HomeMy WebLinkAboutPermit Septic Tank 1984-6-5
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Lane County Authorization
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for:
FOR OFFICE USE ONLY
S~BDIVISION/PARTITION (if applicable)
PyfJ!aco~ Cii{))l~
I RANGb2 I SECYq , 3. Z I:q)/ DOUT OF
I BLOCK
I LOT/PARCEL
APP1icat~ ~ ~? ~
Perm~t # J-
o Two Copies of Plans
DThree Copies of Plot Plans
DMech/Plumbing Checklist
o Legal Interest Document
Dplan Check Info Sheet
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- 'roW.-;SHIP
17
=il{55SS STREam ~
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~~~lTE~(Ht'~ )J(}n
o -I ~n CITY
II( 1.-. .~Lti
~'-.) 'EJ 'd> LLL~
:h thU
ZIP
P~D USE OF PROPERTY
~ Reside_ntial 0 Industrial
o Commercial 0 Public.
'~I~N ~~(rrQ~RK 2J srFao crHlnnrrf'Q J DECIARED ~ VALUE
. OF BE'~ I # OF STORI.ES l I # OF 'EMPLOYE:ES I W~E~ ;..U.P~ ~ 0 Proposed
n~n~ n.R, nfJn1LJ UL}KJ6l,lh'7)' nExisting
O''''P1:t; r: ADDRESS ()m(j Yt/fl n f tL.M. a-hidh U I TELEPHONE NUMBER
CONTRACTOR'S NAME A~q:1)5 H' ~) Aj , 1'1~~~
?ERHIT TO BE MAILED TO lt1AME' AND ADD) fYlwoM, ~Ot/iVL q~/11 TELo'20NE NUMBCR
t) . /J ~ '- \
I HAVE CAREFULLY EXAMINED TIlE COMPLETED APPLICATION FOR , and do hereby certify that ~ l.nformation hereon .1.5 true and corcect, and that I
have the following legal interest in the property: Downer of record; 0 contract purchaser; 0 authorized agent with evidence of authority attached.
I f::.rther certify that any and all work performed shall be done in accordance with the Ordinances of Lane County 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 the permission of the Building Division. I fur-
ther 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 noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. I HAVE READ AND
CHECKED THIS APPLICA~ION THOROUGHLY.
~E M. S/1/iIL
NAME (please print)
~ ~d~ ?n._~
SIGNATURE
X .!J I/!rl? 'j
DATE
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS~
[] PLANNING/ZONING:
Zone
Partition It
Parcel #
Parcel Size
Minimum Setbacks:
COM.\IENTS:W
CL, front
CL, side
interior
rear
(JPQr /11/
J pi 11m fWYlj
nriJ an) Jl O4Ll' n tJ_dJ
~l . J
Date: vrYYJ 11 '?J /Q o1f1D
v-LLl-r- '
Date: r-l
o FLOODPLAIN:
In flood hazard area? 0 No 0 Yes. SEE ATTACHED SHEET.
[] SANITATION: S. 1. *
Installation
Specifications:
Gallon
Tank
Lineal Feet
of Drainfield
Installation Record Issued? DYes D No
Maximum Depth
of Trenches
B. P. #
COHHENTS:
~L..t'1l.U./fnL&-A llWLJ L~r~ Date: n
-/'----, ~ ~eplacement gas furnace
UK PLANa EXAMINATION: Type Group Use
CO"'lE~: Install in exact comoliance with the listin" for the ~~""r~td~~ir counter-flow gas
furnace, Inspector ~erify appro~ed c~nnector and shut-off valve. Verify connector
1..Ld.;:)~ ::iUlCL~ U.L.~t:.L~L, W~U~U.U1 vi Lll.J..CL V.L. 5d.:" app:s....l.O'U'_c. V'C.L..L..L.J .......LLI..L.U.l.u.w. :..: ..:..u~{.. WV.L.h'b
=~,.p~ ~,.r.."" to F ,A,U", .. Date: 06-05-84
. - ~~~J ~.L.V~.~.L.~~.
TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PERMIT
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c:;.lf5U~ 6h. TOTA;:J?1 $$ .2:, 0 I
~R:VED BY BUILDING OFFICIAL/DESIGNEE (per ORS 456.~~lltI:u~) t:J:b"'O~:!I,,!(
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
Sq. Ft.
Fixed Fee"! Floodplain Fee $
Unit Cost Subsurface Fees $
Building J;ee $
!.lech/P 1mbg Fee $ l)t / /JT)
P'ans Check Fee $ /(.7 V
State Surcharge $ .12
DEQ Surcharge $
C 14-25
SEE REVERSE FOR iNSPE~TTON TNF'ORMII'1'TON
.
.
,
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-
CATION 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 HOURS ADVANCE NOTICE FOR INSPEC-
TION REQUESTS MUST BE GIVEN. Have the f~llowing 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,
REQUIRED INSPECTIONS:
1. Foundation Inspection: To be made after trenches are excavated and forms erected and when all
materials tor the foundation are delivered on the job. Where concrete from a central m~x~ng
plant (commonly termed "transit mixed") is to be used, materials need not be.on the job.
2. Concrete Slab or Under-Floor Ins~ection: To be made after all in-slab or under-floor building
service equipment, conduJ.t, prpIng accessories, and .other. ancillary equipment items are 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 p~pes, 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/or Gy~sum Board Inspection: To be made after all lathing and gypsum board, interior
ana-exterIOr, ~s ~nplace Dut Detore any plastering is applied and 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
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 limited to:
A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This
rnspect~on 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 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. 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 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. Swimmin2 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 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POINT or REQUIRED INSPE~TION~ W~L~\~?'~q A~ THEIR OW~ 4~SK..
t
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
1, Permits shall be'effec~~1e for one year from the date of issuance.
2, Upon completing the construction for ~hich a.permit has. been issued, the permit holder shall
notify the Lane Co~nty 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 certi~ica~te of satisfactory completion to the permitlholder.
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 454.745 and this rule.
Setbacks - Subsurface Sewaqe Disposal
From: Interior property lines
Edge of road right-of-way
Building foundation
Wells. other water sources
Septic Tank
10 '
10'
5 .
50'
Drainfield
10'
10 '
~O I:
100'
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lane county
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CHECKLIST
PLUMBI NG / MECHAN ICAL
APPLICANT INFORMATION:
IX. ~ ~~ 1- ~ fj f{ ~11 (J t
( ame or Inn-P ease nnt)
OFFICIAL USE ONLY
Appli. /
Penni t #
(MaIlIng AddreSS)
~[r~~f1.fo~) IJ ~~ ~Ode)
Cont. OSR#
PLUOlBING CONTRAcrOR
D Yes Finn
Address
X IvlEGIANICAL CONTRACTOR
D No DSelf
!ErYes Finn t:.tNIUUlL fIJANltr:;/:.
Address P /) R 1f-J;...,11N OJ tJ f.if-.
o NoD Self
Cont. OSR#
Type of Fixture
PLUOlBING
Nwnber of Each
Fee On Each
$ 7.50
7.50
7.50
7.50
1.50
7.50
7.50
7.50
7.50
7.50
30.00
15.00
. 20.00
15.00
30.00
15.00
7.50
7.50
15.00
Sink
Lavatory [Wash. Basin]
Tub (with or without shower)
Shower, separate
Water Closet [toilet/urinal]
Dishwasher
Disposer (g.arbage grinder)
Washing 1vlachine
Water Heater
Floor Drain
Sewer--lst 100 ft.
each additional 100 ft.
Water Serviceulst 100 ft.
each additional 200 ft.
Stonn and Rain Drain--lst 100 ft.
each additional 200 ft.
Special \\'aste Connection
Seh'age and Swnp PumP [ei ector)
Ivlohii e Home Se\"er and Water
Other (specify)
SUB-TOT.-\L (1vlinimwn $15.00)
I TOTAL FEE
Type of Equipment
~ IEGlAN I CAL
,,'umber of Each
Fee on Each
Total
~Iechanical Penni t Base Fee
Furnace uP to 100,000 BTU/H
Furnace o\'er 100.000 BTU/H
Clothes Dryer Vent
Bathroom Ventilation Fan & Duct
Range Hood h'i th ~lechanical Exhaust
1I'00d Stove (Wood StoVP V"nt B. 00) I
Air Conditioner Onlv I
Heat ?lunn I
Floor Furnace I
Gas Piping System 1 to 4 Outlets I
Per OJrlet Over 4 I "{
I
I
$ 6.00
7.50
3.00
3.00
4.50
6.00
6.00
6.00
6.00
2.00
.50
Other (specify)
I
I
Ic:mm FEE) I
C- ff.lJfl~..Ii..:A
vrr~-W~
SUB- TOTAL
C74-200
Total
S 10.00
l..I"IO
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/q 52-
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LANE COUNTY DEPT ENV MGT RECEIPT 0 138284 DATE 052484
APPLICANT SMITH, PEARLE ,AND PAUL ADDR 2955 HAYDEN BR. RD., SPED., OREGON 'I~
I. ')"LO 1702193200301 . SUBDIV lOT ElU'
· NI"W f: I 1)(" TVF' E' IJSE R F Dr"M" 0 IJN]'~<' 00' s'rOI"IE'~ ''''11)(' ~ ',)0' I:'I-I'('>"I~ -'46" '3'~.
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'OWNEF~ NilE SM ITH,' PEtd':LE AND PAUl.. ,;DDI'~ 29~>~'.) HAYDEN EIR. FW., SPED., om,:GON
CODE ,;PPI_ NO ACTION DESCRIPTION S(~ F'T UNIT COST VALU,ynON EEE Dr.,
· BP
"I " DP
~. BP
BP
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18.00 III
0.72 .
1'1,70
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30.42 CI,."
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LCi 382B4 I,.JS
NO. F I XTUF~ES :
N(L
CONNECTqF~S: '
MECH(,NICAL Er::E:
STt,TE SUI~CH;';I~GE
PLAN CHE:CI< FEE
'I ~'5. 00 EACH --
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CATG: '
SEQLJ:
TAI(EN, BY
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CAD
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SDS
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EST. COMPLETION DATE
,TOTAL FEE'x""
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ACTIVITY INFORMATION
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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PEA JU..t 5MITH
PERSON MAKING REQUEST
/:oJ-.q.'J-'i)jIA I/hJ;-fIf 13(.. I5D
~NG ADDRESS
..J2PJUJ)/6- f I.tL () J 0 Iff,.. i 7111
CITY .. STATE ZIP CODE
JJ/f.ivft._______ ~ _1'iU5 j t.
BUSINESS TELEPHONE # HOME TELEPHONE #
2. PROPERTY ADDRESS 5 Il- rJ 1::-
(IF DIFFERENT FROM MAILiNG ADDRESS)
rYJA V L J<.. (y f ;;Al?ll5 1'1. 5/'11 TfJ
PROPERTY OWNER
t "lS5 H h YO f-/J 13/f. f( /),
. 'MAILING ADDRESS
,.') PI( IN ((- f/~LO J {)/U.... tli.77
CITY STATE ZIP CODE
!iJpA/t, 7t-j/,- "3!:r:3f..
BUSINESS TELEPHONE # HOME TELEPHONE #
3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation.
or from tax statement) .
I>( II 0:2- I~
TOWNSHIP RANGE SECTION
CtO.]o/
TAX LOT(S) OR PARCEL # ZONING
RECEIVED =-
-- -.'" -
MAY 2 3 i9840J0 jO
\ tt~\~~i0';~~ft':;:- TOWNSH I p' RANGE SECTION
", L "', ,ji'lT'C ..
~,:,..::~~'.'!ilTliL}ON' IGUOUS PROPERTY IN SAME OWNERSHIP:
4 "S~g~if applicable)
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL # ZONING
TAX LOT(S) OR PARCEL # ZONING
1 ACRES
LOT BLOCK
(,5 REQUEST (state exactly what you plan to do) f2F ?LAc..E A G A~:~......t.tJl2.1JftC.F
FA y ItLt_/3 J( Y-fi (1/ T - !lA Y A tV D N I 6- 1::1...T r ilJ<7 (.I: D A I J?
_______________ {.' OUA'TELFt61.u' - r;..As
11'.6 DIRECTIONS TO SITE:
** FOR STAFF USE ONLY **
- --
NUMBER
DATE
...
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:;0
VI
.
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ZONE/LAND USE:
BY: DATE:
TI ME IN: OUT:
LAND MANAGEMENT DIVISION / 125 E. 8th AVE.. EUGENE. OR 97401 / 687-4061