HomeMy WebLinkAboutPermit Building 1981-9-2
1("rfl CO~STRU~ION/PLACEME~T. FOR OFFICI: USE O:<LY
PERMIT {\\0 }v~~~;~~.~tg:-00--.r!
. :s tg.. 0 Two Copies of Plans
Cm1PLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT. OTWO Copies of Plot Plans
TOI'" 'HIP J RANGE I SECTION TAX LOT OOU'l' OF
..., 'J' 0/- I 4- I tlf'r^^ DHechanical Checklist
J B. ~ lO. . ~-^J 0 Plumbing Checklist
SUaiv~.::>~N/PARTlTIOtl (if ppliCablef , I LOTl};kEL I BLOCK
LA..) _ _ . . j\J\lllflrrr-- ~ ~ DPlan Check Info Sheet
L~o;;li-"DRESS L6n1ATJuiiw.-l l/\h.. 7m)?Q. CC:f7477
STrtur ~1l;; 'O:;ROPr(iW} I ( H, U ~ '--' rue ( 0 Conunercial OPublic
OESC 'lu'/ld"".JrrltJJD ~ /1~ (] Ih(f .J SGALtJtm. ~
I 0 Proposed
WA, . I 1,.)1/ n!YYI 0, 0 Existing
OWN~A;;AfN.,v."POIO~ 7 Lon' 1/))". ,~\. 74~~EOOIR2
~'rl"~TOR'S NI'HE Ailff l1"fsS d I ~ n (J~~/b.... ) 2SrU-'. ';;'Lf~HONE NOMBER
-LVU'hLl ) ~)Ct _ _. .,..... L LJ. (-n1J751P9f'/I. _B-b-oO'OI
tTl~5b5 I DIRE~l~ ') f)C(j' ~1)1+,l~ ..NjI~;J _ 2Jl-
I "^V~~:::'~ EKAMItl~::J:~'~T':1l FOR PERMIT, and do hocnby cc.Uf.,. that all 'nfo.motion he.non 'H ""' ond concct and I funhe'
certify that any and all wo erformed shall be done in accordance with the OrdillanCQS of Lane County and the Laws of the Sttlta of Oreq~n I'~Ilaillinq
to the work. described herein, and that NO OCCUPANCY will be made of any structure without the permiilsion of the Building Division. I further certify
that registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is not(>d
hereon, and that only subcontractors and employees who arc in compliance with ORS 701.055 will be us~d on this project. I HAVE READ AND CIlECY.ED THIS
APPLICATIO~ THOROUGHLY.
'-
PROPOSED U~E OF PROPERTY
~sidential [JIndustria1
~! t>.V\el\p ('., \O,'P-<-
NAME (please print)
p ~ n.eLPs1GNtf/n} #.-1
~~{/
DOwner
o Cont.ract.or
~gent
pe~ Size I J5?f {t{~
interior S- / rear' I~ at\...atJlO...,
~ '" ) I ~. V 0
. '-- - ""f-~'D:t:,' ~.;2.I-Qj ~~""'--
n
o
Date:
o PLANNING/ZONING: Zone RA, ....-:artih~~.
Hinimum Setbacks: eL, fron~QCJ.\JY'2:..- ~ ~ .
'Lomrnents:" '--Q> ~\.*"- - Q.~"""!l..
Parcel #
t,
o FLOODPLAIN: In flood hazard area?
o RPRAL ADDRESSING: GRID COORDINA,"
[JJISANITATION: S. 1. i
~
[] Yes, see attached sheet.
N
E
Date:
B. P.
i.t.ll5-~S"'
Installation Record Issued? [] Yes [] No
DJ<~
Installation
Specifications:
Comments< 147J.prud (4VlrlYllcl((frI) An/P tt /I~d.. ''ipfLhadcA ~]
~ /, \j2.piJ/1 "Jjdfil./M 1M ,\fJrAlM (A-. ~tI j.d-or ,tih..'IV j...cJ)
/)tJl/lYlIq r!<fo/Jura;/)Alf . Date, r?7-.s0p:t If) ---r.KflM..}
PLANS EkMINATION: TYPe5AL- Group'/Y1:.61~ Use ;:~::;/'~
Comments, ~ (?eQl1lJ'2emp..AA1:' "AI 'fr:nl, <::Qd- '-9i
Or~.
I
Gallon
Tank
Lineal Feet
of Drainfield
Maximum Depth
of Trenche9
Date:
Q- 'L-!f /
~
CONSTRUCTION AUTHORIZED BY THIS PERMIT
--
~ ,;(.i;ft;on
V4{~)
Sq. Ft.
7 yl) f
Fixed Feel
Unit Cost
~S-O
Floodplain Fee
Subsurface Fees
TOTAL FEE
/f~.
/. ~~
$ .sr ~~
PAID BY~l- llia/
By: /-?~ ~
Date: '~~2/-f/
9-;) -y/
$
$
$
$
$
$
$
$
~h-
..,..
;=-
./J
~ &/~/I'/~
~ -
~
Building Fee
Sewer/Storm Drain/Water
Plumbing Fixtures
Mechanical
Plans Check Fee
State Surcharge
~
TOTAL VALUATION
$
FEES
-r. --r: /J1ffl!1~
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (per ORS 456.805(1))
C74-194
SEE REVERSE
\
AVENUE, EU\ENE,
DATE
OREGON
97401
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH
.
.
i_
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT,
CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST MUST BE
GIVEN. Have the following information ready: Permit number; job address, type of inspection, when it will be ready,
your name and phone number, and any special directions to site.
BUILDING DIVISION:
REOUIREO IIlSPECTlONS
1) FOUNOATION INSPECTION: To be made after trenches are excavated and forms erected and when all materials for the foundation
are delivered on the job. Where concrete from a central mixing plant (corrmonly termed lItransit mixed") is to be used,
materials need not be on the job.
2) CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building service equipment,
conduit, piping accessories and other ancillary equipment items are in place but before any concrete is' poured
or floor sheathing installed. including the subfloor.
3) FRAMING & INSULATION INSPECTIONS: To be made after the roof, all framing,' fire blocking and bracing are in place and
all pipes, fireplaces and chimneys and vents are complete and all rough electrical and plumbing are approved. All
wall insulation and vapor barrier are in place.
4) LATH ANO(OR GYPSUM BOARO INSPECTION: 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.
5) FINAL INSPECTION: To be made after the building is complete and before occupancy.
APPROVAL REQUIREO. 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 be 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 fimited 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. WOOD STOVE: To be made after completion of masonrv (if applicable) and when installation. is comolete.
Installation shall be in accordance with an approved nationally recognized testlng agency dlld the manu-
facturer's installation instructions.
C. MOBILE 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 whe~ required by a floodplain
ma"nagement letter. .
(3) Mobil~ home tiedowns, when required, and skirtinglshall be installed and ready for inspection
within at least 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure.
D. SWIMMING POOL: Below grade when steel is in place and before concrete is poured. Above grade when pool
is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS_ THIS PERMIT WILL EXPIRE IF WORK OOES NOT BEGIN
WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANOONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERMIT WAS ISSUED ON THE BASIS OF INCOrlPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIREO INSPECTIONS WILL DO SO AT HIS OWN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
(1)
(2)
Permits shall be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued the permit holder shall notify. the
Oepartment by submitting the installation record form. The Oepartment shall lnspect the constructlon to
detennine if i.t complies w:ith the rules contaIned"iri this divIsidn. If the construction do~s comply ""ith
such rules-. the Depar.tment\sha1l issue a certJficate'.of satisfactory completion to the permlt 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 certffi~ate. Failure to meet the reqJirements fo~ satisfactory
completion within a reasonable time constitutes a violation of ORS 454.605 to 454.745 and th,S rule.
Setbacks -' Subsurface SewaQe Oi sposa 1
From: Interior property lines
Edge of road right-of-way
Building foundation
Wells, other water sources
Septic Tank
10'
10'
5'
50'
Orainfield
10'
10'
10'
100'
'-"- '.
..
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ESTIMATED DATE:
PURCHASER'SNAM~:Z5:/1 (}V/.J/, .tV
ADDRESS:!t6 7.':.. LOA/co ~J.c. P
.' '-' ....-
CITY:.,.rI'R/~e::.>c,'eld STATE:
. -
\.DIRECTIONS: .: ,..,~., '
o
{)&~-
OUOTE'GOOD FOR:
ATTN: Silt1/' '7'1 (.. ~.<.,-o I ;2.
PHONE: 7q/., .- Rnt.../
ZIP:
SLOPE OF SITE: ..1 e f)~ I
GR'O'~ND' CONDITIONS:"' C1 I) D,O
,j , . c. . ,
~. DISTAN.CE TO POWER: ,. S(.)
. BUILDING DIMENSIONS:.2t.. }<.. 30
. EAVE'HT.: /,2 ." " ROOF PITCH:~ / 17
I
OVERHEAD DOORS: 3- la)( 10
. ~. t' . .
. ACCESS DOORS: J ' ~_
'. SLIDING DOORS: A/J.v-e-
SKETCH AREA
(f1,)-V / So tp
po (2.
fJ;? ~ t1I'J
(B)/.S'DIf
rote
{Jtt:/{j~ ui/7
~_y{... rei ~It~ ~
/
WINDOWS: : IV r;..f f".
CONCRETE: y,. 'wJu..>/r.!. e.
INSULATION: R..Dr] j::
SiDIN'G COLOR: J '3 (l ,)/ /}~~
k_.' '.
. "
TRIM COLOR: .. J -:t C-a ld.es
ROOFING COLOR:/ -:? ~(tJt4G.5
RiDGE COLOR:' I 7? e,l/ ~e..5'
:.. '... I, " ' ~,' ~ '"
. SIDELIGHT CgLOR:' <l )( .?lJ
.'
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SKyLIGHT COLOR:
If/ 4,.,-<:-
GUTTERS & DOWNSPo"UTS:
r.-
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'. '.i _ PROPERTy'DESCRIPTION
I
COUNTY:'
'L /:1# ~.
/8
:2.
G.
)it}..- I J:2 no
f-e ,..,& "tt' :7
,
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TOWNSHIP:
RANGE:
SECTION: '
TAX LO+ No.: {
(TO ALL V.A. CUSTOMERS) Due to increases all the time for mater-
ials we are unable to guarantee this contract for any longer than 30
days. When you receive your commitment from V.A. we will then tell.
you if there have been any price increases since the signing of this con.
tract. You would pay for the cost only on any increases..
PURCHASER INITIAL. HERE:
. '.
Down Payment 20% of Contract Price
60% of Total To Be Paid Upon
Delivery ot Materials
Balance To Be Paid Upon
. . Complotion of Work $ .I ., /") ".') .
All the above work ii to tie-corripleted'in-a- suostantiai"and'workmanlike manner-according-to.standard praetices..Payments_sre to be.made as
per written on the contract.- No other payment schedule will be allowed unless otherwise approved. The contract amount will be paid in fulf ----:-
within ten (10) days after completion. Any alterations or extras from the above specifications involving extra cost of materials or labor will
only be executed upon written orders for same, and will become an e~tra charge over the sum mentioned in this abovo contract amount. All
agreements must be in writing. No contract is valid until all three signatures are on the contract. Purchaser is free of any liability regarding acci.
dent of deaths in, conjunction with installation. Metal Clad Builders, Inc. is fully insured and registered with the Workmen's Compensation
Board.' Our Oregon State Contractor', Licen,e Numbe, is 18565. If suit is brought by eithar party to enforce the terms of this contract, ec-
ceptor agrees to pay the IU~ which'the court may adjudge reasonable as attorney fees.
O~Q~.
, .,"'"
/. ,.F>
$ ;:;? /)<,) .~.-
CO~TRACT PRICE,. ',; : 't, 600 .
$?I': /.i/.J.
&~....
.--.-
,.'t,~
METAL CLAD BUILDERS, INC.
Representative :-
I'( ~Pl,d..l Pc42~......-,.,~
PU-Rl:HASER - (/ I
1-1- / -/- Ei'1
It q,(,mtNt~) .r1lD~ >" rf4.i" ;kJ
METAL 'CLAD'BUI DERS; fN\.
President or Secretary' ,.: '
, "
,~ .,J
Date Signed
CORPORATE SEAL
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LANE COUNTY DEPT ENV MGT RECE;PT 0 180681. DATE 0821U~
APPLICANT GLOVE", JI;NELLE . ADDF, %7 LONGIUDGE DF(., SPIUNGFIEU.l, ORI.!!
TLO 1802061411200 SUBDIV WILLAMETTE MANOR LOT 2 BLK 2L
NEW BLDG TYPE GAR USE I' NO BDRMS 00 NO UNITS 001 NO STORIES NO BLDGS 001 r
CODE APPI" NO ACTION DESCFnPTION SQ FT L1NIT COST VALUATION FEE D,.,{
BF' I ~.
HI" t:
BF' e~
HI"
lW
BF'
HP
PL
MECH
Sl.m
PCI(
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4% .
~}0%
1.44
16l.,00
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LC lB0681 NEW I'
NO. FIXTI.JI~ES:
NO.
CONNECTORS:
t1ECHANICAL FEE.
ST A TE Sl.IRCHf.,RGE
PLAN CHECI( FEE
6000
1 ~>" 00 EACH _h
:36.00
CIHG:
. SUW:
TAI([N
AF'P
o
BY F,I...H
RA
FP SDS ,SI PCK (JTH ISS
1 2 :5
EST. C0I1PLETIOW DATE 090181 TOTAL FEE** ~:>~5,,44
.
.
.
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. . Environmental Managemee
ACTf\rITYINFORMATION. SH EET
idne county
"
-.BILLJF'- ,.D. ~PL-~rJ
9 ~ ;ROPEL;::o~~: ~:HASER () fL I v ~
MAILING ADDRESS
SfJe:loJo,{t'eid d){2, "1'7'1'7'7
.CITY I STATE ZIP CODE
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE. REJECTED!
G)
Po P L-'j l\J
APPLICANT/REPRESENTATIVE
0civ€
$JLL/~
.f).
q(p 7 ~rJc fJi nc;P,
:-ilt1.INc ADDRESS
SPt'Ii)Ci\~/LLJJ t2eg.,
. CITY STATE
"7L/~ -,?cJ/(;6
q7<!77
ZIP CODE
BUSINESS TELEPHONE NUMBER
ttTqCE:~~(.
o APPLICANT/REPRESENTATIVE
1 t.f {, ~ $;"0 ( 0
BUSINESS TELEPHONE NUMBER
~ROPERTY O\;NER/CONTAACT
7t/t, --.PO {, (
HOME TELEPHONE NUMBER
o MAIL INFO~~TION TO,
PURCHASER
TuX Map Number, / f'- d- &:.- /t/
Tax Lot(s):
Q) TAX MAP/PROPERTY DESCRIP'I'ION NUMBER (from tax maps in Department of Assessment (. Taxation or from tax statement):
//.;zo?'
OOut of TL I
Tax map number of adjoining property in same ownership: ~one 1
Tax Map Number:
Tax Lot(s):
@ SUBDIVISION (if applicable):
@ REQUEST (briefly describe information needed) :
PE:Q./n i':t
10
BUI/...D
GlIt-~~,
COMPLETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS. OR PROPOSALS . SEE oNOTE BELOW.
<D TOTAL c::ONTIGUOUS PROPERTY IN SAME OWNERSHIP, ~ I acres
o PROPERTY ADORESS,
Q) PAESENT USE OF PROPERTY, US lOt: N II A L
GD NUMBER. OF STRUCTURES ON PROPERTY: Standard home~ Mobile home
Modular home
- RV in use as residence
Storage_
Barn
Garage_
Other (specify)
Shop_
@ ACCESS TO PROPERTY,
/..-0 N f\fLi DoIt,6'.
D~i I/E:-
Public Road Name
Private Road Name
Road", Easement
# of
Users
Width
@ OTHER EASEMENTS OVER PROPERTY:
~
---~- "
(j) N^1'El<nlSTRIC'r, I JJ ILl-llm.e::Tft...
@ FIRE OISTRICT;
G EXlS'l'lNG PE~IITS ON PROPEATY,
-
7/81
(OVER)
By partition fi
o Unknown
BLOCK,
LOT:
,:2 C-/+-P .J
""FOR STAFF USE ONLY".
NUMBER,. 3""3
rt-Z-D ._~ J
/,' AT>
TIME INITIATED, TY
SlZ...
,
..,
IX
'-.
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DATE,
CHECKED BY:
ATTACHED EXHIBITS:
o Plot Plan~ (2)
o Constr. Plans (2)
o Site
o Copy
o Other
Plan
of Tax Map
SCREEijING VERIFICATION,
By, ~M_
Date: <<J. ,
Time In,' Out 1,iO~
~ept 0 Reject
. Routed to, ",if1J (JJv.../
*NOTE: .
ATTACH A COPY OF TAX MAP;
SHOWN EXISTING STRUCTURES
AND TAX LOTS IN YOUR OWN-
ERSHIP. OBTAIN TAX ~mp
IN SELF HELP AREA.
OR.C~NSTRUC1~6N~~;P~~C~~IO~
nktJ /(),.~~t1. '/J1J,~;'.'
- .
COMPLETE THIS SECTION:FOR LAl:/D USE,
I@ PROPOSED USE OF PROPERTY IN DETA!.L.:,
~
'1f' .A~ ~ (J
(J
@ BUILDING REQUESTS:
Contractor's :it
Directions to Site:
(for mobile home setup also)
Check the type of permit requested:
o Dwelling: q Ne\... 0 Replacement
o Addition 0 Alteration;
D Mod~lar. Home 0 Mob;ile Home - Model
ORV
~tional;
?tlA4 -;,"
D Standard Construction;
.0 Plan Check Only
o Commercial: Vse
q'Ag~'i~u.(t'uia'l: . Use'
o Others: Use
t 0 Change: of Use -. How?'
'@ SANITATION REQUESTS:
D- Si,te eV411uation for ',50S feasibility
q ~'ew system. ins,tallation
q Rel:?air/replace~ent
o Alter"ation/relocation
DHook to exist;.ing
ADDITIONAL INFO~~TIO~:
NA-'
//"
/'
/'
.__f.109.!_ Atea
Floor Area
---.-- "
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,
Year
I
I
,
**FOR STAFF USE ONLY*~
ZONE/~ USE':
By:
Date:
Time In:
o Accept
Out:
o Reject
[] Planning Application
[] Construction pcrmi t App.
[] Information Only
Zoning:
Compo Plan Designation:
Comments:
SiI'NITATION:
'By:
Date:
Time In:
o Accept
Out:
o Reject
[] Constr. Permit Issue
o site Evaluation Issue
PERMIT ISSUED (SAME DAY ONL~):
Permit i
By:
Date:
Time In:
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Out:
TRS TL /8-d~~ -N-I/;uJ6
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. Plat:
Plan
Subdivision
Lot
Block
'rv~
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Vicinity Map
c74-150
Job Location
Permit (J
Permit 1/
Permit (J
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(Address) q (,-, '7
For
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For
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~ . () Permit (J F;'r (\ '\j .
Permit (J For
Permit (J For
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. .,-. LANE COUNTY 'J fINSPECTION . RECORD
OW~~~) p~
~n'~~-s r~p tSfL~
SET BACK REOU~EMENTS
CL. FRONT r<:,.e d- CL. SIDE
WORK AUTHORIZ 0 BY PERMIT
A.~ ~~~
DIREJ~IC!,N}.)O/Snr // 'If" /7 (~I
10 vfV( /2,~ '-( ? A-ui/ IJ~ jt- l...d/.1.d Al/J I )
vq&1 iUn~~ /0,/ S!;~. (rt1r; -?/
SITE ADDRESS IY U ;;i..~ (p _ 14 _ II..::> c57) / fA) i I / /1..-h. ~;If;. ~E~~R ~ /Sdd
FOOTING / FOUNDATION INSPECTION OR MOBILE HOME SET UP INSPECTION
Approved Correction Disapproved Date Inspector
&7-IL> -,f(! ~~ /-: . . ~Z~~ II.z,t>< _
tflL.L(.,- 'Xi pg,.. ~ 'h ~ ~ *' /'\~ Qz. ~
cONCRETE SLAB / UNDER-FLOOR INSPECTl[ONv
Approved Correction Disapproved Date
~,"'A',' .
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,.I,~j .'ff;
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"''i\",t'. .
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INTERIOR t;; I
I
REAR 7 .. oIP
If
PHONE NUMBER
--; t/(tJ - c::;- 0 I -;r-
PHONE NUMBER
/1/(0 - f.Of" I
HPLUMBING FIXTURES
'-.
...-
Inspector
UNDER SLAB / PLUMBING GROUNDWORK INSPECTION
Approved Correction Disapproved Date
Inspector
ROUGH PLUMBING INSPECTION
Approved CorrectiDn
Disapproved
Date
Inspector
F RAM I NG INS P I;.eT ION (2,_ . J?
Approved V Correction DisapprDved DateH ~ 2-<;1 LrnspectDr ~~.
7.- .>f?~?" ..k - /. - -- t!..J J?~ L'rH L...-,-,.7r ~..'.,...V
INSULATION / VAPOR BARRIER rMSPECTION / v
Approved Correcti on Di sapproved Date Inspector
IA _ /) ,
LATH / GYPSUM BOARD INSPECTION
Approved Correction Disapproved
//1 fA. '
FINAL PLUMBING INSPECTION
Approved Correction
Date
Inspector
Disapproved
Date
Inspector
FINAL WASTE DISPOSAL SYSTEM
Approved Correction
FINAL INSPECT)ON BUILDING
Approved v' Correction
INSPECTION
Disapproved
vi' MOBILE HOME
Disapproved
Date
Inspector
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CERTIFICATE OF OCCUPANCY
Approved Correction
Disapproved
TEMPORARY CERTIFICATE OF OCCUPANCY
Date Inspector
Form C74-197
LANE ~OUNTY, Op..SGON .
QEPT. OF ENVIRONMENTAL MANAGEMENT
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CONSTRUCTION PERMITS
& INSPECTION DIV.
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DATE t::7- //J -;;r/
BLDG. PERMIT: /4?L)-c'- R,L
NOTE:
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C55-73
RE-INSPECTION REGUIREO /lA~
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