HomeMy WebLinkAboutPermit Building 1984-10-23
Lane County
~cU d~ Ojii~lu.x 1)lJelll ~2L-
I RANG06 l SECas I, J., ~ li0mrtQtOQ ~
SJBDIVIS:ON~~IT~ (if .~ppli~able)r .' ~,: I" LOT/PARCE"c-. "1 B~, ../'
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LOCATI%. A~"':~ IfTREET '\. .' c ", ~ I ...J CITY " ZIP PROPOSED USE OF PROPERTY
rtu~(Q~':O~ 'l":~'f.o'i.~\ W~. u!-1fL ',0 Rmde.ntial, 'D In9u;t~~al
ST~C~S CYRRENTLY ON PROPERTY~U ~ ... # " 0'
"I\{(I)' 0 YI75H' , ( PI I ( 1 rll111'O " , .' Commerc,al 0 public.
-D:RECT;npo;~E, ~ ri ;' ~jrt.f_ : f7nJ2i~tJ) } K'~ j- ; AD (lcl6 J'\Nfi;~' .
~. .o~cY~ rll~<1,-~J' . 'U
I r0?;,~C~l G-e? ~ j,y J 1 ~ ,.~ ~ 'ri1"" I DECLARED> VALUE
, 'J#OF'~C:ES., I., "'r#O~EMPLOYtEJ., _I WATERSUPfL.-YA.U.,., I~._~, OPr~po~ed
, ~ 0 p--.... ," , " . r:Y"lv\ V ", (P k1 Ylt-c..n;(. uu..u n Emh:g 1
o;f7Q&nAoD A~~RE~ W)! nfL' ~() 00 . .-c ,u b:4TON~3t
CONT~~q'SN~~~ (i))Rtf'Q) ) IM.~, .' r7~ji
_TO BE MAILED Tq (NAME ~,o ADDREW . . rZ] _ ld (1_ ~ :._I~LJ:::PHONE_NUMBE*--
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I HAVE CAReFULLY EXAMINED THE COMPLETED APPLICATION FOR ERMIT, "and y cer4tl.fY that all l.nforrn tl. hereon i~ true L....c'(;-r~L 'and that I
have the" following legal. inter~st in th~~prop,erty ;,DowneroJ record; 0 ~ont:act purchaser; 0 authorized nt with evidence ',of. autl1.ori ty attached,
I L.rther certify that any and all work performed shall be done in accordance w{th the Ordinances of Lane County and- the Laws of the State of Oregon
pertaining to the work Aescribed herein, and that NO OCCUP~NCY will be made of any s.tructure without ,the perm,issi'on of the Buildi~g Diyision. ",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 ba'sis for exemption
is noted hereon, and that only 'subcontractors and employees who are in compliance" with ORS 70L055 will be use? 'on this project. I"~VE READ AND. ,
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NAME, (plea~~ print) , J . SIGNATURE '/ ~ ~ATE /"
READ THIS SECTION CAREFU ! ~al:lJ -I.
O.PL'ANNING/ZONING: '~~~f~~' ' ~tl.t n # parc'el . parc~l Sl.;~~O
V\.f[J'-W ",,; - " ~I =1 - rp
Hl.n.l.m~se backs: ~. ~...l', l.de' l.nterwr -a:=;L .- J rear ~!"'7)..
. CO""ENTS, ,')ti i t.'lan' j -O~l otL ' N3",D,QO{',Jd{.:\RkLlrIn!~rm;;rO'h{rVl)
'.fA ~ +Q,J)il~ (()(lCLfod ,(\ lrr;~.)l Lf/iy1;n ~ to~J4bJ1.QQJ1,
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@"~~NITATION' S, 1. # "B. P. # :~ stallat,on ReeO,rd Is:ued? [J Yes 0 No
Installatio'n Gallon ' . , ' Maximum Depth
Specifications: Tank of 'Trenches
to'"'~NTS' .~~. xf.Li2j tJ~~t7, ....;,~~~.J ..a./.1PA';L~<>-,'
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---- .....u-, <'1.AO<""".j) I Date" . /A -..2 _Oc(. ..'
rn!p:;s E::N:TI~~:-1[~<, () R1 ". .use-CANr~~~~~'PPT T~()M:'
,COMMENTS, APPLiCATION DE~V/' LICANT MAY- REAPPLY ,WHEN CONDITIONS..FOR APPROVAL ARE MET.
· lmTTnTMr:;p,~/~ o~;U~~n' P\,!"O T0 '1'U~ .O'1'~T' QV A~nr C0"o'1'oncu;o", < n
,-'. Date,. 05-21-,85
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FOR OFFICE USE ONLY
Application;,,~~~~ '~/~'
Perm1t # ~~O ~~q ~"
o Two Copies of Plans
o Three Copies of Plot Plan's
DMech/Plumb.f.ng Checklist
DLegal Interest Document
D Plan Che'Ck Info Sheet
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WW!';SHIP
15
t11D
TOTAL VALUATION. $
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Description,
}. Sq. Ft.
1f~;'r
, Fixed Fee"/
Uni , Cost.
&-,61'
l~ zq
Floodplain Fefe'
,Subsurface 'Fees
Building fee
t.1zch/P Imbg Fee .
plans Check Fee
..:" ""'-,
sta,te.. Surcharg~
DEQ Surcharge
$ '.
$ ,
$
$ ,
$
$
$
.
TOTAL FEE
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~o/Zl"e6
DATE
GEMENT DIVISION, 687,4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
C 1'4-25
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S~1'BACKS AND .oTHER ,,<;:gN.DITIONS. O-P .AP'PROYAt IMUST BE-~ ST'R\CTLY OBSERVED. VIOL~TION CAN- ,RESULT IN REVO--
. CATION OF THIS P~RMIT, 'CITATION. UNDERPRQVISIONS OF. LANE COUNTY I S INFRACTION ORDI~Adc'E,- 'AND/OR 'OTHE'R
""R'diEDIES - ALLO'WEO-'.BY:-LAW." _ .. '. ..,." .
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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' informa tio'n Orea'dy': - permi't: mimo'ih;--job ~4diess ',. 1;:yp_e
o~ .in~I?ectiov" ~hen ~ t will be ready; your name and phone .nu~be:r::'" ?nd, any sp;cial direc;:tions to site.
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BUILDING DIVISION::
REQUIrfED.tNSPECTI6-Js:'-~ 'I, . t. _'__n'~_'_ .-. ---::---
',' " ; . : - " . . "'" ' " }
f: FoundationJoIn'spechi'on~ TC? be mad~.'~a~.te:r:' t<en~hes "'7~e' excava.ted ,al)d'j for~s f'"H'-~-~!.iii~~iIIi~
. mater.1.als tor the foundat.1.on are ,del1.vered on the Job. 'Where concrete fr~~
plant .(commonly termed ntrans~t mixedU) is Ito be 'used, materials need. not be on the job.
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2.' 'Concrete, Slab-or~ Under-Floor Inspection: To be made' after al'l in'-cslab or'under-floorbuilding,'
serv),ce"-equiprilent,_ .co.D-qui.t., pipJ.~g '~C!cc~e~ssor ies ~=-C!Dd ..o_tl1er. ancilL:;ry .equipmE7n t;- i terns: are"':in _ . _.
:-=_71-,~' ,place_~but before any concrete is poured or floor sheathing installed, including the subf-loor. ;....
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3. ',Frarninq.f:<.. Insulation Inspections: To be-rnade'..after- the:..roof: ,all f-raming,. :fire, block.i:ng~,;-.and',,,:-,,;.;~
.. bracing are in place and all pipes, fireplaces, chimneys, and vents ,are compl'ete'''and all- roug'n" .'
!'..8 - el:c.tt~,~~l and- p:..umbin~ a:-e ,a~pr~v:~. _1?1.1. w~:L}" tn~~,la~~~~an~ :~IC:I:.~: ba:~~er :~:r:~ in. pl~c~: ' ..
4. 'Lath_and/or Gypsum Board Inspection: To be made ,after all lathing and gypsum board, '.nterior
.. _<!n.9_~~~e_r,I9r, is iJ}__p,lac_e. but I::l,etore any. plaster ing~ is, app;tied and before .gypsum board joints,
'." ...!lnd ~~steI1ers are tapeq and fin~shed',. ...-:.....' ~ " ,.',
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5. Final "Inspection: To be made~_~fter the. bui'ld.ip'g is~ comple'te .and.,':be..fore occuJ?ancy.
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APPROYA~REQUIRED'I No work shall ,be do,ne on any part of' the building or structur~ bey6nd~the point
,.j indicat~d" il!"eacfl s~_ccessive i!1spect,ion without. firs,t 9b~aining the approv~l of the ~pilding .offi~cial.
Such approval shall be given only after an inspection shall have been made of each, success~ve step ~ '
in the, construction as' indicated by each of the inspections required.
. .. .... NOT~: '~I,l';bUildi~g' p,ermi ts~..req.ui7e: .~~spe:F~OI]s f.or ~:t~: ~ork ~,utl)or i4zed'(" ~u~h;, ~s.' bU,t. _~ot limi ~e~ t_o:
'A. '" Block Wall:: To be made a'fter reinforcing is in place, but before any grout is poured. . This
oin.sp ~ ~'c:;4re':1~":'''',?,~. .h l.... ...... r .j;"",~' '.' ~a' -r'Val"U,ntil the plumbing', '\
.~ ....,,~I. .!~. "It,~ .--,:-__ '~"
~ <3:.n~ ,;t} oa .-i~ ;soe- on9~ ,vewlre, m . e .' ; ~-o""4V. . n. .' t ~ ;"
Be. 'Wood Stove: To be m~de ~fter_, completion ot"' masonry (if appl,icable) and when installation is
:.-, '.complete. ' Installa tion. shall be in accordance wi th ail' approved, .na tionallyrecognized testing......
'.agency.and the manufacturer's instalL~,tio": in.tstruc~iors. ' .
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C~ Mobile'"'; Home :An i'nspection ~is required after. the mobile home is- 6::>nne'cted to ,an, approved
'. sewer~ or septic) system .for se'tback requiremen1ts, blocking, 'footing connectioh, tiedowns."
- - -- skfrtfng;. and-' plumbing connectionS:- - - '-' _... . -. - --.-- ., -. -- - "-7 --
..... ., . I .', .. +
- --1,. - Foo.tings" and....piers to comply.'with, State' foun'dation-requirem~nts' for-' mobile homes~or as _~
,recommehd~d by the manufacturer.
2. ':Mobile, ho~~'mirtimUm finish floor e~r...:'ation I~~a~l,~~e certifted' when:requ{red by a '-f'iood~'
"plain' mana'ge'nlemt "letter,; ", .. , ~ l.l
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3. Mobile home. tied'owns, ~h~n required; and'skir'ting shall be installed and ready,for inspec-
tion wi thin at leas't,}O \ d~.r's af ter{~ccupancy. Tiedowns - and skirting shall' be installed
, ,r-per enclosure. '.~' ....., ,'.. ,.'," '"
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D~ Swimming'Pool: Below grade when steel ~s~in'place and before concrete is poured.
when pool~installed. .., \.......1 ~I ' I.~' '..
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APPROVED PLANS MUST BE ON THE JOB SITE AT'ALL TIMES. DURING WORKING HOURS. THIS PERMIT WILL EXPIRE
. Ip:.WORK DOES .NOT,; 'BEGI-N WITHIN.180 'DAYS, .OR ..IF _WORK.: IS SUSPENDED .OR. ABANDONED,.FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY..OCCUR IF THIS piRMI'I':~WAS"'ISSUEDbN, Ti:lE BASIS OF INCOMPLETE o"R ERRONEOUS
" INFORMAT'ION. ' ~ '.....:...... ./< 't.., _ ''--'-.: ..
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~.':~N,:ON~ P_R~C~EDING .P?\ST,' T~E. POINT or REQU~ltED INS1?ECTJ~~S~,,,,~~.L~' ~O~ SO ?\1 T~1.R OWN RISK.
SUBSURFACE .AND 'ALTERNATIVE SEWAGE' DISPOSAL SYSTEMS: ' ....~. '-.-..-/ .
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permi~s shall be effective fo~'one'year from the date~o~ is~uance.
Upon completing the construction for which a.permithas fiee~'tssued, the permit holder shall
notify the Lane County Depa~tment of 'Planning and Community' Development by submitting the
-. installat{on record form. The Department shall~inspect the construction to determine if it
complies with the rules 'contained in this division.. If the cons't.ruction does comp'ly with such .
~:......_.:. ~,:.. ~ .~r,ules ,-,the '!?epartm.ent .shall i~~~u..~ a c~r:tifi,qpte 9f s.?ti"~of.actory ;,:OfuP41~~tio.n~9 _the 'per~~ tf hOold,er..:.
. , If th~ ._construction do T'lfl~ r:nll:\~~~' iI~')- [0'1r:. .y1e.~ _ _ . ent sha'll-noti.fy"'the-permit..
holder and shall requis~~'s ~r J i:&{ cdm5m ";& ~ore S:s' g the certificate. Failure to
meet the requirements sa 1.S ac ory comp e ~on w~t 1.n a reasonable time constitutes a vio-
lation of ORS 454;.605 to' 454.745'and this rule.
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Interior property lines.
Edge of Foad right-of-way
Building foundat~on
.- Wells, other~ water sources..,.
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. 'Septic
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5'
50'
Tank
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Drainfield
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100'
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Setbacks' - 'Subsurface Sewaqe
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L,ANE.
fWDNE:Y
SUBDIV 1919
USE F: BDF,f-lS :3
COUNTY DEPT ENV'MG7 RECEIPT
ADDR 1063 tOLE WAY,
* 298984 DA"fE 10248b
SF'RINGFIlD, OREGON
. LOT . I<LY
IBLDGS 061 PliONE '747 3384
UNITS 001 STORIES
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T!...~::' 1 BE)2{S)~)0'~I{) i 900
IEWBLDG TYPE SFD
OI."NEI', Nr'lE
CODE APPL NO ACTION DESCRIPTION
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. i'lECHAI"ICAL FEE
ST!1TE Si.mcr'IM,C!:':
PLI'\N CHECI< i"'EE
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EST. COMPLETION DATE
3.4'..29
Vf',L,UATION
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LANE COUNTY
DEPT EN~ MGT ~EtEIPT' I 294584 DATE 102284
ADDI~ PO BOX 184; SPFnNGFIELD,' OREGON
LOT ,BLI<
, IBLDGS 001 F'HONE 746 0471
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ACTION DESCRIPTION SQ' FT ' UNIT COST VALUATION
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STATE' SUF(CHAI~GE
PLAN CHECI< FEE
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SLIP
lane county
-
APPLICATION # 2989~84
LOCATION '1063 Cole Way, Springfield
Rodney and Verna Reece
: NAME
ADDRESS
~
P,O. Box 184
'Springfield, Oregon'97477
ZIP CODE
.. The above appl ication is being held for the 'following reasons :
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Please review the' attached copy of a "hold slip' dated 10-25-84,
.... ~
1) ~rovide the information requ~sted so that your pr~ject may be reviewed,
2) If you do not intend to continue with the project, at this time, please
inform this office so that the permit may be voided'and the building portion
of your fees may be reviewed for 'refund. Plan review fees and. an administrative
charge will be retained:
3) If this office has not received some infomation indicating (~u:.inten(Fto-'- :,.
proceed,~thenyoui-'permit 'application yiil:h'ecome ilwalid at the start of-
. - .- - .. t- _../
business, Ap'riT ,22-; 1985. '0-
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Bn<:.~'" Mr>r,;-:};1.-in
SI GNATURE
AVAILABLE BY APPOINTMENT ONLY
04-08-85
DATE
,
687-4061
PHON E
(
HOURS
)
This application will be held until 4-??-R~
above has not beeri furnished by that date your
If the information requir'ed '
?pplication will be cancelled,
RETURN THIS SLIP WITH THE ABOVE REQUESTED INFORMATION.
BUILDING PROGRAM / LAND MANAGEMENT DIV./PUBLIC WORKS DEPT,
125 East 8th Avenue / Public Service Building / Eugene, Oregon 97401 / (503)687-4061
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lane county
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:,~P;ryLI CAJ~ ON # 24,f71fl . EA.
LOCATION I Ob~ cot..e; wA'1' I 'Srt1ktt"fIGw
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NAME
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AODRESS
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Zl P CODE
The above application is being held for the following reasons:
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-H \.lef-AP::Me. .1'tJ r-.JOT' ~tzlW CIZ- ~-O ~ A ReGZjIJ1Z&7 ~/!L.. /I~\lil>-l(,.l1'
A';;: ~iJt1 APN-OIW A"':? 1>1') ,Al...~,,~ BUII..{IiNi Me-1tW / 17lr~>r fI?oM a-l-;Vs'_1]1~
c.c>-.~U<i'DJ ' ,
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--.J PjzWIVE: ~il\jE;lSlf.llVi1 AI\lC\L.-~~7 \PI A/0 c:::IztZp-l ~~i1j~~ t:l2- Ar?ai~ "
S~l~ ~Cjtje/.lv /.I.Oi;:;~'i ItJ Ao:.c:~O Wlj1-I11-!(;. 1'1'05 ~AfE: L?(JIto\IJ~ ~, \..
o A\)f'L'V!"'7 -s+!t:(.....,l.Z.ttlce ~-L.O<h. CAL.o..llAPf.? ~~X4 ~~
LJ)Ijl-l- c./WfG~ '97, Iqi?~ 'On ~1U?/i'1 u;.C/E. _
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SIGNATURE .
. AVAI LABLE BY APPOINTMENT ONLY
I D- ;2.'5 -81
DATE
687-4061
PHONE
(
HOURS
Thi~ application will be held until 11-'E:J-8~ ' If the information required
above has not been furnished by that date your application will be cancelled.
RETURN THIS SLIP WITH THE ABOVE REQUESTED INFORMATION,
BUILDING PROGRAM / LAND MANAGEMENT DIV./PUBLIC WORKS DEPT.
125 East 8th Avenue / Public Service Building / Eugene, Oregon 97401 / (503)687-4061 ;I;fj
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Lane County Authorization for: APplication/-?4P4-:' 6-/,L
-i:) Perm~t W t~ ~1.7 / . {1 -r
(7-u,~1 d_, o\Wy~j (-Y-+(ln~IJl.J\)-C::tLI(J I, ~7( DO~: ., -~-":-~,_~.:n':,~,
',j T\ I 1\': / 'J_ , 'UJU1' ,
~,<:;SHIP{fJ I P"\NG~l SEC/5 _: I Tt0(0~OrqOlq '~ B: ~'*'~ ,'. ';
S:"BDI\'ISIONPA",RTIT13.1 (if applicable) I LOT/PARC.EL I BLO,'9q{ ./ 0 ~~ ),'
A\...... kX;- nt:: +J1 ~7 00, VJ- --' c:;.(it'Y/- ~ :.
"'''CATtOA0RE.;j (ls;;l~ )Y-fu ,5) _ ILV'JO' S~lri CITY ZIP I P[j ~,e: r rill;) //./1"'7 i
STRUCT,~S C'~~:LY ON PROPEi<TY~ 6- P <.-:;JJ:.J I d,i'~ <<1/!!fW ~/L7 /'1
.' Nfl OYI /ifr .YT-'<, nn-r ,rTf (}to ('~ ,_
DF0~;;{Sct;E, R(1~ ri ; h/GC,.t ,AI nycti.. __ ~I~~t- ,An (\'~.rl.o" \M(L7).
i8rG.o(0'rtJ-J,~/' QL +P~.o/\'lO A-L (1 J I }-ti (1,,- "?;elf') i~
J::;~IPTION OF"'PROP~ \ ORK - B~?SPEC~ty_+,i . ..-&~. _ I DECLARED $ VALUE
1/\LldCL --:lln~',.,~)V)G5)JICI..JX' }-')(!y>Jlt n'X .~
" ?!..\l'EOROQ,,\lS I #- Of StOR ES 'il # OF EMPLOY~E~ WATER SU:PLY U ,! 1- ,L"""..;.... 0 Proposed
\11 ~ ().~ ,'- ' 'J . I n -I-- j,~k\J...L) n EXist\,: I
O;P2;J'~A~Dt~;RE~trYl(:L\~~ 110, ~o 00 , I . 11J7~i'~3t
CONTRA\:"S NANE(AC\D,OSRj# A A~--\; -. ' .' (',aJ. ~}~EPHONE~ER '
.JJ....(.:r,;~rr! /<<\('0; I~' ,3)' ~ ,(c.(rj-(n71
?~8NlT TO BEMAILEDT(Nl<:E^".DADDREiSU~.JJ7~~rId.()10CNJrV.l2J?~r/-/.BE...
I HAVE CAREFULLY EXA.'''IINED THE COHPLETED APPLICATION FOR ERlUT, andl"'t1ti'<l~ certify th~t all inform~Jn hereon is true ~'corL~, and that I
have the following legal interest in the, property: Downer of record; o contract purchuser;Dauthorized ~nt with evidence of authority attached.
I L: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 arc in compliance with oas 701.055 will be used on this project. I HAVE READ ~~D
c~~~ A~"::O~;);;~ff k&ECE' ~4?/~ --J; ;2{l,~ 0 . /c10 ?/?5/ ,
NAME (please print) -; ... SIGNATURE /.::...,t. ZTE- /"
READ THIS SECTION CAREFULLY. cr21..AUTHORIZATION HAS BEEN BASED ON THE F,'f;LOWING CONDITIONS: ~'~.r. -;,
D PLANNING/ZONING, Quo~ A,Lox..;.." ...--.~,t't~n '. Parcel It::lb It fJ OJ Parcel SiZ;;j4" uC-1.f1.'j
(;j!J!Ji<VJIL- /)7'\1 p:p , ,,~/F'I ....-F-/
Hinimum S,>tfaCkS; f8p-t _' /;J. ) ; s~de . . ~nter1...or ~ J rear.-rt::'1. _ ")
Cm":'ENTS~(hd i t'f ~~ I\( tDrh{Jt ot ~, N""o QqO('((l ~pJQ~') nL'Y('.y (}r~(m)
.J3[ j\f'A-~ ttI /,'](1" (()(l(J fnd, 01n?f'IJ! fl-:'n IY\ ~ '+0 nl1.ljf'-f8nrJOI7 -'
,., Dr ?tic?/l;YllI, .., . j ,
1IfYY~'fJlh.L~~) ~L 101?~6-~~/ Datef"!'/- ?~; IQ~
B. p, . IrsC?7- (5) ,..:.,
Installation Gallon Lineal Feet
Specifications; Tank of Drainfield
Cm",'ENTS, d<..e..--- r(lQ~;'5i~ "'I' /rf:.,7~j7t-/ 4-7
/7 ~. ~ ' 'il
1C::.v2"U..U1 _ _J... ;...,___ /':..--<!g ~ J/,:t.,.(j/"?~i' ,~T ......~ 2<1'
~ - rl -. -.
~ ,(i;;;~ uA:]/,Mf'.,I /1'f.,.:{.I'&"" ~t-6jl /(-({,.?<,
< (It!
[b}'" PLANS EXAMINATION: Type
FOR OFFICE USE ONLY
-
(IYj)
@"'SANITATION:
S. 1. It
Installation Record Issued? DYes 0 No
l-laximwn Depth
of Trenches
_:..A;-Q/Uk~\ j ..c/.1f,:'1\~/L('/L~:n"Va-j
II +-.YI) /} // /l .' '1. '
"., <'.'::~V ~~:;;~~~ ~"A
Group
Use
CO!<1:.1ENTS :
Date:
n
TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PER~IT
v\l1;;~
1E~:vYu
I '1
Description
Sq. Ft.
'l..::P',
;/j~9
.,',--){)
Fixed Fee'!
34,3Y
::::x I '7[;('
_ ~,L_
Floodplain Fee
Subsurface Fees
Building fee
!'~3ch/P 1mbg Fee
Plans Check Fee
Sta te' Surcharge
DEQ Surcharge
..5'- UJ-1J 5' ~ u-r _.. t-, .... '" -r -
~. (HAJ?(..---
~
TOTAL FEE
$
$
$ \
$
$
$
$ . , l~
$$ S C:.:.5~
P~:...:lIT ,WI'P.O'JEO BY -BUILDItlG OF~'ICIAL/DESIG:1EE {pcr ORS 456.805 (1))' DATP
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061, C 14-25
12S EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
.\ 1
idne county
-
'.. -
OfFICIAL .USE ONLY
CHECKLI,ST
PLUMBI NG / MECHAN ICAL '
"
APPLICANT 'INFORMATION:
RnJM4 T R G6CP.
(Namedr F1 nn- Please Print)
Po. /)0)( I?'i
lMailIng AddreSS)
PLlJiIlllING CONTRACTOR
DYe,s Finn
Address
rnNo~Self
MEOIAI'-iICI\L CONTRACTOR' DYes
Finn
Address
..",
iXl No.l~ Se If
Type of Fixture
PLUMBING -
Number of E'ach
Sink
Lavatory (Wash Basin]
Tub (with or I"i thout shower)
Show('r, ' se]la )'ate'
Water Closet (tb:t1et/urinaI],
Dishwasher
Disposei' (garbage grinder) ,
\~ashing Machine .-
Water Heater'
Floor Drain
Sewer- - 1st 100 ft,
each addHional 100' ft,
\I'ater Service-,-lst 100 ft.
each additional 200 ft,
Stonn and Rain Drain--lst 100
each additional 200 ft,
Special Waste Connection
Sewage and Sump hUll])' (e.iector]
~Iobiie Home Sel\'er and Water
Other (specify)
SUB-TOTAL (MlilimLUn 515,00), ,.
~
,
J..
/'
/.
;J,..
I
./
,
i
I
I
'I
I
I
I,
L
I
I
I
.1
TOTAL FEE
J
fL !
I
I
I
I
I
I .....f
T~l}e 0 f '.Equi pment
~!EGIANI CAL
J\umber of. Each
,Total
e
olechanical Penh t Base Fee
furnace-up to 100,000 BTU/H
furnace ovei 100.000 B11J/H
Clothes Dryer Vent I
Bathroom'Ventilation Fan & Duct, I
Range Hood h'i th ~lechanical Exhaust I
1I'00ci Stove (Wood StoVP. Vent B. 00) ,"
Air Conditioner Onh I
Heat hUllP I
Floor Furnace ,
Gas Piping System 1 to 4 Outlets I
Per OUtlet Over 4 ,
Other (specify)
SUB-TOTAL '
,C74-200'
I
I
I
'I
I
I
,
,
I
I
I
I
I
I
.1
I roT At FEE
AprIl.;
,. ,
'Penliit ff
, .
, , ,
:5/JI'Ih~ -f, e / J
l'L~ty or 10\\71)
t{:;1 )/
lLlp Lode)
, .
Cant.. OSR# .
.'+.
. Con t. OSR#
'.- ..
Fee On Each!
$ 7,50.
:7.50
, 7,50
'):50
.' /,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
Total
7,~n
n;',oo
'),$0
-) ,So
", "'." .o~.
..." ,':,~o
, I ,.:;0
'''),0'0
) ....ib
....-----
, ).,0.00
!e)" f>-O
. '
Fee on 'Each
5 10,00
"5 6.00
7,50-
'3.00
3,00
4.50
6,00
6.00
Q,OO .
.6.00
2.00
.. 50 '
3,oc
i*t 00
:2 ..C/O'
I
~' I
'I
A I. Cia
ACTIVITY INFORMATION SHEET
kJne county
(!
,i
,
.
COMPLEiE THIS SECTION, INCOMPLETE FORMS WILL BE REJECTED!
~
.
f?odl7e<{ ry- (/ erne.. /U 9 ec?(! e
I PERSON MAKING REQUEST
f? 0, fS elL- / S<j
MAILING ADDRESS,
c;,Qj'-';~Jt1 -1/ eld ole
=r - tyrr STATE
7-</7- 33 J'Y. _ 7.y'&-O'7'7/
BUSINESS TELEPHONE # HOME TELEPHONE # BUSINESS TELEPHONE # HOME TELEPHONE #
2 PROPERTY ADDRESS 1700 e CZSS;'C;)ledJveIICcc.5> -Ir-?vl? Cole k.J~ J
(IF DIFFERENT FROM MAILING ADDRESS) U _ / \ 3,~ v
: 3 MAP & PARCEL NUMBER (fr,Om tax maps in Depar.-tn1eilt of ASSess en~an xation
(REQUIRED INF Rt4ATION) or from tax statement) '/90--0) 0'9
p r i 8 <..... 0 20S . f u..
'\ \ - TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
ti?oc?7 eq Fq- (/e/,r7C-<.- /U
- / PROPERTY OWNER
f? 0, 8 cJV / rY .</
MAILING ADDRESS
gee:' e...
;/7<-/77
ZI P CODE
(;' r> .J!..d
r- CITY
()J?
STATE
7/,Y77
ZIP CODE
7-7"7.- '3 '38'''/
7'YcO - 0 '77/
t /
\
jJ;
- d
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
4 SUBDIVISION (if applicable)
TOWNSHIP RANGE SECTION TAX>:I:D;f:J S)
CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ~,~~
~
LOT
OR PARCEL #
ZONING -
ACRES
BLOCK
.
5 REQUEST (state exactly what you plan to do) p~ ~ ~e.d ro ~ ;:t.
/ 'SV"') l~h7- y0
\ ".----, ' ____=-- d
~ .~-........_--- --::----.._- .---"
6 DIRECTIONS TO SITE: 0'--, CLS De. Rd (Q"1/ C'9-n - Oi "ti e /-:~ (9-,., ('0/ e 1),)C<.,u
.,./ I ,--" /~ /i
-rir6re...4;y ic:, ccf- end oj c.u../da.so.c,
S -,kn '-/
U
dume
J, ov s e,
ZONE/LAND USE:
BY: DATE:
DATE
......L.
-l
'"
V>
-l
r-:
** FOR STAFF USE ONLY **
--
NUMBER
TIME IN:
OUT:
LAND MANAGEMENT DIVISION I 125 E. 8th ^VE., EUGENE, OR 97401 / 687-4061
I
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.. .. ..
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LANE COUNTY
FILE ,NO,
2q4?- f54
, GENERAL LAND USE APPLICATION'
H.O, APPROVAL-
DIRECTOR APPROVAL
Zone Change
\
Partition: Preliminary
Final
Subdivision:'Preliminary
Final
Cluster Subdivision:
Preliminary'
Einal
Cond, Use Permit
Greenway "Dev. 'Permi t
T"mporary Use Permit'
Special Use Permit
Variance
Site Review
Special Exception
Hazard Check List
Site Investigation~port ~
Special Use Permit~ jiC2::Cd.nlri lfl\..)
Planned Unit Development: I
Preliminary
Final
PLANNING COMMISSION
Request for Interpretation
FEE PAID
COMBINATION FEE
additional
DATE SUBMITTED
(Applicant's option-highest fee plus $25,00 for each
application).
DATE RECEIVED
, ,
.----------------------------------------------------------------------------------------------------
I, APPLICANT AND OWNERSHIP IDENTIFICATION
Name of APPlicant, VOhV\~ .'l-~a/1d~~~O(lO, p~one---4!f;. - M+'
Mailing Address prLf77n-v tFt~ ~n'5<~ t1 ~r:l ~(7
Street 'l)'{' I' Wity '- 1........ Zip
L
2, Legal Interest -'Titlerolder X Contract Purchaser
Other
Lessee
3, Signatures" ~', ~~ ~~t?
I (we) have completed all the attached application requirements and certify that
all statements are .true and accurate to the best of my (our) knowledge and belief.
I (we) am also authorized to submit this application as evidenced by the signature
of the owner below, ' ,
, Owner's Signature~LfI \ y,{JM--Date /0 - '19. r;1
Agent" s Signature f ,Date
Agent's Address
Phone
Zip
II, PROPERTY LOCATION
Assessor's Map 1~-(f,-05 -* IQOO.
Tax Lot
Size
Tax Code
Property Address~~~.o171 ~61~,~H
Road Status - State~o,ldty Rd.'/ Public Rd, Easement'
Abutting Property Owned d (acreage)
Map / ' Tax Lot(s)
Present use~ ri ()rvrhr; '/ ) Present Zoning
f" ,
Structures Krnof'~n{) nnHrhmoY
Water Supply - Public Onsite Wells Community Water System
- ,~
M(~\
\.... /
If Co~unity Water System, please list na~e
Sewage - Public System (list name)
Community System ~list name)
III. SCHEDULING ~r /A/ ,-/........,,0. /-tff~ Zd;-J6- ~:'6"~rl. -.:rA/
Hrg, Date - Report Avail~ble ?C4-Y- p~
PUBLIC WORKS DEPARTMENT, LAND MANAGEMENT DIVISION./?l-~ZZ. 8LjC-
COURTHOUSE.PSB 125 E 8TH AVE. EUGENE", .OREGO.N 91401. ~ .
C_ 98-239
IndividualOnsite-
. ......"',.
~. . q. .;., , ....
';
.".......-. / \
l ~ANC,ELLATION/REFUND AUTHORIZAl......./ PERMIT #
j 'NAME'(pLEASEPRINT~ .. "" TRSITL#
:.. ~DDRES~' ..
APPLlc!ANT (. ) OWNER ( ) CONTRACTOR (
REASON FOR CANCELLING PERMIT (OR APPLICATION)
d767- 6>'7
~
SIGNATURE DATI=
~
FEES PAID FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE
SEPTIC TANK AND DRAINFIELD) ARE ORDINARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE
BUILDING, PLANNING, OR PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION
PROCESSED,
FEES PAID % REFUND
% Flood Plain Fee $ ,. A H E;>)
I, .>1 1-1 .1:''') I. .j % Building Permit Fee $
... f
.' .1 "'- . .__.... % Mobile Home Fee $ ~.~
..., "
it" ,"/') I ;}T> % Plumbing Permit Fee $ . -
~ , ,.....,-'\
..LJ. ~ i ,tr1? % Mechanical Fee $ ,
1':;>.2.:1- D % Plan Check Fee $ 0
:L '1f,-;.71J ^ % State Surcharge Fee $ 1';)
% Septic Disposal Fee $
% Site Inspection Fee $
% DEQ Surcharge $
% Land Use Application $
% Planning Director $
% Recording Fees $
% Partitions $
% Copies ,& Ordinances $
% Surveyors $
- .2. 5' c,.v
\ Minus $25, for Processing Fee $
TOTAL AMOUNT TO BE REFUNDED $ .:::?r"J ,Y.~t?
, C)rL " ~ r r:- ","-
.. ~ ~,
, ') .. -rV/..C12d/ nATE ..J ::>>t./ 0..-
SIGNATURE
J
v
TO DEPARTMENT OF FINANCE:
Building Permit Refund . $
State Surcharge Refund $
Septic Disposal Refund $
Site Inspection Refund $
Land Use Applications $
Planning Director $
Recording Fees $
Partitions $
Copies & Ordinances $
Surveyors $
TOTAL AMOUNT REFUNDED $
PLEASE MAKE CHECK PAYABLE TO:
NAME MO/'JEV /POD //I::?d:/?A' h-e:ee
ADDRESS ,f? 1/ /5/J V :t,,( /fL/ .J/'P'J'/l'?;?7-,?/''rJ
, ....~ /
.:30g.~
:!4'17'88/Ac~t. 42120/Prog. 060 Recelpt# / .?CJj '7
24,17-88/Acct. 42124/Prog, 060 Receipt# '
:!4,17-88/Acct. 42133/Prog. 060 Receipt#
?4,17-88/Acct. 42134/Prog. 060 Receipt#
?4,17,88/Acct. 42150/Prog. 060 Receipt#
?4,17,88/Acct. 46202JProg. 060 Receipt#
?4,17,88/Acct. 46210/Prog, 060 Receipt#
:!4,17-88/Acct. 48474/Prog, 060 Receipt#
:!4,17'88/Acct. 44419/Prog. 060 Receipt#
:!5,06,74/Acct. 444511Prog, 010 Receipt#
~oR. .g.
/3 k7,c- h/l .h' /
....... - - -
7'7;/ 7 /
LAND MANAGEMENT DIVISION / Public Works Department / 125 E. 8th Ave" Eugene, OR 97401 (503) 687,4061