HomeMy WebLinkAboutPermit Fire 1999-1-22
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726-3769
Office: 726-3759
LOCATION OF PROPOSED WORK'
(70) 2)'>'2-
ASSESSORS MAP'
LOT'
. 373>7
OL'\J\f\.\ ~\L
. I \
BLOCK:
OWNER' Tel~~Ro~ 1\\c>Sh,S;"'r'--'--
ADORE'''''' \ ?,C;;~ ()G-j Il-."-'t" C
CITY: _~r;;-, \I. "t-- ,,\, A-JJ.
= \ \ "- \
DESCRIBE WORK: ~1{lQ '1b:2..\M..~
NEW
REMODEL
STATE: _I'i,fC..
.
JOB NUMBER JJ 00 91
225 Filth Street
Springfield, Oregon 97477
TAX LOT:
SUBDIVISION:
Ii) 'Too
PHONF'
ttt "l-<tS e;;;;:;."
ZIP: 11 '11 /
H~l!'
f}a"",~y. .
ADDITION
DEMOLISH
OTHER
CONST.
CONTRACTOR #
CONTRACTOR'S NAME ADDRESS
GENERA' ' '" '-" (.. - C J:\ \.
PLUMBIN'" "';") ~ --:s.~
MECHANICAl'
ELECTRICAl.
~~~
C \
~
EXPIRES ,'"' PHONE
QUAD AREI'J' -" ~ -
III II"-!:;
# OF BLDGS, --- # OF UNITS'
In,,, rc:n,vII' "nALL ti\t"IHt: IF THE WORK
oCCY GROUI?: --'--- ... - CONSTR. TYPE:
MV ,rlvn'LC:u U'~UC:M I MI" PERMIlI::i NOr
# OF STORtES:'~"~~~ ~~ '- - - -. "ONED HEAT SOURCE:
. ""'.........,'-,........."'" VI' h..l nUM/"U I rUN
WATER HEATER:"! r'IAv ~:~~~;.; RANGE:_
- OFFICE USEA:!:. rENl"iON:Oregon law reqUIres you to
follow rules adopterl hILth" Or""''''n Ut"'t
LAND USE: tJ -~f' '~ ::Flooo PI:.A.IV I I V
. v. ,v~t,~" vonter. Those rules are set forth
In OAR 95'.on1.0010~~~ \9FlR19se-ev;'
OoeO:.Youmay obtain.c8piEO~~~El rules bv
va,)). 'II "'''' ..anter. (Note: the telephone
number tnr the Oreg61:i~HIY"l'~tihlEj}L"
Center is 1.8n().;;li1~'~~L
'SQoJARE'''FOOTAG E:
To request an Inspection, you must call 726-3769, This Is a 24 hour recording, All Inspections requested before 7:00 a,m, will be
made the same working day, Inspections requested after 7:00 a.m. will be made the followIng work day.
D Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
D Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel locallon, bond
.beams, grouting.
D Foundation - After forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
D Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Post and Beam - Prior to floor
Insulation or decking.
D Floor Insulation - Prior to
decking.
D Sanitary Sawer - Prior to filling
trench.
D Storm Sewer ~ Prior to Hlllng
trench.
D Water Line - Prior to filling
trench.
rNOU9h Plumbing - Prlor,to
\.Jcover. .
!
VRE~UIRED INSPECTIONS
CJ::}i!ou9h Mechanical -' Prior to
cover.
~~U9h Electrical - Prior to
~~~er.
D Electrical Service - Must be
approved to obtain permanent
electrical power.
D Fireplace - Prior to facing
materials and framing Insp.
W /Celllng Insulallon - Prior to
ver.
D Wood Stovo - After Installation.
o Insert - After fireplace approval
and Installation of unit.
D Curbcut & Approach - After
forms are erected but prior to
placement of concrete.
D Sldawalk & Driveway - After
excavation Is complete. forms
and sub-base material in place.
D Fence - V\then cor,lpleted.
D Street Trees - When all required
trees are planted.
L F::)Plumblng _ When all
~e!\lfIlblng warl' Is complete,
o Final Building - When all
required Inspections have been
approved and building Is
completed.
DO'her
MOBILE HOME INSPECTIONS
D Blocking end Set.Up - When all
blocking Is complete.
D Plumbing Connections - When
home has been connected to
water and sewer.
D Electrical Connection - When
blocking. set-up. and plumbing
Inspections have been approved
and the home Is connected to
the servIce panel.
D Final - After all required
Inspections are approved and
porchos, skirting, decks. and
venting have been Installed.
Lot faces
L~t ~yp.
Interior
''J t'r':
Lot sq, ltg,
I P.L,
IN
Is
Lot coverage
Corner
Topography
Total height
;
Panhandle
Cul.de.sac
W
'.
,E
BUILDING PERMIT "i 'i; '~
ITEM SQ, FT, X $/SQ, FT, ~ VALUE
Main
Garage
"
Carport
Total Value
15'. Quf) ~
.
--LIt), ",>'0
f,n h.H...
_1L1. 3 (
SYSTEMS DEVELOPMENT CHARGE (SDC)
Building Permit Fee
State Surcharge
Total Fee
(A)
(B)
PLUMBING PERMIT
ITEM
FEE
.5"V
Fixtures
:5
Residential Bath(s) N'
Sanitary S~wer !
Water
FT.
FT,
FT,
Storm Sewer
Mobile Home
Plumbing Permit
rt:). f),)
}...., I /,ra
';-'(.'0
State Surcharge
Tolal Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsert/Flreplace Unit
Dryer Vent
Mechanical Permit
{'l,r/I;
/".~IJ
Issuance
State Surcharge
~
off. 71
Lt. )oJ
Total Permit
(D)
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
I
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
,
.Life;, )~
. . ;:' .~, .. i \:.~ "" .
),'.1" ,"j' ,,~. .11 ."...;. '!:< 1 .
. 1,.1, "
,
,
Is THE PROPOSED WORK IN THE,
"HISTORICAL DiStRICT, OR ON
THE HISTORICAL REGISTER?
II yes, this application must be signed
and approved by the Historical
Coordinator prior, to permit Issuance.
Setbacks '
HSEIGAR
I
Acc'l
I
I
APPROVED:
BUILDING JhLl1E, PLAN CHECK
AND BUILDING PERMIT
This permit Is granted on the express condition that the said
construction shall, In ail respects, conform 10 the Ordinance
adopted by the City of Springfield, Including the
Development Code, regulating the construction and use of
oulldings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee'
Date Paid:
Recel pt Number'
Received By:
Plans Reviewed By
Data
Systeffls Development Charge is due on all undeveloped
properties within the City ilmlts which are being Improved,
ADDITIONAL COMMENTS
Note:
Building Inspector may require
additional plans information.
and/or fees for the complctio~ of
this project.
By sIgnature, I state and agree, that I have carefully examined
the com plated application and do hereby certify that all
Information hereon 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 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 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 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.
Slgnatur~ ~~
Date \r ~d.. ~ 9 f9
VALIDATION:
RECEIPT NUMBER {J 32 ("l.f7
DATE PAIr> //)..)..o!qe:;
AMOUNT RECEIVE'D ---12..1. ~)/,
RECEIVED BY IJJI N J
~ -- --"--.
01/22/99 16:25 FAX 5~63667
-r..........z~t~_
SPFLS Dca TR ~~~ ADMIN A
.
-r:'b 11:
vu 19000[ 1
/70325 3~ //)~O/)
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
....::.I~=-.=I--__.=-=--......~::II=-- __...-.-
1aI0l,
DATE: / -;1..2 - 99
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
,
/355 O/y-'V'/)/'r
/' I
Name of OIiner ~/P'" <:A L. " /.:> /......,..,
.
Type of building _ )/T1t/.,.. .PA..I'Yl/I~ [;)t-W.~//~;'l9
(Dwelling, store, Warehouse, etc.)
00
Estimated value of building $ 103 ,~d('J, -
Address or location of building
"1</6-Wl/
Estimated loss to building $ "",0 f1f'lO. ~
Date of fire 4./o,u,,,Aov..h.,,..... /7 /99 ~
, .
Location of damage in building L/~/;"'~ A",,_ ~ /aa,A. ; /,,(),d..L
I 1
~~~~e.....~ L,:'-,.'"y~,..... d- 2?.-9-I..,( ~ ~
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire jl?tjR..I ,~A ;::-/00"'" Jo;s;6-
d- S./~ -~/CJo~
(Burned rafters, Beams, Joists, etc.)
. ,
Additional pertinent infonnation ~ ,; ~""A'11QU~ /H fO/A-.ftgJ<"
h,.., - A1-bJ~r:1/1 A~"'A /Mt:!P..4.0 r/L'Jn /L ";'-12/R"'/~ :10 OU~J.9vl.
E1ectric:a1, Hazard 7JLJhI~"'" u,,>>'<' ,..~"" /'" /./ J'~ I ~q ~
c;?~.~-"'.~...../ /"I/Ir/... -/ fJ~~_5',::"...IL... tu!4t/ D F /'~;7 R......
(Wiring, Outlets, etc.)
cct'Pw
Signed~A..'?~):" G.N
, . ,
00
I '2.'2.. -Cf~