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HomeMy WebLinkAboutPermit Fire Damage Report 1996-8-8 r 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 (" A:~~ l'~ ...- . Jkr~ YF.sO NOD o cont,onback o Other b -'7-/.f~91 '7 -/9- 9.? 0... D... () :J:O 0:<: rn"" ..,"'" t=~ l'll'l ..,,,, -0 ~~ "'" "'" () :J:O 0:<: rn"" ::1~ [;;l'l ..,.., -0 ~~ t"" t"" () o ;;:: ~ .., o ::<l > ~ :J: o rn .., t= l'l .., ~ rn rn .., ::<l c: () .., c: ::<l l'l .., ~ rn o Z t"" ""