HomeMy WebLinkAboutPermit Building 1982-7-20
. TO\-il'biUf.
, CONSTRUCTIC-,./PLACEMENT
~~\iYPERMIT
I
COMPLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
, ~ ,
RANGE SECTION I TAj( LOT O;:UT or I
'1 . 02. ,q,L,-," ~);;;<...5CU'.
:3LJBD~~dRTITION ~C~~/1 ! LOJiARCEL
WC:a ADD"'~ ,IT'" ~ .
S~~~S CURRLNTLY rt~ ~ ~ P9 'J ~bi
'Ut~-lf)^ ~t f 0?)
Dr:Oda~t~t~D w1Q ~~ n X L1weLll(\?\ I $ VALUr:
~CO~R..\1g0 'bIll l' OF STORIES if 6FE~OYEES W'm'ER SUPPLY [1.P.,r-oposed
::::>( /1/ ',J.Y ~ ~ [7] EXlstlng
O\~A~ AND ADD(rherr-nVW0 I a311 Y\LU-~ ~. ~. ~d 4~77NLJtlBER
CO~~Al!fm'V1:--~_~ AAA, :V'--?f. 1 ~;I C114.;r~ fJ7~O~~'t .
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: I lll\VE CAREfULLY EXAMINCD THE' COMPLETED APP~ION FOR PCRMIT, and do he 'I" cLir, tho";f{ lnform1twIl here')n 1', t l~ ,nd correct and I f\Jrlhcr'
~ cert~fy that any and all work performed shall be done In accordance wl.th Lh Ordllla'1CCS of Lanr> County dnd th(' La,vs of thp St<-Ite of Otr>q-m ,(\rLallllnq
! to the work descr1bed l)ereIn, and that NO OCCUPANCY w111 be made of any structure. w]thout the pcrmlsslon of the BUlldlng Dlvlslon I futlh~l Ci'r':lfy
; that regIstratIon w1.th the BUIlder's Board 1S In full force and effect as requIred by ORS 701 055, that lf eycmpt the basIs for cXem1JtIon 1S notrd
i hereon, and that only subcontractors and employees who are In complIance wIth ORS 701 055 wIll be uspd on thlS proJect I HAVE READ AND CIIECY,ED THIS
; APPLICATION THOROUGHLY
~
, FOR CJF?ICr: USE ONLY
BLOCK
5
cl~{7
APPhCatlon//1A~ 0"'/
Permlt t ~~~4 ~L1 ~
, ,
o Two Cop~cs of Plans
DTwo Cop~es of Plot Plans
DMechan~cal Cneckl~st
[JPlumb~Dg Checkllst
[JPlan Check Info Sheet
ZIP
PRoposr:b u'sti:5f"')"F;ciPERTY .. .",....~
~es~dent~al []lndustrlal
D Corrunerc~al
o Pubhc
Ml'llmUm Setbacks
C
L,
(j)~~L;) lfiJ~
A-\
#5/ cL, slde
6~~
DOW1102J
~Oltrdc..t.o:
::J Aoent
C7'A~L \/. I/L>wl--! ~
NAME (please prlnt)
...",...,",,,,,.,..,,,,.,,, ",_". I..'..,..... ..,." ".. I .
~LANNING/ZONING:
Zone
l--artltlon #
Parcel #
Parcel Sue 99)t"9 L7
rear 7' ~/lE
front
/
lnterlor ~
Comments
--..-
~
n
o
Date
~ 4/ -;J:' ;2.
0 FLOODPLAIN: In flood hazard area? G2(NO
~- o RURAL ADDRESSING: GRl D COORDINAU N
0'SlUHTATION: s. 1. # B. P.
DYes,
see attached sheet.
Date'
/ c; ?-?- /..-7
... .- J..;/
# /.. 7 ::? - 7./ InstallatlOn
Date
Record Issued~ [] Yes [] No
Installatlon Gallon
SpEclflcatlons' Tank
Comments ~Q...., ("]1) ,~~/ra clor
?I J J..Jc .0..-, ~ Sa!"", ~f Jp/~.L~ 5.uJ~
Llneal Feet
of Dralnfleld
Max~mum Depth
of Trenches
dor,)...,Jt ....ij
- ~ J
of
~JD ~mJ-.j
Jrcu ,~ 1',:' If)
~ IJ ".PILI UJ ~IJ f-(tJfl'JS@j)
4.S jJ (,2<j 6v tAf"I"'4 Sdi#
' rli/ /
Date/I ~ i' J- .
useAIJJJJT /..L!YJ
/
J'fd/'" h;"'p.c
Comments
EXAMINATION:
+f~t' 1"& lJ
Type...y:.AL- GrouP_if- . L
I!-SNPTl:J)
[E"'PLANS
Date' J --.hJ "'8:;,.1fJr
CONSTRUCTION AUTHORIZED BY THIS PERMIT
TOTAL FEE
$
$
$
$
$
$ ,~-::? ~
$ "/~
$ :s:~ Z-r-__
$~$'7~~
;v1,4-
/l/ //4
/gd, 6~
t ~
."
Sq. Ft. 'f
#/~
Flxed Fee/
Unlt Cost /)
,y;; !-
Floodplaln Fee
Subsurface Fees
BUlldlng Fee
_ ~r/Storm Draln/Water
.~&'~Plurnb~ng Flxtures
/ Mechan~cal
Plans Check Fee
State Surcharge
Desc.rlptlon
FEES PAID BY: 0 Check 0 Cash
By:
Date:
'7-UJ-R.,>
DATE
LANE COUNTY DEPARTMENT OF PL~~NING & CO~~lUNITY DEVELOPMENT / 125 r:AST EIGHTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
....
~"
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~ ...... , - '\ .' : P .. (;0 J . i 't'
SETBACKS AND OTHER 'CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. : VIOLATION CAN RESULT IN REVOCATIO~ OF THIS PE~~IT,
~CITA1ION UNDER:PR0VISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAW.
W"FN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FrOR INSPECTION REQUEST MUST BE
GIVEN. Have the followlng lnfonnatlOn ready: Perm:it number, Job address" type of lnspection, when It. w,n be,ready,
your name and phone number, alJd any special Qlrectlons to site., .,'; 1 ' "
, '" \ " "
'-.. , ~ :... ~... I
BUILDING DIVISION: .' , ,'-
, ~~ ...",.
REQUIRED WSPECTIONS -i '
, . ,
1) FOUNDATION INSPECTION: To'be made after trenches' are excavated and forms erected and when' all materials for the foundatlon
are delivered on the Job. "Where concrete'from"a"cer\tral mlxlng pl,an't (commonly, termed "translt.ml'xed"),ls to be used,'
materlals need not be on the job. ' ..'. " .'. ,.- , '" ' ., . .\"," ',' .,
2) CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or' under-floor bUlld;rg serv;ce equlpment,
condult, plping accessorles and other- anclllary equlpment ltems are. in, place but before any cbncrete,ls,pQured .
or floor sheathing installed, lncluding the subfloor. . ' " I ',' _ ' t....'
. ~ }.~'. ~ I ~' .. /'
3) FRAMING & INSULATION INSPECTIONS' To be 'made:after't~e roof, all. fr~mlng,~fire blocklng and bracl~g Qre ln place and
all plpes, fireplaces and chimneys and vents are complete and all rough electrlcal and plumblng are app~o~ed. All:~
wall lnsulation and vapor barr:ler are ln place. 1_ .' '... . ,'. ,.,.. '. -.
4) LATH AND'j'JR GYPSUM BOARD INSPECTION: To be made aft~r' ail] ia'th;lng an'd\gypsum board: 'interlor.and' ~:terlOr, lS lr/PJa.~e'
""but beforl' any plasterlng is applled'or before gypsum"board Joints and fasteners are taped and fl,nlshed.,
~ i \...., \ - \ t- ,I~... ". .. i l . '~..
5 L fI1NAL 'iNSPECTION. To be ma.de, aft~r th,: bu'~.1d; ng 1 s c.om~l ete ,an~ .P~f~'re occupanc.~' '. . ' , '. . -!' '.:' '. ,
- .""' . ,\ '.', ',', "\''''--
APPR9V~~,,~EQU,IRED., No wor~.sha~l.b.e"don~ on any part of~,the b.!lllding,q!:.s~r,uctur:.~ beyon~ the pO;l.nt lQdlc'ated In'\~a,\h''q'';:
succeSSlve ~nspec~lon wlthout flrst ebtalnlng the approval of the building otflclal. Such_approval shall be glverr only\.
a~ter,an inspectlon shall have been maae of each succeSSlve step In. the constructlon as lndlcated by each of the lnspectlons
req u 1 red. - ..' '._ , _, .~:...... _ '>,: ' "' ',':.'
NOTE: All buildlng pe~mits require inspectlons for the work authorized, such as, but n~t il~~ted*t~:
A. BLOCK WALL: To be made after relnforcing lS ln place; but before any grout lS poured. ThlS ln'spectlon lS
requlred for each bond beam" pour. There wlll be no approval, untll the plumbing and electrlcal ,l'n,spec~lOns
have been made and approved. .'
B. WOOD STOVE: To be made after completlon of masonry (If appllcable) and when lnstallatlon is comolete.
Ins ta 11 atlOn sha 11 ,be 1 n accordance with an approved na.ti ona lly' recognl zed tes tl ng agency dud 'the manu-
facturer's installatlon instructions.
If'.
.~ '"'\
C. r~OBILE HOME':
system for:
. connecti ons.
(1) Footings and plers to comply with State foundation reqUlremerit-s~ for moblle homes' or as recommended'
- by the manufacturer. " '...
(2) Moblle home minlmum flnish floor elevatlon shall be certifiea'~hen requlred by a floodplaln
management 1 etter. '
(3)' r~oblle home tledowns, when required,'and Sklrtlng shall ,be lnstalled and ready, for inspection
_ .wl~hln pt least 30 days af~er occupancy. Tiedowns and sklrtlng shall be installed per enclosure
An lnspectlOn is requlr~d after the\iob'ile home 'lS conneCted'to an appr~Sed \ewef" or s~Ptic
setback requlrements, blocklng, footlng co~nectlon, tledowns',sklrtlng, and plumblng,
~,
/'
D. ,SWIMMING POOL: Below grade when steel' is ln place and before concrete lS poured. Above grade when pool
lS lnstalled.
t : .
APPROVED PLANS MUST BE ON THE JOB SITE AT*AtL 'TqMES UURING,WORKING HOURS. THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN
ViITlli~ ,.=: DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR"MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF'T.HIS
PER~lIT WAS ISSUED ON THE BAS IS OF INC0f1PLETE OR" ERRONEOUS -INFORMATION.
, ANYONE PROCEEDING PAST THE POINT OF REQUIRED' INSPECTIONS ~JILL DO SO AT HIS OWN RISK
SUBSURFACE ANjJ ALTERNATIVE. ,SEWAGE. DISPOSAL SYSTEMS
'~
(1 )
~.
(2)
Perml'ts shall be effectlVe for one year from the,dat~ -of ,issuans;e.,
Upon completlng the constructlon for WhlCh a permlt has ~een lssued the_permlt holder shall notlfy the
Department by subnllttl'f')g the instilllation rec9.rd\~;f.orm. The Depart~n,t shall lnspect ~he constructlon to
determlne if It.\;:ompl.ie's,w,th'tlle\'rules contain~d:;,n thlS dlV1Si'Qfl.. '."!f,the constructlon 90es comply vll'th
such rules, the Department shall lssue a certlflcate of satlsfactory completlon to the permlt holder. If the
cons tructl on does not comply Wl th such rul es, the 'Department,; sha 1 J; nO,tl fy. the 'per:ml t ~(}l~er and shall requl re
satlsfactory completlon before lssulng the certlflcate. Fallure to meet the requlrements for satlsfactory
completlo~"wlth:n a reasonable. tlme constitutes a vlolatlon .of ORS 454.605 to 454.745 and thlS rule.
'1 ~ _ t",''e.''~t'''''' ~\~
Setbacks'~~Subsurface Sewaqe Dlsposal
0:: ~.:.:\'I<,~:")._
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From: Interlor property llnes
\,-.." ", ..~, Edge of road rl ght-of-way
, BUlldlng foundatlon- .
'-. '\ '. "s .. Well s, other water sources
'''\'',\'' .
!.
Selitl c Tank
10'
10'
5'
50',
Dralnfleld'
. 10'
10'
10' '.
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CHECKLIST
PLUMBING / MECHANICAL
APPLICANT INFORMATION:
J)~AllZff' Y H PrP !()fI/
. ame 0 Finn-Pease Print)
OFFICIAL USE ONLY
AppIl.;
Penni t # L002-9.1..
-#;'''' d.H"EN tie ..('PFb
lM~ess) lClty or Town) lZlP Code)
PLUMBING CONTRACTOR
D Yes Finn
Address
D No DSelf
MEGlANICAL CONTRACTOR 0 Yes Finn
Address
o NoD Self
Type of Fixture
1-'LUMBING
Nwnber of Each
Total
Slnk
Lavatory (Wash Basin)
Tub (with or without shower)
Shower, separate
Water Closet (tollet/urinal)
Dishwasher
Disposer (garbage grinder)
Washlng Machlne
Water Heater
Floor Draln
Sewer--lst 50ft.
each additional 100 ft.
Water Servlce--lst 100 ft.
each addltional 100 ft.
Stonn and Rain Drain--lst 100 ft.
each addltional 100 ft.
Speclal Waste Connection
Sewage and Swnp Pump (eiector)
Mobile Home Sewer and Water
Other (specify)
SUB-TOTAL (Minimwn $10.00)
TOTAL FEE
\ .. ,.... -. .... -. -
..
Type of Equlpment
MErnAN I CAL
Number of Each
Total
Mechanlcal Pennit Base Fee
Furnace up to 1001000 BTU/H
Furnace over 100.000 BTU/H
Clothes DFyer Vent
Bathroom Ventllation Fan & Duct
Ran~e Hood with Mechanical Exhaust I
Wood Stove
. Air Condi tj oner Only
Heat Pwnp
Floor Furnace
Gas Piping System 1 to 4 Outlets
Per Outlet \
Other (specify) EJIT~AJI..U2M /J;: J-rE;;r D "' rJ'
SUB-TOTAL
, TOTAL FEE
~
Cont. OSR#
Cont. OSR#
Fee On Each
$ 5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
15.ob
10.00
15.00
10.00
15.00
10.00
5.00
5.00
10.00
Fee on Each
$ 6.00
7.50
3.00
3.00
4.50
6.00
6.00
6.00
6.00
.50
$ 10.00
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t. (,PPUCA}H DOWNES' l)'~NIE:::ANE .CQUNTY
r;i1'"f"D..~;: "j '70~>j ')4007'1 GO' ,S.'lj[lQIV DFn::OGE F:'(iF;:i(
. lEV! BL.DC;: T"';'PE:
{) (,.l!) E F;: i\i j"! E: 'N t!
CODE APPL. NO ACTION,DESCRIPTION
~P . LIVING AREA ADDlT.
,13 F'
USE: R ~DRMS 31 UNITS 001 STORIES
DEPT tNV MGT ~ECEIPt, ~'100282.DATE 06t482
ADDR 3871 HAYDE:N DRIDGE, ,SPRINGFIELD, 'GRE
. LOT;? 'BL.!( ~:;
~BLDGS 001 PHQNE 747 9971
(:j D D'F~ i....1 (::) ,
S'Q. F'"j"
UNIT
CCls'r
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\ltl L, U tl T I CH',,~'
FEE
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1'~lECH(~lj\! I Ctll... I FEE
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EtlCH ..,.
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PL(~'IN CHE:CI< FEE
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CONSTRUCTIC 4/PLACEMENT
PERMIT
FOR uF?lCE USE ONLY
COMPLETE THIS BLOCK. PLEASE USE BLACK INK
TOI-il'bHIP RANG~ SECTioN
\ "t < ()Z let <~
Sl.JBDI\; ISION /PARTITIO~\ \'~fJ apphcab1e) "
14;' .;>t l d n (, t~tr)l It:, t,,' (lt~ { ,
LOCATION ADDRES;; I STREET ,-} (; ~, , ~"(<;:.;;""A
3o~71 ,1"tl'",\t.:tC)'I r-")~IA.d.qL. f ,\-,' J~ 'J-\
STRuCTUReS C.URReNTLY ON PROPERTY ,-- v
t li...' ~A i I \/~\ Ck,c~d, I i (' ;;,;(
LlCSCRIPTION OF PROPOSED WORK ~ /\
()e/Ortl(ln.; +0 e}~::'i~nn(~ (..J,U)e<Hld~
~ O~BEDROOMS ~ ~ OF STORIES # OF~EMPLOYEES
c51IY/C) &Jj) ~
Ow"NCR' ~ ~ME AND ADDRESS~.' .,. ~ - "'7 tA vi ,'" ..... - t
<1""",(\ lie l..7\ (1 t')Crn"\ r~'7)'') 1 ,af.S j r ,(;1j r--\-t/n I >t' t""'p. ,~P/)L~
CO~~'S1~O~~-C: iT".!O;'\'St~' ~CfY~ A\Cu n.'-~ ) r~ Cj?Ij~!r7 ; ~7:qq;~i; _
c~p0Y 7R # .21;;~~~,$- /f7~;;~;;'~ ,~'f~~~~~t:d /~~
!/ '7 ' /' //' t' / ) /- ".' , p/ '~'/'fJ/./ p"" / ~ ./1 '
/~ ._.--;?'?/~U ~/// /..j~~// /'::,.ht;,~/ ~ ..b..//L..r;, ?":;~; /.-;,~~//~~
< , , /' -/" / # '// '
I HAVE CARE['ULLY EXAMIN'CD THE COMPLET:CO APPLICATION FOR peRMIT, and do hf"l~lbl r Ptllfi thLlI a-fl Inform"ltlon h""r~'.:m .lC" \t~"""'i1nd (.orr('r:t and I f\Jrt~1cr
! certl fy that any and all work performed shall be done 1n accordance Wl th the/Ord-1lla 1cQS of Ln.n0 County dnd the T..a,"'s of tl"')f~ St d! c of CJl "'{pn J"'" t La 1 tl \ no
. to the work descrlbed hereln, and that NO OCCUPANCY wlll be made of any structulo wlthout the pcrmlsslon of the BU1ldlng OlV1.<;1.0n I fUllhol ("rtlfy
tnat reglstratlon w1th the BU1.1der's Board 1S 1n full force and effect as requlr<"~d by ORS 701 055, that If eycmpt the bas.ls for c.xemptlClIl 1"" notrd
hereon, and that only subcontractors and employees who are 1n compllance wlth ORS 70l 055 wlll be us~d on th15 proJect I HAVE READ AND ClIECr..ED THIS
APPLICATION THOROUGHLY
AND PRINT.
TAj( LOT DOUT or
71 if,)
LOT/PARCEL BLOCK
.;) ~
1'--' .....,/
CITY ZIP
G(';:t"'17
APPllcatlon~~ ~ ~~
Permlt H ~~~~~~L1 ~
[JTwo CO;lCS of Plans
[J Two Coples of Plot Plans
[]Mechanlcal Checkllst
[] PI umblnc ChecLllst
[JPlan Check Info Sheet
PROPOSED US!.:.: ~UF" PkOBERTY' ,.... - "....".. ""
""-
~ Resldentlal D1ndustrlal
o COJ\UT1erclal
DPubllc
$ VALUr:
WATER SUPPLY
D"Rroposed
!]l EXlstlng
! ~~~17'l.JI1BER
i 9,t\f'-.Ul?L
,
V. )?OW""'" e,.;>
NAME (please prlnt)
(' _l:-
/~l
~J 1J!..;C/11~~ ,~"
SIGN;;TURE
c/~:;h2-
; '. D.'\'Ii::
o OI..,'1Ier
0.....co1t.rdc-"t:O::
=:J Aaen t
..
I'
~ PLANNING/ZONING:
Zone
A-\
;/-'"
'7' ..:..>
Partlt~on #
Parcel :ff
Ml'llmum Setbacks
C
L,
front
CL, Slde --
lnterlor
~/
-:;
q r~ 1J"'C7 #J
Parcel Slze / ,/ /' / L~
rear :7; nfE
Comments
Date
./ /j ~'-
r -/ - ...".,&:
.? l '
[J>\"
D
o
t(.~ ~ \
o FLOODPLAIN:
o RURAL ADDRESSING: '~< GRID COORDINAn
.. ",
B SP.NITATION:
In flood hazard area?
[!2j'No
DYes,
see attached sheet.
Date
I, '
S
I
#
/ ~ ....,.E -1_ L ,? Date
/ (,.0' ...,.. ~"I"
B. P. # t, 7:;)- 7 J Insta11atlon Record Issued? 0 Yes D No
N
j
, .
O!;rt!' 'f .-.!
.I'-
e>f'
&.1!) n fJ ..;
lltu ., /,:~ I.'
Maxlmunl Depth
of Trenches
(1 ~') f' '-I'lj; I (.() 111 f) k.'i?G$"':)
'\ "" I! J ff
<t s 'M t,';: b;I it~fI<"; /-,
"1/ r C""~""'"
Date 1I--.I'-'<-..f> &' ~ ~ ~~~:?
/)O/)) T /S',cf)
Installatlon Gallon
Spec~f~catlons Tank
Comments li.s pO, f ~t:.~ IrCi tr/a K"
-i',3 ; J. {. f ~..,. 3tA~,;,;) 4 ,~:,L} Sf ,rJA
Llneal Feet
of Dralnfleld
d (,(J I, h~! r>~"
Comments
)/ Iii
J1 S /V.?'Tc})
Group J(-.5
Use
[~r PLANS EXAMINATION: Type
lIJ-lrJcKC r/: I)
..
Date
7--.rUJ .- 8:2 tirif1
CONSTRUCTION AUTHORIZED BY THIS PERMIT
TOTAL FEE
$
$
$
$
$
$
$
$ s;c. 4--J ,-
$~3?:'r-~
,v1,4
/v /fi <
/ hi' cJ,. -.s.-::_
(
Descrlptlon 1;'.; /), d
OCI~,'ti t6-n _~ / '7/& 7
d/?",~./7 /:~".~~ /~
d.;Z/2~.~/ C/l..;' ~ &6t>t.-#Pr U:...
/7/' ..".....#--".;:, J - ~.'#/'
..-e;.t:{~~..?~..d~~
~M/~6'~4 /7
/b//Y>L-- ,;?{{rdfDr~f
//6 ' X v-7~ / .
Flxed Fee/
Unlt cO;1t'
,y;;; ~
Floodplaln Fee
Subsurface Fees
BUlldlng Fee
Sewer/Storm Draln/Water
?.N)" Plwnblng Flxtures
Mechanlcal
Plans Check Fee
State Surcharge
/r;;/ q 2i
Y/J-
-...- -- ----:::::._---......
t'6TAL VALUATION $ - ---...........,
(~+I PI (..... ,;,::::, , f""l . - "
\ .p (/ V, 'uL) .j~ u;.~~..... ./ /~ '.
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....~... ...._..._ __ ___~... ;('_. I...... ...;1.,.. ../
., - ~.- -.- fh...;:;;i'; v6/~~.('VP-f-
PERMIT APPROVED BY BUILDING OFFICII\L/DESIGNEE (~'er ORS 456.805 (1))
FEES PAID BY:
o Check 0 Cash
By:
Date:
~7 -2.0- 6"2-.
Dl'.TE
LANE COUNTY DEPARTMENT OF PLANNING & COtlHUNITY GEVELOPMENT / 125 LAST EIGHTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
~~-,
~
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVOCATiO~ OF THIS PE~~IT,
CITATION UNDER, PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAW.
W"FN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST MUST BE
GIVEN. Have the followlng lnformation ready: Permlt number, Job address, type of inspection, when lt wlll be ready,
your name and phone number, and any speclal dlrectlons to slte.
~
BUILDING DIVISION:
REQUIRED INSPECTIONS
1) FOUNDATION INSPECTION' To be made after trenches are excavated and forms erected and when all materials for the foundatlon
are dellvered on the Job. Where concrete from a central mlxing plant (commonly termed "translt mixed") lS to be used,
materlals need not be on the job.
2) CONCRETE SLAB OR UNDER-FLOOR INSPECTION' To be made after all in-slab or under-floor bUlldlng serVlce equlpment,
condult, plping accessorles and other anclllary equipment ltems are ln place but before any concrete lS poured
or floor sheathlng installed, lncludlng the subfloor.
3) FRAMING & INSULATION INSPECTIONS: To be made after the roof, all framing, fire blocklng and bracifo~ 1re ln place and
all plpes, flreplaces and chlmneys and vents are complete and all rough electrlcal and plumblng are apPI'oved, All
wall lnsulatlon and vapor barrier are ln place.
4) LATH AND/~R GYPSUM BOARD INSPECTION: To be made after all lathing and gypsum board, lnterlor and exterlor, lS ln place
but beforl' any plasterlng is applled or before gypsum board Joints and fasteners are taped and finlshed.
5) FINAL INSPECTION: To be made after the bUlldlng lS complete and before occupancy.
APPROVAL REQUIRED. No work shall be done on any part of the bUllding or structure beyond the point lndlcated ln each
su~cessive lnspectlon wlthout flrst obtalning the approval of the buildlng offlclal. Such approval shall be glven only
after an inspection shall have been made of each succeSSlve step ln the constructlon as lndlcated by each of the lnspectlons
requlred.
NOTE: All
A.
B.
bUllding permits require lnspectlons for the work authorlzed, such as but not llmlted to:
BLOCK WALL: To be made after relnforclng is in place, but before any grout is poured. ThlS lnspectlon lS
requlred for each bond beam pour. There wlll be no approval untll the plumblng and electrlcal lnspectlons
have been made and approved.
WOOD STOVE: To be made after completlon of masonry (If appllcable) and when lnstallation lS cpmolete.
Installatlon shall be ln accordance wlth an approved natlonally'recognlzed testlng agency dud the manu-
facturer's lnstallatlon lnstructlons.
C. MOBILE HOME: An lnspectlon is required after the moblle home lS connected to an approved sewer or septlc
system for: setback requlrements, blocklng, footlng connection, tledowns, sklrtlng, and plumblng
connections.
(1)
(2)
(3)
Footlngs and piers to comply with State foundatlon requlrements for moblle homes or as recommended
by the manufacturer.
Moblle home minlmum flnlsh floor elevation shall be certified when requlred by a floodplaln
management letter.
Moblle home tledowns, when requlred, and sklrtlng shall be lnstalled and ready for inspectlon
wlthln at least 30 days after occupancy. Tiedowns and sklrtlng shall be installed per enclosure.
D. SWIMMING POOL: Below grade when steel lS ln place and before concrete lS poured. Above grade when pool
lS lnstalled.
APr~OVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN
WIT' 1~ ;:: DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PER~IT WAS ISSUED ON THE BASIS OF INCOf1PLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT HIS OWN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DI~POSAL SYSTEMS
(1)
(2)
Permlts shall be effectlve for one year from the date of lssuance,
Upon completlng the constructlon for WhlCh a permlt has been lssued the permlt holder shall notlfy the
Department by submlttlng the lnstallation record form. The Department shall lnspect the constructlon ~o
determlne lf It complles with the rules contained ln thlS dlvlsion. If the constructlon does comply v/lth
such rules, the Department shall lssue a certlflcate of satlsfactory completlon to the permlt holder. If the
constructlon does not comply wlth such rules, the Department shall notlfy the permlt holder and shall reqUlre
satlsfactory completlon before lssulng the certlflcate. Fallure to meet the requlrements for satlsfactory
completlon wlthln a reasonable tlme constltutes a vlolation of ORS 454.605 to 454.745 and thlS rule.
Setbacks - Subsurface Sewage Dlsposal
From: Interlor property llnes
Edge of road rlght-of-way
BUlldlng foundatlon
Wells, other water sources
Septlc Tank
10'
10'
5'
50'
Dralnfleld
10'
10'
10'
100'
,..-
~r >
'!I"' = .
, ,
./dne'~Ounty" .
@
----
OFFICIAL USE ONLY
CHECKLIST
PLUMBING / MEeHAN ICAL
APPLICANT INFORMATION:
y\ I
*, r J\AJ/= u I J-I 01'1 i~ (rJ/\/
, (Name ot FITm,Please Print)
Apph./ j. "
Pennit # I)02~/)L.
.:5 f? 7/ ilA/.llJJ7J1/ /?/<. J-t~ jj
(MaIlIng Address) (CIty or Town) (Zip Code)
PLUMBING CONTRACTOR
D Yes Finn
Address
DNoDSelf
MErnANICAL CONTRACTOR 0 Yes FInn
Address
o NoD Self
Type of Fixture
l-'LUMBING
Nwnber of Each
Total
SInk
Lavatory (Wash Basin)
Tub (with or without shower)
'- Shower, separate
Water Closet (toilet/urInal)
DIshwasher
Disposer (garbage grinder)
Washing Machine
Water Heater
Floor DraIn
Sewer--lst 50ft.
each additional 100 ft.
Water ServIce--lst 100 ft.
each addItional 100 ft.
Stonn and Rain Drain--lst 100 ft.
each additional 100 ft.
SpecIal Waste Connection
Sewage and Swnp Pump (elector)
MobIle Horne Sewer and Water
Other (specify)
SUB-TOTAL (Minimwn $10.00)
TOTAL FEE
..
Type of Equipment
MEGIANICAL
Nwnber of Each
Total
MechanIcal Permit Base Fee
Furnace up to 100,000 BTU/H
Furnace over 100,000 BTU/H
Clothes Dl!yer Vent
Bathroom Ventilation Fan & Duct
RanJ:?"e Hood with MechanIcal Exhaust I
Wood Stove
Aur Conditioner Only
Heat Pwnp
Floor Furnace
Gas Piping System 1 to 4 Outlets
Per Outlet I
Other (specify) EYT.t=llIf//JA/ ?j:: J.lcJ'T Dul. 11'
SUB-TOTAL
TOTAL FEE
Cont. OSR#
Cont. OSR#
Fee On Each ~
$ 5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
15.00
10.00
15.00
10.00
15.00
10.00
5.00
5.00
10.00
Fee on Each
$ 10.00
$ 6.00
7.50
3.00
3.00
4.50
6.00
6.00
6.00
6.00
~.~-c
.50
L.otJ
,.,...-
~........
70 SO \,
,...... I
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--..._-,._-~
..
~
.
LANE COUNTY, OREGON
DEPT OF ENVIRONMENTAL MANAGEMENT
-
-
CONSTRUCTION PERMITS
& INSPECTION DIV
CORRECTION NOTICE
JOB ADDRESS 3??1 / ~~ ".,
t</.#.A' /' /J-1 ~~ 7
AOTE
fA, ' // '
- r~ IT.
(g j,(4-<-~~
~..~ ,~
~,U
DATE
8"- 9- 92----
./ (2CJ 2. - 22-
TO
BLDG PERMIT
"7// .
/ to, C!-. ~~
~~... ~.) , ~ ,/!I~
~ ' ~.- t? / /J I
teL..... ~,~ ~~~.
C55,73
./
~ /'
~,"""'"
RE-INSP~.l' REGUIRED
Phone 687-4065 /"'..... APPR AL
INSPECTOR
, -
.. '
~)G~
, :p
... .,.' LANE 'tOUNTY
OW~RIS NAME /f
M4/! .~;:~. _..._J/; .-/j-r??k&.:2JJY? j
C N1RACTOR I S/ AME -, /l /,
tI ) /..dbJ ~J I ''7);/,.vi!tA / Ie. h- )))~j
~~: ~~~~T~~RE~t~T~~DE ~- -~~TERIOR ,,5 REAR 7 H/$LUMBING FIXTURES
W..QRK AVTHORIZED B~ jERMIT., ~'- '1rI:Z~4z:c
4$r~c'fro~fo-'t:lh /-fV._d/~/.l d-l/rt:tt; "'zJi db'fJ1' /1P!H!/J. ,y~ /;~:"
4~nt:Lr17r17L/t--iC./-tfbb~~/.y/#./,. Ci'-,,' (7ky11-;u:. 1k(J''731 I !I/I.ft/~
3g 7/ ~)/Lud;P,t..lj t5nA;;~' fJ~ ~44,d /()OZ -)(7
SITE ADDRESS () U () .. - / (I , PERMIT NUMBER
FOOTING / FO~DATION INSPECTION OR MOBILE HOME SET UP INSPECTION (1 ~
Approved-1/' Correcti on Di sapproved Date 8'- 5'- f? Z Inspector ~ ~
1,2/-<iJZ, -/;d~ "," ~ ~ ~,-,e_
CONCRETE SLAB / UNDER-FLOOR INSPECTIO~
Approved Correction Disapproved
,
J}.~'~~<)
',.1 "
't 1,(j'o.
, \ ,Ap
\,'''''..;J .. "'fi' .~'
l-q _ t ...
l -...~t ~ ,,~,
. ,\ s-
"'~t- *;..(t~
INSPECTION RECORD
..~." ~...
1> .)-...
, ,.
PHONE NUMBER
PHONE NUMBER
Date
Inspector
UNDER SLAB / PLUMBING GROUNDWORK INSPECTION
Approved Correction Disapproved Date
Inspector
ROUGH PLUMBING INSPECTION
Approved Correction
Disapproved
Date
Inspector
FRAMING INSPEyTION
Approved ,/ Correcti on
Disapproved
DateJ'- S--~)nspector
~
,
INSULATION / VAPOR BARRIER INSPECTION
Approved Correction Disapproved Date Inspector
-'t~) "'..4.//~~ /:~ y~ -
LATH / GYPSUM BOARD INSPECTION
Approved J/ Correction Disapproved Date~- ~~f.?2- Inspector
~~.~~~
FINAL PLUMBING INSPECTION
Approved Correction
~
v
Disapproved
Date
Inspector
FINAL WASTE DISPOSAL SYSTEM INSPECTION
Approved Correctlon Disapproved
Date
Inspector
FINAL INSPECTI)1N BUILDING
Approved L/' Correction
1/ MOBILE HOME
....Disapproved Date 7-/-f?;e. Inspector~
CERTIFICATE OF OCCUPANCY
Approved Correction
Disapproved
TEMPORARY CERTIFICATE OF OCCUPANCY
Date Inspector
Form C74-197