HomeMy WebLinkAboutPermit Mechanical 1981-10-26
~~ N~
ta \ l CONSTR~TION/PLACEMENT .
~ PERMIT
FOR OFFICE USE ONLY
PLEASE USE BLACK INK AND PRINT.
PANGE ~:3 l:?2,.::?.2 j ;?7~ DOUT Of'
SUBDIVISION/PARTITIDr~" Ie) ..J Pb-I B$~
LOC~~-';""7?' mTREET A .././ ./~" ".;;F!iP 4?-:? ZIP
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:~:-B;DR~;r ADO -'so~ ~ /f1 o~ 1 WATER SUPPL~~ TELE~~E~~~
~~~ ~/~ ~~/V 79"'7-:~7's-
( ?-~ A~~~ _ - _ _ TELEPHONE NUNBER
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I HAVE CAREFULLY EXAMINED TilE COMPLETED APPLICATION FOR PERMIT, and do hereby certify tl1ilt all infA'rmiltLbn hereon iu t[U~ and correct and I further
certify that any and all work performed shall be done in accordance with the Ordinances of Lane County <lnd the Laws of the St..lta of Orc'I:'m I'crLilining
to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Oivision. I [urth,)r ct~rtify
that. registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if cxempt the basis for excmption is notr:!d
hereon, and that only subcontractors and employees who arc in compliance with ORS 701.055 will be used on this project. I HAVE READ AND CHECKED THIS
APPLICATION THOROUGHLY.
Tm-mSHIP /7
APPlicot.i,,?,//] / 7- r: /
Perml.t #_ _..__~ fn 6"
- ,
o Two Copies of Plans
[]TWO Copies of Plot Plans
[]Mechanical Checklist
o Plumbing Checklist
I Dp1an Check Info Sheet
COMPLETE THIS BLOCK.
PROPOSED USE OF PROPERTY
~Residential [Jlndustrial
o Conunercial
Dpublic
S VALUE
,f!?c:/ / ~li~ET
Zone AY/l Parti tion #
::::s~~k- G;~Z::~
/~i~~ ~~
DOwner
o Contract.or
~AgQnt
o PLANNING/ZONING:
Parcel #
Parcel Size
.#//4-
/
rear
Date:
/C/~~~ ~
/ / n
o
o
o
o
FLOODPLAIN: In flood hazard area?
RURAL ADDRESSING: GRW COORDINATE
SANITATION: s, 1. #
D No
[] Yes, see attached sheet.
Date:
N
E
Date:
B. P. #
Installation Record Issued? [] Yes [J No
Installation
Specifications:
Gallon
Tank
Lineal Feet
of Drainfie1d
Maximum Depth
of Trenches
Comments:
o
P(PLANS EXAMIN~TION: Type~ Group e-~ use~ f..lJ7J'lnI~~
Comments, A~ '"'>tm~~' '.o/-r 1..hL.LJc:..-t1Mn.,~
MI-\ 11(~52.: S~AL1 ~ -'~U_~.,Ac:r:bLJ-N ;":'O?P (lAtv-~rrJd
---11.1_. ~pF"..I'---IFtr~tiIt~ A1JD fMr...1()FAcrT)~c..~S'~ oate'-I~ -1{;-?"!--s,
Date:
CONSTRUCTION AUTHORIZED BY THIS PERMIT
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s;~/
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$
$
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$ /... ,
$
$
$
$
$ " 0 ~
sdlJ. h4?
FEES PAID ~ ~k .f}I..Sh
BY~ ~.//)(/:-,
D:te, I j' /~;;::~
.-r r MneiJ"S_ (0 -1.J~ J? I
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (per ORS 456.805 (1) ) DATE - .
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT I 125 EAST EIGHTH AVENUE, EUGENE, OREGON 97401
Sq _ Ft.
Fixed Fee/
unit Cost
Floodplain Fee
Subsurface Fees
Building Fee
Sewer/Storm Drain/Water
Plumbing Fixtures
Mechanical
Plans Check Fee
/ f/. :.;-
4/~
State Surcharge
TOTAL FEE
TOTAL VALUATION
$
~
C74-194
SEE REVERSE
SETBACKS AND OTHER CONDITIONS OF'APPROVA~ST BE STRICTLY OBSERVED. VIOLATION CAN ~LT IN REVOCATION OF THIS PERMI~,
CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/DR 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:
REOUIRED I1ISPECTIONS
1) FOUNDATION 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 (colTl11only termed IItransit ffiixedU) 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 AND/OR GYPSUM BOARD INSPECTION: To be made after all lathing and gypsum board, interior and exterior, is in place
but before an~ 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 REQUIRED. No work shall be done on any part of the building or structure beyond the' pOint indi~ated in each
successive inspection without first obtaining the approval of the building official. Such approval shall be giyen 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
haye been made and approved.
B. WOOD STOVE: To be made after completion of ma,onrv (if applicable) and when installation is comolete.
Installation shall be in accordance with an approyed nationally recognized testlng agency and 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
~y'stem 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 floodplain
management letter.
(3) Mobile home tiedowns, when required, and skirting shall 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 DOES NOT BEGIN
WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERMIT WAS ISSUED ON THE BASIS OF INCffi1PLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT HIS OWN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE 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
Department 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 \'lith
such rules, the Department shall issue a certificate of satisfactory completion, to the permit holder. If the
. construction does not comply with such rules,. the Department shall notify the permit holder and shall require
i.satisfactory completion before issuing the certificate. Failure to meet the, requirements for satisfactory
. completion within a reasonable time constitutes a violatfon of ORS 454..605 to. 454.745 and this rule.
, '; "',' \} .:" '
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Setbacks - Subsurface SewaQe Disposal
From:
Interior property lines
Edge of road right-of-way
Building foundation
Wells, other water sources
: Seoti c Tank
10'
10'
5'
50'
, ,
<-."
:\
.
"
. ,
"
Drainfield
10'
lD'
10'
100'
..
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APPLICANT FAPSET.
TLO 1703262200218
NEW HLDG TYPE
CODE APPL NO
BP
BP
BF'
BP
LANE COUNTY DEPT ENV MGT RECEIPT
BETTY AD DR 2378 GROVEDALE,
SLmDIV
USE f( BDF,MS 0
ACTION DESCRIPTION
o 226701 !){d'E: 1 (')2201
SPRINGFIELD. OF<EGON.
LOT BlY
UNITS 00' STORIES OBLDGS 00' PHONE 747 7A'l",j
SGl FT UNIT COST VAL.UATION FEE DAe:
..
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.~
..
BP
.!!. BP
.'
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-.
PL.
MECH
SUf(
PCK
PP
tlECH
SLII'(
PCI(
4~{'
50~
NO. FIXTURES:
54
-:-lo ~
.
NO. CONNECTor;:S:
t1ECHANIUlI.. FEE
STATE SUf(CI-II',I~GE
PLf4N CHECK FEE
I ~-). 00 EACH -..
2'...
LC 226781 WS
6.00
'0J)0
0.6-4
4.00
,
e~
.
12 ~
11.~
10 :
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sa
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CATG:
SEIW:
TAKEN
AF'P f(,,,
o
BY I~L.H
FP
SDS
SI
F'CK
I
102981
OTH ISS
2
TOTAL FEE**
20.64
Q
.
6 .
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~
EST. COMPL.ETION DATE
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COMPLETE THIS SECTION.'
\
CD _1"OhM
INCOMPLETE FORMS WILL ,BE,REJECTED:
kJne county
~
Environmental Managemen.
ACTI.TY'INFOR,MA r I ON ~H EET
STATE
ZI: ?cot??
c; or eQ~JV 7 .Y ~ J:-C>J1"'"
t7^ / --. PR?PERTY OWNER
~ 3:7 ~ C;=I"O ve Ja/C'"
MAILING ADDRESS
S4t ; ~/~;-=-/J e7,~
/ CITY (,/ / ~ STATE
F;/'S'-T
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/
v , ~ <I' = , ~ /c1
C117/
9 '/ 1"::> ~
ZIP CODE-
BUSINESS TELEPHONE NUMBER
7t/'2-?r'Ys
HOME-TELEPHONE.NUMBER
BUSINESS TELEPHONE NUMBER
'74/? -;/7"9<;'""'
~o~ TELEPHONE NUMBER
Q) TAX MAP/PROPERTY "DESCRIPTION NUMBER (from tax maps in Department of Assessment & Taxation or
lIap & Parcel Number: /7 ' tJ3 t:5(b.2.2 Tax Lot(s): .,;(/ ~
Township Range Section
from tax statement):
o Out of TL ,
By Partition #
Tax Map, Ii Parcel Number of Adjoining Property in Same Ownership:
Tax Lot(s):
.Township Range
o None
Section
o Unknown
Q) SUBDIVISION (if applicabl~):
@ REQUEST
(briefly describe information needed):
r; t"' C" JO /0 Co- c>
~L~,/ ~>l-
L~ey-l-
BLOCK:
e P'TO'1,,'f
R~"",,'f
LOT:
I
.
COMPLETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS, OR PROPOSALS. ,SEE *NOTE BELOW.
**FOR STAFF USE ONLY**
CD TOTAL CONT.IGUOUS PROPERTY ,IN SAME OWNERSHIP:
Q) PROPERTY ADDRESS: ,~/..p '(;:"CI <o/,f' JQ ,k.
~~r I;' /- />kI /[2C!-
(j) PRESENT USE OF PROPEtry: ,C/' h""" e-..
acres ~UMBER:
DATE:
>-3
ill
'-
>-3
t"
,97 Y./ / TIME INITIATED:
CHECKED BY,
ATTACHED EXHIBITS:
Garage_
Other (specify)
Shop_
Barn
o Plot Plans (2)
[] Con~tr. Plans (2)
o Site Plan
o Copy of, Tax Map
OOther
SCREENING VERIFICATION,
@ NUMBER OF STRUCTURES ON PROPERTY: Standard home V Mobile home_
Modular home
RV in use as residence
Storage_
@ ACCESS TO PROPERTY: Public Road Name
Private Road Name
By:
Road Easeml:!nt
width
i of
Users
Date:
GlWATER
EASEMENTS OVER PROPERTY:
DISTRICT: ~Y1 60/_]
Time In: Out:
@ OTHER
@ FIRE
(1' ..,0 Accept 0 Reject
DISTRICT:~R /"'lr .../.:f
',;:7/ Routed to:
*NOTE: ATTACH A COpy OF
TA}: MP; SHO','" [XI;::TI,:;':;
STI\\..lCTURES Aim TAX LOTS
IN YOUR O~~ERSHIP. OB-
TAIN TAX ~~p IN SELF
HELP AREA OF A & T.
@ PENDING PE~lITS ON PROPERTY,
9/Bl REV
(OVER)
COMPLETE THIS SECTION FOR LANeSE OR 'CONSTRUCTION,'APPLICATIONe
, @ PROPOSED USE OF PROPERTY IN DETAIL:
~ BUILDING REQUESTS:
Contractor's It
Directions to Site:
7-, C, CJ v'-
C:CJ/~Tj
(for mObile home setup also)
dt.h.., K. f~ /J)'" "
cI<)~ ,/Ph'- ~/oc.R
SY;FY'C-~'
" .~
C\"" VC'. J", /t.
Check the type of permit requested:
Dowelling: 0 New
o Addition
o Replacement
o Alteration;
o Additional;
o Modular Home D Mobile Home - Model Year
o RV 0 Standard Construction;
o Plan Check Only
o Commercial: Use Floor Area
. .DAgricultural: Use
o Others.~ .Use.
o Change of Use - How?
q) NUMBER OF BEDROOMS
..
Floor. Area
NUMBER OF STORIES
{J SANITATION REQUESTS:
[]Site evaluation for 50S feasibility
[] New system installation
[] Repair/replacement
o Alteration/relocation
D Hook to existing
ADDITIONAL INFORMATION:
,
**FOR STAFF USE ONLY**
ZONE/LAND USE:
...
By:
Date:
Time In:
.Jut:
o Accept
o Reject
D Planning Application
[]Construction Permit App.
o Information Only
Zoning:
Compo Plan Designation:
SANITATION:
By:
!
I
I!l
Date:
Time In.:
Out:
o Accept
o Reject
o Constr. Permit Issue
o Site Evaluation Issue
PERMIT ISSUED (SAME DAY ONLY):
permi t ff
By:
Date:
Time In:
Out:
\