HomeMy WebLinkAboutPermit Miscellaneous 1995-8-30
.
e
Lane County Authorization
e
for:
G-G-
<6-30
FOR OFFICE USE ONLY
mITr. n~, ~Y~TEM INSPECTION FOR LN. REV.u;W
Appl~cation/ ,,// 0./ n"';-
Perm~t # ~~ ;r~-~
TOWt\SHIP
RANGE
SECTION
TAX LOT
o OUT OF
PROPOSED USE OF PROPERTY
1";1 Residential 0 Industrial
o Commercial D Public,
,~ 03 27.3.3
SJBDIVISroN/PARTITION (if applicable)
4800
LOT/PARCE:'
BWCK
n
LOCATION ADDRESS STREEn~
1580 Cottonwood[. Springfield, Or. 97477
STRUCTURES CURRENTLY ON PROPERTY
CITY ZIP
SfD
DIRECTIONS TO SITE
wESCRIPTION OF PROPOSED WORK - BE SPECIFIC
DECLARED S VALUE
I C'ipti~ 1\j ~~f',..' C::;:s.t.e"T'
= OF I BfDROOMS # O!' STORIES
't"V\ ~ 0 O. , CJl"JL...
O;v'NER 0 S NAME AND ADDRESS
i~S~~("t-;nT", t:.c>,. '0;>" r\'-"'pus.~Q nn1y
, ''"'''''''' ,~7)fV'l ~
I....... 4 - 0 Proposed
0,( ~ ~ ?-f) fXI Existing
f { TELEPHONE NUMBER
T~' 11' T M,"r"j~
CONTRACT~p rffi.ft~: OSR #
C~nryi~ ~toiT"~t-7 J1fL7
I PERl-lIT TO BE MAILED TO (NAME AND ADDRESS)
n~onrnT"f- Tn't7t:)QrmAnrc.. 1 'll.7 T,;nc.L'1"_
li'110~n~
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TELEPHONE NUMBER
.=
T.;nrn]n, Eu~en\l=I.
pre 97401
683 5265 683 52i3
TELEPHONE NUMBER ~--
r."mn; e S teinmp. 1':Z.
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT. and ,]0 hereuy ce rtHy that all information hereon is true and correct, and that I
have the following legal interest in the propetty;. (iJowner of record; 0 contract, purchaser j Oauthorized agent.
I f::.rther certify that any and all work performed shall be done in accOldanc;e wi th the Ordinances of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and th~t NO OCCUPANCY will be made of any str1lcture without the pennission of the Building Division. I fur-
ther certify that registration with the Bu~lder's Board is in full force nnd effect as required by ORS 701.055, that if exempt the basis for exemption
is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on t~is prqject. I HAVE READ AND
CHECKED THIS APPLICATION THOROUGHLY. t-O l2- '1)e VlJl^-~C) ~ -t-:::",jJ 1~..,A-V--'
~'f\Y"ll-e.- P . ~-Y^~ 8-29-85
SIGNATURE rn- ""u,___.
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NAME (please print)
.,
DATE
......
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION ~AS BEEN BASED ON THE FOLLOWING CONDITIONS!
[] PLANNING/ZONING:
Zone
Parti tion #
Parcel #
Parcel Size
Minimum Setbacks:
C
L, front
C 'd
L, S~ e
interior
rear
COMHENTS:
For loan review purposes only.
No special planning required.
Date: 8-29-85
A
~
B. P. # Mu...dL.~ Installation Record Issued? 0 Yes 0 No
Lineal Feet Maximum Depth
of Drainfield of Trenches
COMHENTS: t,~ .' :S-1lS ':f1fPAA/J -r- L..L ~~~
~~~U. ~' /)~LoJ dAA.. M ~ _V Date:' U ~_?t}..1D-
[] PLANS EXAMINATION: Type
[] SANITATION:
S. 1. #
Installation
Specifications:
Gallon
Tank
~JiY
Group
Use
COMl-1ENTS :
Date:
n
..
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PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (oer ORS 456.805(1)) DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR I-NSPECTION INFORMATION
C 14-25 RB4-
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.
..
SETBACKS A~D OT!IER CO~DITIO~S OF APPROVAL ~UST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-
Cn.7IO:-J OF THIS ?ERHIT, CITATIO~: UNDER PROVISIO:--JS OF LAt-;E COCXTY'J INFRACTION ORDl;;ANCE, AND/OR OTHER
REMEDIES ALLOWED BY LAW.
I'HEN READY FOR INSpeCTION. CAL:' 687-4065. A ~lINnlU~l OF AT LEAST 24 HOURS ADVA1~CE NOTICE FOR INSPEC-
1'IO~ REQt.:t:STS :.l!..:ST BE GIVE:-.!. Have the following informa ticn ready: pcrmi t number, job address, type
of inspection, when it will be ready, your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIRED I~SPECTIO~S:
1. Foundation Inspectlon: To be made after trenches are excavated and forms erected and when all
materlals tor the toundation are delivered on the job. t~herc concrete from a central mixing
plant (commonly termed "transit mixed") is to be used, materials need not be on the job.
2. Concrete Slab or Under-Floor Insoection: To be made after all in-slab or under-floor building
servi~e equipment, conduit, piping accessories, and other ancillary equipment items arc in
place but before any concrete is poured or floor sheathing installed, including the subfloor.
3. Framinq & Insulation Inspections: To be made after the roof, all framing, fire blocking, and
bracing are in place and all pipes,' fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approved. All wall insulation and vapor barrier are in place.
4. Lath and/~ Gv~sum Board Inspection: To be made. after all lathing and gypsum board, ,;,nterior
ana-exter~or, is in place but betore any plastering is applied and before gypsum board joints
and fasteners are taped and finished.
-<;0 . .
5. Final Inspection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. No work shall be done on any part of the building or structure beyond the point
indicated in each successive inspection without first obtaining the approval of the building official.
Such approval shall b~ given only after an inspection shall have been made of each successive step
in the construction as indicated by each of the inspections required.
NOTE: All building permits require inspections for the work authorized, such as but not limited to:
A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This
inspection is required for each bond beam pour. There will be no approval until the plumbing
and electrical inspections have been made and approved.
B. Nood Stove: To be made after completion of masonry (if applicable) and when installation is
complete. Installation shall be in accordance with an approved, nationally recognized testing
agency and the manufacturer's installation instructions.
C. Nobile Home: An inspection is required after the mobile home is connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tiedowns,
skirting, and plumbing connections.
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Mobile home minimum finish floor elevation shall be certified when required by a flood-
plain management letter.
3. Mobile home tiedowns, when required, and skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. Swimminq Pool: Below grade when steel is in place and before concrete is poured. Above grade
when pool-rs-installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE
IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN"lBO DAYS.
SUSPENSION OR REVOCATION 11AY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POINT or REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATIVE SENAGE DISPOSAL SYSTEMS:
1. Permits shall be effective for one year from the date of issuance.
2. Upon completing the construction for which a permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Community Development by submitting the
installation record form. The Department shall inspect the construction to determine if it
complies with the rules contained in this division. If the construction does comply with such
rules, the Department shall issue a certificate of satisfactory completion to the permiti holder.
If the construction does not comply with such rules, the Department shall notify the permit
holder and shall require satisfactory completion before issuing the certificate. Failure to
meet the requirements for satisfactory completion within a reasonable time constitutes a vio-
lation of ORS 454.605 to 45'4.745 anu this ,rule.
Setback5 - Subsurface Sewaqc Disposal
.
c
From: Interior property lines
Edge of road rlqilt-of-way
Building foundation
Wells, other water sources
Septic Tank
10 .
10'
5'
50 '
Drainfield
10'
10 .
10 .
100'
~
lane county
"
A~IVITY INFORMATI~ SHEET
: 1
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
WR..l(s' L. Mor\l\..1"'"
~e vono~rL -:ot\ Vest-n"eit~~
I 'PROPERTY OWNER
(' '"' 1'"\ v"\ ; -e. ~ 4 I YH"h -f'~ "Z..
PERSON MAKING REQUEST
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MAILING ADDRESS
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MAILING ADDRESS
ELl Ci P (l e....
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b~3- .52"S-
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BUSINESS TELEPHONE #
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STATE
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ZIP CODE
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t")R. g 7"1 l) I
STATE ZIP CODE
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~ 8'-3-52. 5..3
BUSINESS TELEPHONE #
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HOME TELEPHONE #
HOME TELEPHONE #
2 PROPERTY ADDR,ESS \.s ~() c.~ u.J ~ S'?\")V'O'+; e-\ rt . ~ q 7 q. 71
(IF DIFFERENT FROM MAILING ADDRESS)' - J" -
3 MAP & PARCEL NUMBER (from tax maps in Department of Assessment and Taxation
(REQUIRED INFORMATION) or from tax statement)
11 03 27.33 '+~o ~ RA
--;:n! ~ ~ TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
TAX LOT(S) OR PARCEL #
ZONING
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LOT
ACRES
BLOCK
5 REQUEST (state exactly what you plan to do)
~ (;;.. '" / ~ ___ V-M/I &.r.
6 DIRECTIONS TO SITE:
~E ~' ?ft)~ef4 'I C%dd. r'('Ss. ,
** FOR STAFF USE ONLY **
NUMBER
DATE
.
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ZONE/LAND USE:
BY: DATE:
,
TIME IN:
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OUT:
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061
-
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.. ROBERTS "
.. ENVIRQl6MENTAL
.. SERVIC!!
~INCORPORATED
1598~.
.
hydrO-cleaning
,
installations
repairs
estimates
P.O. BOX 10093
Olllce: 1719 .",Ing Rood
EUGENE, OR 97440
688-4531 . 746-6331
pumping
industrial waste
derootlng
consulting
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Date
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SIGNATURE: to
THIS IS YOUR INVOICE. PAYMENT IS EXPECTED UPON COMPLETION OF JOB
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/7-05 ;273r3
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RECORD Of Ai'PItOV AL OF '
INDIVlDUAL1:SEWAGE DISPOSAL SYSTEM AND
APPIOY Al TO OCCUpy ~ESlDENCE
.
ISSUED TO. .~ L ,'. , LANf COUNiY
eName.. C"'~~{~'-'~ y~~ (.-;.-- '2./ permllNohi{~r[Z..-
'l '~', Addreu, t~_l:.....'.L_~t~ ') " I S r Lr~.&~~d' let I.'
MoilTo..,
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Totoi numbef': LI"'~ Unlll ,. _._._ Bed .. L. ,~.___ BcrthL,_____ BoMment. Ye~..._.._..... No...-"",;._.. Other,.....___..
Wafer Supply b) x.:.. p..hlir C\f' . m_ '_____'Incli'tlclual SysNm_.__.... Community Sy."'m......,..". Gorb. Grinder,c~~/
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SEPTIC TANK: Distance from _1I...___._..__fetll. MateriaL~...-,----.._.... .No. of C. ','" ,n, ,J, ,----
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j/_.._I.L. _..gal. Inlid40 len""'--..--...-i'..~....,..ft. 'n.lde width._..__. y" ..-.. ft.
Totoll;quid capacity
,feet. liquid deplh .-- .....feet
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TILE DISX)SA,i FIELD: Distribution box m.x.':'-..--Y". ._,_.._.____-"0. -......----...------...-...........-..---....-.---...'
Ot.tonce from well ,/tL.-d---i.A~_-.. feel; Buildl"9 Foundation ......._/~~..._..,____,_,_._._.,. .."., ..,ft.
~nt lot line: front J. .~_.___..___ft.; tide.___....L:2._,_,..___ft.; rear ._.___.....~_,~'--___.__ ....,____..._...___u......'-'
length of each line .......6:....)'_.":::' CO __n', .__feel. No of li,......_...._.~__...... ....________..____._u___....._._'
e TOfollengril of tile lin"'.........I. -,..__~~.______..._...feet. Diltance betwlMn linn ,....:'.~,>__:_:~...________.u..._...,.......
T 0101 eff~C1ive abwrption area in bottom of trllnchel:-,----...m....2,:7---~---.--.... ........._... "...."'_'''_'''' ..'....... -..' .q. ft.
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Trench width ,/..,~.. ,.....inches.
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TYF>4 of filter material. . .)(___grave1l broken .,one___.__..._______; Other ...___.................___..____u_..______.____,___-'.
Depth of filt~r, material beneath lile ___.__.._~......u..._.Inche... Deplh of filter over tile ........,1-.. ....._,..____...__.......__in.
~emorh:
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/7-tl5 ;273r3
.
/ RECORD Of APPROVAL OF
INDIVIDUAL ~SEWAGE DISPOSAL SYSTEM AND
APPROVAL TO OCCUpy ~ESlDENCE
.
ISSUED TO, t::' LANE COUNiY
Name, C-,~~{~.--~ 6/~.-.L (.-;.-- , a. /, Perm I. No..L{~r[Z.._
, "" '. Addreu. L_.~...'L:_IJ,,/A") IS/'" Lt"~.&~o Itl f
Mail To...."..'.---- ---
To.oi number: Living Units ../..._ aedroomL_ ,3..--- Bathl..,__'!__ Basemen.: ye..,..__........ No...L._.. Other...,.:=:::-
w Su Iy b v P hi' S ' I .~. ld I S C' S G b Gri ~- -t:-/ ",-
al'er pp ) L... "_.le -I" ,'____.__ ,...IV ua ystem_.__.... ommunlty y.",m.........,.. or. n_,C......._ '
- J. Y /
SEPTtC TANK: Distance from weIL..._.._____fettt. MateriaL-L.,("~-..-<......_.... .No. of Compartrnenn , ..,t. .....
Totolliquid capacity />L~<L.___ ___gal. Inside len"."........,r~......h. Inllde width......., 'r-:, ft.
feet. Liquid depth ,-, .....Mt
...
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TILE DISPOSAi. FIELD: Distribution box m~_.._-y". ._...._.__.__.no. _......__......_..____,.........,._..___....__..._.,CJfher
O;stance from well ,/tL._d_---L.4.~--.----fee.; Building foundation ... .....I.?:~..._..m_ -.-.---... ..,-. n h.
'- J
Neore51 lot line: front 1.. ,~...___..._,..._ft.; aide_.._..J:~._,_...___ft.; rear n._'_.....' _-::.:" -...._ ....----,..-. ..-.-........' feet
L.ogth of each line ..-...~..s=--..::: C 0 .__' _.__feet. No of lil'"'I.-.__.__.__7.::-_.. -- ,-..-~,.--.-----_.._-_.-"- ..--.
Total length of lile linM".. ..., I ~__~~.__~ ..m...feel. Dislance betwlMn lines __/<,C..._____......."......,'.feet.
TOlo1 effective obwrption area in bottom of trenche5:-,-..--........2.::7...~.._.-,-,....,...---.., ".....,....._.:: ..._.. -.. Iq. ft.
J'
Trench widlh ,L ~ .. ......Inches.
Oi-ameter
Ty~ of filter material:. .. .)(___grav.ll broken slon....,__...w____; Other ......_.....,................----.--..---.-.-------..---
Deplh of filter, material beneath til. ........_~_m...__ .Inche.; Depth of filter over til. "...., ,J-." . ........_.._..__"n ..__in.
Remarks:
.------..... _._.._._._~-- ..._--. -----.--. -.. ____A. .... .._. .....____. _____.._ _. _____. ._... . ..._. ___.
.. Dat. of Inspection
(~ij :c-(~;~=.~;p~;.:;:;~~.-~Z2~1;~~;'(.:~.: ...... . ........... /
By ..._.. .:&: _:.:.!:~.!. cJ_...,..~~I~ :=~~~_____.._.., ". :',itl.
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