fire too small
4 Fire'rlltl'dc(tmp.<Jf<Jr~in 4 0 .. 0 0 4 Notinrmoforigin-notoper.firetoGsmall
5 F]()orofori~n 5 S. 5 0 0 5 In room of origin-no toper. power disconnect
6 Structureofori~n 6 0 6 ~ 0 6 Not in rm of origin-no toper. powerdiscon.
7 Extended beyond structure of origin 7 0 7 0 0 7 Inroomo{origin-notoper.deadbattery
o 8 Not in roomo(origin-notoper.dead battery
o 9 No detector present 0 10 Undetf!rmined
, . .
"_., " .. \' .... . ..,. J.
14 FORMOF'itt:ATOF IGNITION
.00
5.000
o &0 atories or more
.oo.S"?
I IS~~tS
TEI.EPHONE
7 (..] ) - 01..75'
TELEPHONE
TELEPHONE
TELEPHONE
I LICENSE I
I VOLTAGE
?
o
Undetermined
.00
TOTAL
.20S'()oo .00
4~.HO .00
o SOO,OOOaqft
o Equipment operated
o Equip. should have oper.-did not
o Equip. present fire toolmall tooper.
9 0 Not classified above
o 0 Undetermined or not reported
8~NoequipmentPf'Cl('nt(N/A)
Sprinklers Controlled Fire;
9 No dallUlll:C of the type (N/A)
9 0
'ofHeadsOpened
2\ REMARKS \\'t'8ther CondilwlIl!l {optionall:
<:;I!"(:- f'/{!;((,Qf) vJVt
22 Follow Up Investiltation Requested Y X. N_
IfYI!!l,whowillinvestigate
f/, f-.J IC.Ae.O
23 Number of Injuries
FireServke
I Number of Fatalities
Fire Ser...ice
Title
1
Other
D
24 Member Makinll: Repon ....-:"') r:":
. YAlJ<.... =.>S<6<-~:r'r".)
25 Additionallnfofmationb)' ).Ott~ ---" ~~
Title
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. Jkr~
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