HomeMy WebLinkAboutPermit Building 1981-8-28
~ CON STRUCr.0N/PLACEM ENT
C~~~PL~TE ~J~LOCK' PLEAS~~~~L:K INK AND PRINT.
TOI""SHIl 1"7 j RA'GE03 I StcTI<2?J 2 Z I ™ 310 DOUT or
sU?)f8oN}?r;;rf-ftJap~~aJ 0 , I LOT/rCEL I sLrB
L~807ADDRESS I W~V-rLU . ~t~ . d CI0~7-7'
nCTU~ CuAACNI'LY at 71R1Y - U / 0p ~ '-..(.
. j( I .\1 Y1~n" . I 0f H 1J~:(,y
DusL~10D~J;.?;;/~t=tino CillA- nriri +0 cltvcl[,n
, 0"000115 r · OF STtES f # o~oms f "l~(rt~ ~) D
. 'R'C A~ANO_A~~~~.lv.u.VtY11-~) I~ ~b':2Zlg~
~':T\;;sNl1Jn"u=oo. ~~ N,' 37~ I %--,)d ~77_1..ftqq":55
aNT CTD}S~R # ,!!"REC 5 TO SI~ l/?.A a ~+r' l /rc ~lir7r;.- 'jj 9ij
9;~ -:::') hi t1:{ .G ,YaJ I .?V D l}P d AA... c ./ - UJ"'L61.. 7=)
(ern ~. *-h ~ld-eJ 1) Brv (J JA..._~ (bm{()-H>d h01A.~-,
I !lAVE CAREIULLY EXAMINE.D TilE COMPLETED APPLiCATION FOR PCm:rT ~ do herf'b, ,,.,tl1f, tlnl -..11 lnform-..tLon herr-on p, tnJ" -..nd correct and I f\!rthL'''''
cert.lfy that any and all work performed !.ohall be done 1.n accordance w.lth the Ord1.113nCCS of lane County and tIle' La",s of thf' Stl!" or Ornq"'l1 l' rLaIll1tlg
to the work descn.b€!d here1n and that NO OCCUPANCY ...all be made of any <;tructurc w1thout the perm1 o.lon of the BUIldIng DlVI';10n 1 [U~ Lhr>r cLrLlf>
that regIstratIon wIth the BUIlder s Board 1S 1n full force and effect a<; requ1red by ORS 701 055 that 1f exempt t Ie bas~s for cxempllon 1<; notf'd
hereon and that only subcontractors and employees who are 1n compl1ance w1th ORS 701 055 wIll bf' used on th1S proJect I HAVE RFj\D AND C1IEcy..r:D TinS
~PL~TIL"LY~
/1 NAi.'1E (PJeaSE- ~
(/ 0 PLANNING/ZO~ING:
+0 rl('('7fh nO (jJI)"~~ -
/ . Date -LL(f8- LID
G2(NO [] Yes, se~ attached she~t Date r-l
D
;<
J( f;rI SIG"~""~ Jof r
Zone ~
NUJJ..mum SctbaCY5 c~, front
Comments !
t'artltlon 1;
Parcel o!
eL, slde
lnterlor
,,'7;
~
o FLOODPLAIN.
o RURAL ADDRESSING:
g SANITATION: s I
In flood hazard area?
rR1D COORDI~AT}
N
E
Installatlon Record lssu2d? [] Yes [] No
DaLe
B P
#
Ins-callatlon
SpeClflcatlons
Gallon
'rank
Llneal Feet
of Dra1nflcld
Comments K c Go /1
,
.A.,.Jc!~-J"'" I\....-....l
t=: V I::> 7'.....L. "-
,
/& I
;C'...__ ....---
FOP 0tFICB USt O~LY
.,
Apohcdb'lni::,. c=. r::.. ~ I
Perfil t :It -1-("\ ~ ..1""- )-01
o Two COP1CS- of Plans
o Two Caples of Plot Pla'15
Dr1echan.l.cal Checkl.l.st
o Plumb.l.n~ Cheel l.l.st
l C plan Check Info Sheet
PRC'OSLD'U~L or PROPERTY.
GJ RCSldentlal [Jrndustrlal
o Conunerc.l.al
Dpubhc
PtRSDo
O)'-<'OPosed
~E^.l5tlng
';:---2 7- ~(
- DATE
DOwner
~::.rdct.o_
DAgen t
1
Parcel Slze 'T(x'103
real,
Max~mum Depth
of Trenche<"
n /SA_,,,..,. L L'~..c." l,.J
.~ ~ Date 2'7(",u ~ l<c( D
~PLANS EXAMINATION: TY~e 5;1/ Group}'.=-::S ,Use D/tJ AeeA-1lO0rTlotJ
Comments 5RR--/ ~AI0? m~ ff"L~.V' tAfrvmreL( ~fr1L
pill MLJ.... , U U
Date Cl-7?-);f ~
$
$
$
$
$
$
$ -2.(') (Xl-
_'t -I 00-
TOTAL FEE ~kl tC:[)
FEES PAID /ty ~heck 0 Cash
By l~ a-E>' ,
Date 5/9:1/01
, I
- ?-2-c - 5<'1
DATE '...1-)
BUlldlng Fee
Sewer/Storm Draln/Water
Plumblng Flxtures
Mechanlcal
CONSTRUCTION AUTHORIZLD BY THIS PERMIT
,
0d(r4ri~Z1
-Lhlon
Flxed Fee/
Dnlt Cost
5;j C!)
Subsurface Fees
Floodplaln Fee
Sq
Ft
IX
Plans Check Fee
State Surcharge
TOTAL VALUATION
'j) '60
$ lG.:, ('0 -
----r T MQ fL1IJv s
PERMIT APPROVED BY BUILDING OrFICtAL/DESIGNEE (per ORS 4S6 80S(l})
LANE COUN'I'Y DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVEN
C74-194
SEE REVERSE
4-r) . ()(")
(
EUGENE, OREGON 97401
,
. q
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVEO VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT,
CITAYO~_ UNDER P~OVIS~ONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHE,R. 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 followlng lnformatlon ready Permlt number, Job address. type of lnspectlon, when It wl11 be ready.
your name and phone number, and any speclal d1rectlons to~slte -
be made afte~ trenches are excavated and forms erected andlwhen~all~materlals_for_ the foundatlon
Where concrete from a central mlxlng plant (commonly termed lItranslt mlxed") 15 to be used,
the, job ' . .. f" .
. ' t _ .. 1 r _ _
2) CONCRETE SLAB OR UNDER-FLOOR INSPECTION To be made after all In-slab or under-floor bUlldlng serVlce equlpment,
condult, p'plng accessorles and other ancl11ary equlpment ltems are 1n place but before any concrete 1S poured I r
or floor sheathlng lnstalled, lncludlng the subfloor .. f "'-' - t '{l-
, , 'I I , . '.
3) FRAMING & INSULATION INSPECTIONS' To be made after-the roof, all framlng, flre blocklng and braclng are In place and
all plpes, flreplaces and ch1mneys'and vents are complete and all rough electr1cal and plumb1ng are approved All
wall lnsulatlon and vapor barfler are 1n place '\ ~) '" .
'. ... 'i
4) LATH AND/OR GYPSUM BOARO INSPECTION To be made after all lathlng and gypsum board, lnterlor and exterlor, 15 In place
I but before any plaste!lng lS appJled o~lbefore gypsum.b"oard J~lnts and lf~s.teneri !re~_tap:.d and, f1n1shed
, "
5) FINAL INSPECTION ,To be made after the bUl1dlng lS complete and beforejoccupancy I
~ I ~ j 1 \- \
- - .., - ,~ . - -. - i
APPROV~L REQUIRED ,No work shall' be, done on any p~rt of the bUl1d,lng or s,tructure beyond t~e pOlnt lndlcated In each
succeSS1Ve 1nspectlOn w1thout f1rst obtaln1ng !he approval of the (bu11d1ngl offlclal Such, appr9val shall be g1Ven only
after an 1nspect1on shall have been made of each succeSSlve step 1n the'construct10n as 1nd1cated by each of the lnspectlons
requlred , \' I '
,....' I '\ I
NOTE All bU11d1;'g permlts requ1re H]SpectlOns for the work authorlzed/'such as but'not'11m1ted to ", - ..
A BLOCK WALL To be made after re1nforc1ng 15 In place. but before any grout 1S poured Th1S 1nspectlon lS
requlred for each bond beam pour There w111 be no approval untll the plumblng and electrlcal lnspect10ns
have been made and approved
B WOOD STOVE To be made after complet10n of masonry elf aPDllca~l~)'and when lnstallat10Q lS comolpte
Installat10n shall be 1n accordance w1th an approved nat10nally recognlzed test1ng agency dlld the manu-
facturerls 1nstallatlon lnstruct10ns r
BUILDING DIVISION
REOU I RED I1ISPECTI ONS
1) FOUNDATION INSPECTION To
are dellvered on the Job
materlals need not be on
"
-,.
- -' ~
;
, \
i,
C
I~OBILE HOME
system for
connect10ns
~An lns~ectlon lS requlJed'after the mob11e home lS connected to an approved sewer Of septlc
setback requlreme~ts. blocklng. foot1ng connectlon. tledowns, sk1rtlng, and plumb1ng
-- ~
,J
(1) Foot1ngs and p1ers to comply wlth State foundatlon requlr,ements for moblle homes or~as recommended
by the manufacturer
(2) Moblle home mlnlmum flnlsh floor elevatlon shall be certlfled when requlred by a floodplaln
management 1 etter ~...... ~
(3) I~oblle home tledowns. when requ1red, and sk1rtlng shall be lnstalled and ready'for 'lnspect10n
w1thln at least 30 days after occupancy T1edowns and sklrtlng shall~be lnstalled per enclosure
\ > ' - >
,
D SWIMMING POOL Below grade when steel 1S In place and before concrete lS poured ~bove grade when pool,
15 1nstal1ed I,. ~...
Ap,PROVED 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 lS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS SUSPENSION OR REVOC~TION>MAY OCCUR IF THIS
PERMIT WAS ISSUED ON THE BAS1S OF INCOrlPLETE 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)
(2)
Permlts shall be effectlve~ for one year from the date of lssuance
Upon completlng the constructlon fo~ WhlCh a perm1t has been lssued the pe~lt holder shall notlfy the
Department by submlttlng the lnstallatlon record form~ The Department shall lnspect the constructlon to ~~
determ1ne 1f It complles w1th the rules contalned 1n thlS d1v1s10n If the constructlon does comply ~Ilth
such rules. the Department shall lssue a certlflcate~of sat1sfactory complet1on to the perm1t holder If the'~
constructlon does not comply.wlth such rules. the Department shall not1fy the perm1t holder and shall requlre
.sat13factory completlon~before lssulng the cert1flcate Fallure to meet the requ1rements for sat1sfactory
complet1on wlthln a reasonable t1me co~stltutes a vlolat1on of ORS 454 605 to 454 745 and thlS rule
'''.:;:..
. ,
, '
.
Setbacks ~ Subsurface Sewaqe D1sposal
_,4 \
From Interlor property llnes
Edge of road rlght-of-way
BU11dlng foundatlon
Wells. other water sources
Seotlc Tank
10'
10'
5'
50'
Dralnfleld
10'
10' -"-
10'
100'
~
,.
. ~
~~(.
- .
.
"
.,
,LJ t
,
,
,
.'
. ,
'1
'.
.........
j
J' .:'
I ~
'I I
1,
~ .
I
ft.:
I (\Nf COUNTY [)D'T I NV 1"1[, I 1([ CC J F'l ~ 1 w>~,q 1 1)(\ f[ 082 [,
i,I-'F'11u)I'./! fxU(!(Y, J1M r,ldll, ;,4'54 N. 3,111, Sf'FD., 974U .
fU 1 iO:i;,{,;:>;'Oi);'19 \UI<DIV ~)lH AD!) 10 [,RllVUIAlf Illl 1 IlI/<)rl
NEW PLD(, 1 Yf-'1- lISI: Ii NO BnF, '1S 00 un UN I f S ,)1) 1 rJ() Sl(1r' [ES . NO BI DG,\ 00' !
C(lD! (,/'/"'1. NO ACflON DrSCRH TrON ';Q rl IJNll (OS'f VALlJAl](lN IEL DI'iJ'l
t'l' (\DI) I'l D 1 N 1I1GI,M "
I:{I' Af\[A 1 ;,t ~:'. 00 M 78 ~
n
BP ;I
.-
I'l "
.
~~' <
i/!' 6
FW 1[' Hl:,581 I(fir,,"> 66;8 40.00 r II!
!'I NO.! I ,;[iJRI-S IW. ((J,;N[f;fORS 15,(,0 EACII - .~
J11:L'1I I'1L U IANl('AI I I L ~
"
::U1-: ,HA II: ,SUf(CIH'''~[,L 4 i., 1,60:!:
...
f'CI( !'I r,N Cllr CI( FCE ')\)i.' ;:>0.00,
Cl
I~
" I
, I
cr, f(x
SEPlI
Ti"1Kn1
AF'I-
o
Vi ((\D
1,(\
II
Su,~
s [
o
[-S f. COMI U:l [llN l\(il E
[-'CK
1
OC'14Bi
UfH
.
r .;S
. <:
rx
~
:>
) (lTi,1 FEE",..
6'1
..!.
,
2-
~
~
-.!.
.!
10
l!.
14
"
18
ri y
~
12
14
~
18
10
,,' (,
'!
14
~
'!
10
12
14
16
"
~
;,
;,
~>
!
- "
.,
"
~
-'-
I L ~l i ~~O'} ~lll {)() 1.)96 (n'.:"r
I'll:"! 1,1 T)r, \ (1"1
L(1j)I'_ "I 1-'1 NO
HF'
H'
t ('l?J~
t,l'll [r-('I~r r'un,jl fl-, SII[I,I F,'
,'lIB1>] V
il.\I- I, Nfl HI.f'1'
(j('IJ(Hj lli_"Cf,Jf'll0",
CfJU"'-(Y rwf'l l Ni lib1 1:1'_'EJf'1 ; 'I) '13Cl j pM!:: or!ifit'l
lliJ!)[, ~I'> \'; 1"VE-h,"l!!l- PI-, , [LEr;;>;. tI]1 L, 1l1,1-
lOI HU;
l),} rH) UNIT'; )1,' rHl SlflfUI:S 1'(1 'OlL!),;': ,)()'I
SQ I \ UN I \ UJ q ',',\I_ll,,1 JUrJ 1- U n(,'(,\
FP
.1 [,
Pf
l"['
f l NfJ. [j X-I lIhL ?
lif CII
"IJI,
1-'(;1<
HI 1 r ',20-I"U 1 "I"
111'1;11
r [1<-
Stlf.'
C{~lC. (I:'!'~
srqlj ('l
Tf,;/ l f~ lp( /t lJ I
1,(-,
ND. I. tlrJilLL f lll' ~
IkCI1.->ln C"I ,: I' F
.\'1 t,l F :'''-'I-,CIII\I,t.[
I 'l (,N ('I-IFCI< F EF
f f'
SDS
i
I ,I)
: I
I "
o
1 =. _ c~) ~ ("!lll
A'"
t""
I) t) ~~
H?OO
__0. ()t)
<t ... ~} il
"
~
.
.
r~', ~
I ~:.> "12 ~ " ~
\'1
11 0
10 re1
1}9... 0':.> f~' "
r
-.
0
"
. ~
0
.
0
.
0
I \ Hf ...
I l'l~
i
('"[lr'dHt 'HTIDN i)()I:'-' O(I,..)t~Ui
lSS
ill II
I U1 (,L I 1 1-' ,
lvlronmental Management
ACTIV.ITY INFQRMATION SHEET
~ ~ J i I I
Idne county
(J
. COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! . .
Q) ~c::;;; /Y' eu ~()f) Yi1 (.e, '(
\! PERSON MAKING HE~)uEST
~75c~5" fiiyf,(S/J~(IVr,
MlIILING ADDRESS
f!/JLeJ see Y1 t Ii l/ tJl? r7.1fcJ I
CITY
SlA'lE ZIP CODE
. "
117:!{L:foN7 ~B1 ~ '-,
.'
b<t7-1Pf/I/7
BUSINESS TELEPHONI: NUMBE
fl/('"k:/rrl. " ')~ dell rt')() h1 )~,'{"
PROPERTY OWNEo/
--37535 /?/Yer'S,dp Drt'v~
MAILING ADDRESS
_Plea s4nLH// tit? 9'7"!oL
CITY STATE ZIP CODE
" 16_$'~7 !.. //1 7' '\ 7.if / -:J- 7 ~ :3
BUSINESS TELEPHONE NUMBER
1 }";j
HOl'1E TFLEPHOfJE NUl'lBER
, ',' ....
Hap & Parcel Number
,
It") DqJilrtmc..nt of Assessment &.. Taxatlon or from tax
) \ I '\ J, . -'
'Tax Lot(s) ({,fJO
statement)
.
@ TAX MAP/PROPERTY DESCRIPTION NUMBER (froi,l\ tax maps
('i t'J:1 ': ~5
'lownshlp Range ~ Sectlon
D Out of TL ~
By Partltlon f!
Tax Map & Parcel Number of Ad]Olnlng Property l.n Same Ownerslup /'I ()/JR..-,.
Tax Lot(s)
Townsh~p Range
D None
Section
,
Q) SUBDIVISION (If apphcable)
Nt!vJ...
o Unh.nown
BLOCK
LOT
(j )t<lt?"'/ :; f() 1/ ~
~lt~t.
(D REQUEST (br.lpfly descnbe .lnformat.lon needea) _r:.IJ~ rA I.J l:,I/'J ~ of"
q'fo..V\d'iY\a 'lSruJ.\ fJ/, oJ.- :#~~ ~ P.1~
~isl.Je'(
/1'\
h. IIYY\ ~ tJ 11-d ~ '/
SEE *NOTE BELOW
7~
":57,'535 -R,Ve."{s/de Or-ive...
ED ~ CrJ V\t f/;[I Ol? <17,/0/
NtjfYt <2.. site-
COMPLETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS, OR PROPOSAL~
Q) TOTAL CON'l'IGUOUS PROPr:RTY p~ SAME mVNEHSHIP
@ PROPERTY ADDRESS
Q) PRESENT USE OF PROPERTY
ac.res
@ NUMBER OF STBUCTURES ON PPOPERTY
III c.,O~Sty-,-,ctiOA)
Standard home~ Mobl.le home~
Modular home
RV In use as resldence
Garage_
Shop
Other (speC.lfy)
Storage~
Barn~
@ ACCESS TO I'ROPf,RTY
Publ~c Road Name
Rt'v'e 'IS idl!?- 0,<, f Ve..
Prlvate Road N~mL
Road Casement
@ OTHER I:.ASE\1ENTS OVER PROPERTY
-
w~dth
# of
Users
GJ WA PER DIS'I'RICT --
@lIRE DISTRICT De.i- re:{"
lJ/':}'M.1'- ul'{ JQ>(" c!'O"5 t'C'(,{C t,'ollf
@ PENDING PERMITS ON PROPER'I Y
JI- i..J r.
( l5 "-1 - 79
(OVER)
9/81 REV
**FOR STAFF USE ONLY**
NUHBr:R
DATE
>3
61
~
t-<
TIME INITIATED
CHECKED BY
ATTACHED EXHIBI'IS
D Plot Plans (2)
o Constr Plans (2)
DSl.te plan
o Copy of Tax Map
DOther
SCREENING VERIrIC1TION
By
Date
TJ.me In
Out
D Accept D Reject
Routed to
*NOTE AT"'Il.CH A corY OF
TAX MAP SHOW EXISTING
STRUCTURE<: r.rm 'I A" lOTS
IN 'yOUR mr'il:.RSlIIP OB-
TAIN TJ\ ( 11AP IN SLLi"
HELP ARrA OF A &. '1
COMPLETE THIS SECTION FOR I
) USE OR CONSTRUCTION APPLICATl
,.
I@ PROPOSED USE or PROPERTY IN DETAIL
1./,.,lV\... ~/f~
19'1'cbJl'("...J~eV\
'"
QP BUILDING REQUESTS
Contractor's #
(for mob~le home setup also)
Dnechons to Sl te J-I ~ u.J~ .s ';?JO V'I'I ~T- 7: I fi!. r;r
~r Dr.: ed sfop S ;~\\ 'fr. 0 1\ ~
leFf o~R;Vers{Je j)f';v'e. t()~V\~~
of perffilt requested ..,..h YO<t~ k ~ q
~+o
UJ..1u.&j e'\;
Check the type
~ Dwelllng ~ew
o Replacement
o Addl tlonal,
o Addltlon 0 Alteratlon,
o Modular Home 0 Moblle Home - Model Year
o RV 0 Standard constructlon,
D Plan Check Only
o Cornmerclal
Floor Area
.
Use
o Agrlcul tural
Use
D Others Use
rIcor Area
D Change of Use - How?
Q) NUMBER OF BEDROOMS
.3
;L
NUMBER OF STORIES .
~ SANITATION REQUESTS
[] Slte evaluatlon for SDS feaSlblllty
[] New system lnstallatlon
[JRepalr/replacement
o Jilterat1on/relocatlon
D Hook to eXlstlng
ADDITIONAL INrORMATION
**FOR STAFF USE ONLY**
.lONE/LAND USE
By
Date
Tlrne In
Jut
D Accept
D Re] ect
o Plannlng Appll.cat~on
o Constructlon Perml. t App
o Informatl.on On) 1
ZonlI1g
Camp plan Deslgnatl.On
SANITATION
By
Date
TJ..me In
Out
D Accept D Re]ect
o Constr Pcrmlt Issue
o Sl.te Evaluatlon Issue
PERMIT ISSUED (SMlE DAY ONL1)
Permlt #
By
Date
Tune In
Out