HomeMy WebLinkAboutPermit Building 1975-07-02-
-
IANE COUI
BUTLDTNG E
TDING PERMIT OR
MHE
MOBIIE HOM. /SE PERMIT
PERMIT NO
PROPERTY OWNER MAILING ADDRESS PHONE
CONTRACTOR MAII.ING ADDRESS PHONE
PROPERTY TOCATION _ INCI.UOE POST OFFICE
PROPERTY LEGAL DESCRIPTION _ METES, BOUNDS
Lor 8t &oc
RANG E SECTION TAX LOT NO CODE CENSUS TRACTa
3r? { i{tr EXISTING STRUCTURES ON PROPERTYAPPI..
NAME
&
MAITING
ADDRESS
LEGAI. ACCESS TO PROPERTY
PROPERTY SIZE _ FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms System !New m
VALUATIONRES TO BE BUILT THIS PERMIT TYPE CONSTRUCTION
Harr t66 I el.8o
se. FT.BDR MStmrty re Sluirt.fIrrrr *rurry
SEWAGE DISPOSAT
PUBTIC N SEPTIC TANK N OIHERD
PLUMBING INSTAIIED BY
OWNER n OTHER: NAIY{E
BUII-DING
WASTE DISPOSAT
PTUMBING
PtAN REVIEW
PARK TRAILER
FEES WATER SUPPI.Y
PUBUC tr n oTHER
-\
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAI..
DRAIN FIEID
TIN. FT
REQU IRED
TRENCH WIDTH FT OR SO. FT
* ruex rr.L rrLr.s
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTI[. EASEMENT
BIDG, SETBACKS FT. FROM
FRONT SIDE I
CTR. OF ROAD RIGHT OF WAY
NT. SIDE EXT. REAR
USE CI.ASSIFICATION
AUTHORIZED SIGNATURE _ DATE DATE
Tft,ft1
BLDG. PERMIT _ WH ITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PLUMBING _ CANARY
BUITDING - GREEN
SANITATION _ GOLDENROD
Coll 687-4065 to schedule oll required inspections. All construc-
lion sholl comply with Uniform Building Code, D.E.Q. stondqrds
IMPORTANT: for subsurfoce sewoge disposol ond counly regulolions covering
plumbing. All buildings require o certificote of occuponcy before
being occupied.
(See Defoils on Reverse Side)
(POST TH|S pERMtT ON MA|N BrDG. AT S|TE)
LANE COUNTY, DEPT. OI ENVIRONMENTAT A,iANAGEA,{ENT
COURIHOUSE ANNEX, I35 EAST 6th, EUGENE, OREGON 9740Ironv *g5<-13
Connect to Existi
II
SITE INSPECTION
AppRovro
RruaRx s
Dr sappnovro
I
Dare -I rusprcton
FOUNDATION INSPE l0N
AppRovto
ReMrnxs
Drsappnoveo
FRAMING INSPECTI
AppRoveo Dr srppRovEo
Re t'ranx s
oo,, '/' t 7:./ f I ruspecr
r-/ fu?( rnsprcr &Dnr r
/,
J.,
/
/,
LATH OR SHEET NSPECT I ON
Appaovro
REurnx s
Dr sAPPRovE o [--J oorc f "r?0 '' I{t*rr.-Oi
FINAL INSPECTION
Ap pRov e o
RrurRx s
D r sappRovro D oo-,,7-2b- /{,,,,,,
CERTlFICATE OF OCCUPANCY
Reaov ro lssue Cl Nor Reaov ro lssue D DorE-
ReurRx s
/ /re. f,t:
-drtr z /
I Nspecron
?2
d
-)
L
,?4 4n
PERMTT + \t-"\n 1-elNOTE: NO PERMIT WI
CONS?RUCTION
BE ISSUED UNTIL THIS APPLICATI
APPLICATION FOR:
HAS BEEN APPROVED
CHAI'(GE OF OCCUPANCY
zip
MOBILE HOME PLAN REVIEW
OWNER
ess
Address
City
City
Phone
Phone
Twp
O.S. REG. /I
Section
ACCESS TO PROPERTY (Road Name)
Existing Structures on Property
Property Location - Address/Directions:
Tax Lot Code Census Tract
Pro perty Acr ea ge_______I^,id
5*/
J/
\cqa
lce UseBelowr0
DISPOSAL
Site Inspection /l
WAIER SIJPPLY
Well
Valuatlon ecs_
o
S
SPr Other
PLI]MBING:
Installed bl Owner
Eing Sewage Disposal System
Public
or Ner^r Systen Requlred
of Community or Pub1lc Systen
\Q L-
FEES:
B1dg.
Waste Dlsp.
Plunblng
Plan Review
Moblle Hone
1% Surcharge
TOTAL
oe)
of Fixtures
o
Sewage
Connection
PLANS
YES
Signature of
Fee Received By
\u
NO
Water
Connection
FACILITY PERMIT
YES
Date
NO
5
5
Mln. Septlc Tank Capaclt'Voo Required - Llneal ..u.---l(t)Maxlmuu
Type of Construction Group Fire Zone Use Classification
Blde Setbacks - f- fe'7-rFront tl {rw, *t
rom Center of Road Rlght of
, Side Int. 2 '
way: rzd _
S lde Ext erior __YEZzr:&.-, R.ear f
LANE COI]NTY D OF EIWIRONMEN MANAGEMENT
Zone
DATE
<q
c55- 12
DATE:
XT
l---r
w
(f 1
UILDING PERMII OR MOBILE HOt USE PERMIT
PER}'A\T NO.)(LANE COUNI'
BUILDING E
.JPERTY OWNER
CONTRACTOR
PROPERTY LOCATION _
MH
MAILING ADDRESS
MAILING ADDRESS
INCTUDE POST OFFICE
PHONE
PHONE
PROPERTY LEGAL DESCRIPTION _METES, BOUNDS
RANG E SECTION TAX LOT NO CODE CENSUS TRACT
EXISTING STRUCTURES ON PROPERTYAPP[.
NAME
&
MAITING
ADDRESS
TEGAL ACCESS TO PROPERTY
PROPERTY SIZE _ FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existin Sewoge System I New
TYPE CONSTRUCTION se. FT BDRMS VALUATIONSTRUCTURES TO BE BUILT THIS PERMIT
SEWAGE DISPOSAT
PUBLTC D SEPTTC TANK
PLUMBING INSTATTED BY
OTHE OWNER OTHER: NAME
WATER SUPPTYBUII.DING
WASTE DISPOSAT
PTUMBING
PTAN REVIEW
PARK TRAIIER
(F EES
PUBUC n tr oTHER
t
COUNTY BUILDING & SANITATION SPE ctFtcATtoNs
MIN, SEPTIC TANK CAPACITY
WITH DIST. BOX: GA[.
DRAIN FIETD REQUIRED
TIN, FT TRENCH WIDTH FT.OR SQ. FT
TYPE OF STRUCTURE OCCUPANCY ZONE PUBIIC UTIT. EASEMENT
BLDG. SETBACKS FT FROM CTR. OF ROAD RIGHT OF WAY USE FICATION
FRONT SIDE INT.
BIDG. PERMIT _ WHITE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PTUMBING _ CANARY
BUII.DING - GREEN
SANIIAIION - GOI.DENROD
SIDE EXI
AUTHORIZED SIGNATURE _ DATE
REAR
DATE
ronu f 955- 13
coll 687-4065 to schedure orr required inspections. Ail construc-
,M p o R TA N r, li,.., i[: x,"#']l*: u : 5l [:q 3 : l, x "ff i:t,,, j,,:;,".T* ,*t:;plumbins. Att buitdinss reguire o cerriircorl "i;;;;;;.y'b"ror"being occupied.
(See Detoils on Reverse Side)
(POSI TH|S pERMtT ON MAIN BLDG. AT S|TE)IANE COUNTY, DEPT, OF ENVIRONMENT,AL MANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6th, EUGENE, OREGON 9740I
SLAB FL00R '.-
PLUMBING GROUNU/ORK
Ap pnov e o
Rrulnx s
I rusprcronDarr
GAS PIPING GROUND/ORK
Ap pRov E o
ReulRx s
D Drsappnoveo D DarE I Nsprcron
ROUGH PLUMBING
Appnovro K DrsaPPRovro D oo,,flj//-fft*,,,
REmaRrs
ROUGH GAS PIPING
Ae pnov E o
Reuanr s
Drr E I usprcron
FINAL PLUMBING
AppRoveo @ Dtsaeenoveo
RE MARK 5
FINAL GAS PIPING
Ap pRov r o
Rrua Rx s
DrsrpPnoveo Dnr r I Nsprcron
CERTIFICATE OF OCCUPANCY
Rerov ro lssue D Nor Reaov ro lssuE D Darr-lxsercron-
Rrunnxs
D Drsappnovro D
fa Dt sapPRove o D
D oort? -2o-)C tNsrc*oa *<1i/-{
pu-r!0 tNc s,trL EyALUAT I o[
J ) BUtLDtNG pERMlr AppLtcATtoN No"
( ) srrE tNsPEcrtoN
PLANN I NG D tv ts l0N
rsI
LOT :_ BL0CK:_
a/*s n 6 rAx Lor.r.it-
ALL
T
s
l-gEar *,2-{
Not
Appl i cabl e
APPL I CANT
DATE
No Yesr) ril( ) (l,
8rt( ) (t
CKID BY:6- Setbacks'
-/d
nes:
2'€
I
2
3
4
5
Zon ing Ord i nance Cornpl i ance : Zone ,s" ,-j--(
Subdivision Ordinance Compl iance (
Requi red Access (
Bui ld i ng S i te (Area, Width, Frontage) (
Other (see cornments) (
COI{}.IENTS:
T rotn
)
)
)
elFront
Side Exterior
Setbacks from inter or
Side
Rear
PLANNING DlUlSl0N ACTION PENDING: YES( f N0( )APPLICATION#
BUILDING INS l0N Dtvlsl0N
Plans Submitted
Soi I Stabi I ity (footings)
Flood Plain
0ther (see conunents)
No Yesr) rfi'() ()
() ()
() ()CKr D BY: i
Not
I icable
)
)
(
(
7
8
9
0
DATE
COM},IENTS:
I,ATER PoLUT I o-llloXrEot
I l. Heets Department of Envi ronmental
Qual ity Standards.
12. 0ther (see comments)
Not
Appl icable--rr No Yesr) TrI
( ) ,1 ,()CK'O BY
DATE
COHHENTS:
TO APPL ICANT:
'ry{
Your()()
Building / Site lnspection:
Can be approved.
Cannot be app roved at this time as indicated on item N0
Questions and further information on items I through 6 contact t e E
COUNTY PLANN I NG DlVlSlON" Questions and further information on it eilil
through l2 contact the N COUNTY BUILDING AND SAN TATION DIVISI
you can reso vet prob I ems
above.
ld'
Wi I I be held in this
ls being returned.
ce unti
c55-28
)
)
Your bui ldi
135 Sixth Avenue East Eugene Oregon t/
PHoNE. 697-4065
LANE COUNTY PLANNING DIVISION PHONEZ 687
n cated.
ermi t ti tion fee is u
401
-4t 85
I
flfl /qqc- /5
t\9a-IiI\\PERMII OR MOBILE
MH
IY\AILING ADDRESS
MAILING ADDRESS
SE PERMII
PERMIT NO
PHONE
PHONE
LANE
BUILDING
PROPERTY TOCATION _ INCLUDE POST OFTICE
PROPERTY LEGAT DESCRIPTION -I.{EIES, BOUNDS
TWP
RANG E
2
SECT rex loi hmxloN
APPt.
NAME
&
A.tAtUNc
ADDRESS
MOBIT E
of Bedroo
Roarnr ll
Srme
PE RMITS
I.EGAI
TO
FOR
No.
slzE - FT.
ONTY
DEPTHms
STR
IGIE
UCTU RES TO BE BU LT THIS PERMIT Connecl
TYPE
lvh rr I
to Existi
RU ON
ng Sewo
SQ. FT
AREA
B
New mDRMS
\C
SEWAGE
PUBI.IC
BUII.DING
WASIE DISPOSAT
PI.UMBING
PI.AN REVIEW
PARK IRAITER
FEES OWNER OTHER:NAME
SUPPIY
OIHER
oo
005
SEPTIC TANK
BY
srprtc tnN K
COU NTY BMIN.
WITH
CAPACITY UII.DING
DRAIN F IEI.D
&sA NITAI roN SPECIF tcA ilo NSDIST.8OX: GAl,.REQU IRED
uN. Fr 1 TRENCH WIDTH FT.-3orp OR SQ. FT,
TYPE OF
BTDG.
-
FRONT
STRUCTURE
occ
OF WAY
UPANCY ZONE PUBTIC uT[..FT. FROM CIR. OF ROAD RIGHT: SIDE INT. :
AUTHORIZED
USE
SIDE EXT.R
IMPORIANT:
J
_ DATE
DATEBI.DG. PERMIT _ WHIIE
OFFICE COPY _ WHITE
COUNTY TAX _ P'NK
PI.UMBING - CANARY
BUIIDING _ GREEN
SANIIAIION - GOLDENROD
Coll 6.97_4065 ro schedtion sholl comply withfor subsurfoce'riwoq"
plu.mbing. All buitdiissoerng occupied.
(See Detqils on Reverse Side)
(POSI THIS pERMtT ON MAIN BLDG. Ar srrE)
LANE COUNTY, DEPT. OF ENVIRONMENTAT A,TANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6th, EUGENE, OREGON 9740I-- c5s- rJ
A
NO
C
t
PUBI.IC n
REAR
P OSED SEUAGE OISPOSAL SYSTEH-REC
INSTALLER: Complete top part'o-form to signature and submit boErr copies with app
PERilIT NO
I ication.
l\
JS
Ferrco
ths Bas t Wat er Supp lyNo. Living Units
1
Ba)Y No Public " 0the ist
ic Tan
Ft. frorn well Steel tr Concrete No. Compartments -r Gal. Capacity :1.0:,n
Bedroomsa
ns e mens t ons:
l',idth
Ft.
+?' Diameter
NNIAL l^/E sr
e sPosa e
th Distribution Box: Yes
r str ut On-Pe
rom
lt
t ne
.,: No
OWNER
NAHE
},IA IL I NG
ADDRESS
Roarnr N Hlt-r-
B
teeF
NT F I
PRINGFI
6
o Front Side
Lengt i nes-Ft.
4
For Sanitarian Use 0nly: Date:
ln accordance with 1973 0regon Laws Chapter 835, Section 214 this certificate is is
as evidence of satisfactory completion of a subsurface seurage disposal system at th
I ocat i on.
ffnpproved: System lnstalletion conforms to current standards
I-l Disapproved: Does not conform to current standards
Remarks:
r_
ile
er
sued
e above
OVt,e
I
8-t z-'tf
Ft. Between
Lines i'
erf
.i_..
er ePt
r- lnTi le2
r
!Jidt
ota
0F
q
n
see nst ruct
t'o 'u-'-
. 7i'
N*
z'-z8-I ta'
,1,n- /J" >'----2
(lrr!.t-tl fti
r" f\-tI t'i \
D 97s r
l<
€
on
sr:
r\1
L*u P EL 5r'
Si ature
an
LAN UNTY
c55-r1
STATE OF OREGON DEPARTMENT OF ENVIRONHENTAL QUALITY
gnature
1Ot2 Launel
I OnS
l-
)_ _ ;,.!
il***
;-,/- LJ^ t
POST THIS PERMIT ON MAIN BUILDING AT SITE
.,o, Aooags, ro92 Laurel Stteet. spfd' ote8on coNsTRUcTloN PER[4|T#
rRs, TL: tg4z-cc.t,3 * qztr_..--. -__ 4 =- h:E
*,;,m*j::,'Hi",1;".,Ut"lti",m',":".';,,H,""Tlll;""*',Tffl1x:"*:%"#"'j*X::::ij[:;:lH:,T,11';'JH?T[;-''
vio,q
t;
Apprcant/+9!f."*:H:
owner/Address: t
Iontractor/Addresg:
E:lilffi;1' os " /
ter M. AubreY, same as above**
this permit
Telephone:
Telephone:
Telephone:
s746-24g,,-)
sarneI
oQ n
,
Total Construction Value: t
Addition of bedroom and fanily room @ 748 sq ft;
Public # Bedrooms: 2 + Plumbing Fixtures na + Emplo
Wate rSu ly:
PLANNING DIVISION Zonins:
lVlinimum requ
side exterior:
RA Partitioning +na Parcel +
ired structural setbacks,from: centerline of road, front
451 ; interior propertY lines:
PERI"trT CAI.ICELLED.
5t ;rear propertY line
na ParCel Size: na
45f centerline of road,
7T PUE
Sp ecial lnstructions
SusanFor information call 687-4394,
B6'[iX#biJ':i31, :i"';];::iiff 3' a,uintLlo,"q
SPecia
lnstallation specif ications: na gal. min. septic tank caPacitY;
uired; max. dePth of trenches: na
I lnstructions PERMIT C.ANCELLED AT APPLICA]{TS
For information call NA between 8:00 - 9:00 a.m., NA
Setbacks
'€7io-r p
Septic Tank
-Td---roperty lines
Drainf ield-lT--
10'
10'
100'
-dge of road right-of-waY
ing foundationBuild
10'
5',
50'
Wells,water sou rcesother
IJ$:;l ffl*' $81ifi?' ciituu.uo od8 u8prr'Siir' s [ii€u6Bt".
3 Use Classification STD/ADD
F3l',fili'YfilJ3l",'o*
DIVISION
Directions to Site: NA
For plans information call i{A between B:00 a.m. and
it) call 687-4065 between
9:00 a.m., NA
8:00 a.m. and 5:00For i ons (see back of this m.
lane"^,
Nc55-13
J o3-LB-80
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
By Hans Ettlfn/lky
/
.. .I{CELLATI ON/ RE FUND AUTHORI ZAT IOI.Permit #
Name (please print)
Address
Applicant() 0wner()
Reason for cancelling permit
Contractor ( )
Si gnature Date
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 made-on the
building and p'lumbing portions according to the amount of the permit processed.
CONSTRUCTION PERMITS & INSPECTIONS
Authorization for possible refund:/o
/o
o/
o/
lo
o/
Building permit fee
Mobile home fee
Plumbing permit fee
Plan check fee
State surcharge fee
TOTAL AMOUNT
Date
$
$
$
$
$
$
WATER POLLUTION CONTROL
Authorization for possible refund:Septic disposal system
Site inspection fee
TOTAL AMOUNT
Date
ol
$
$
$
ol
Si gnature
TO: DEPARTMENT OF FINANCE
Building permit refund
Septic d'isp. syst. refund
Site inspection refund
TOTAL TO BE REFUNDED
24-08-24/Acct 4696}/Prog 021
24-08-25/: Acct 42133/prog 0l I
24-08-25/ Acct 421341 Prog 012
R'|ll
$
$
$
Receipt #
Rece i pt #
Receipt #
$
PLEASE MAKE CHECK PAYABLE TO:
Name
Address
Signature Date
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE/PUBLIC SERVICE BUILDING
125 EAST 8TH AYENUE, EUGENE, OREGON 97401
c74-L79
i
Si gnature
A\ \S
\ll
Xu,n" (p
i Address
lease prir
/o?"?
nt) o
/C
Permi t #48;-tr0
Appl icant (X] 0wner ( )
Reason for cancelling permit
-ANCELLATION/REFUND AUTHORIZATI.
rs
Contractor (
7
-1*-.4<,.) -/*4,
)
J
I
J
I
S i gnature Date *-A .4€ - /f rb
Fees paid for waste disposal sysseptic tank and drainfield) arebuilding and plumbing portions a
(si!e inspections and/or applications to install thearily nonrefundable. Some refund may be made on theing to the amount of the permit processed.
ordin
ccord
CONSTRUCTION PERMITS &I NSPECTiONS
Authorization for poss'ible refund:
E N
Building permit fee
Mobile home fee
Plumbing permit fee
PIan check fee
State surcharge fee
0
lo
b
E
$
$
$
$
ig.fo
o/
lo
db -O-r
$
$
t,7 >
SJ gnature *'4*
WATER POLLUTION CO NTROL
Au ori za or
a
Signature
Septic disposal system
Site inspection fee
TOTAL AMOUNT
Date
TOTAL AMOUNT
Date
{e , l2-
- lz-o
o/
$
$
o/
lo
$
TO DEPARTMENT OF FINAN CE
'#wif;##;?*u^
Site inspection refund
TOTAL TO BE REFUNDED
*,giiwffi\Y#,ffi:::$ s:. so4.77-eipt #7 5680
eipt # 7s68o
24-08-25/Acct 42.|34/pr.og 012 Receipt #
58.22
d$
$
$
PLEASE MAKE CHECK PAYABLE TO:
Name Ch ester M.
Address urel er leld.
c74-179
1092
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
- - COURTHOUSE/PUBLIC SERVICE BUILDINGI25 EAST 8TH AVENUE, EUGENE, OREGON 9740I
0regon 97477
Si gnature Date 4-/
aI
h
1
lo
LANE COUNTY DEF,T E:NV I-IGT RECEIPT * 3S?80 DATE OIOTSO-!1 AFF LTcANT AUBEEv, cHEsrER u ADDR t 0?? LAUREL s'T. , sFFD, oRE
TL* IS0?06130?T19 SUBDIV I.IEADOI,' 6REEN 4T}{ ADD I-OT ?t BLK 232 NEU BLDG TypE usE R N0 BDRt'is 0J N0 uNrrs 00r No srnRIEs No Bt-D6s 001
CODE AF,FL NO ACTION DESCRIPTION SGI FT UNIT COST VALUATION F'EE DAYS
-!1 qF ADDrrroN oF trED-dtP R00tl AND FAI,IILY ?48 35^?5 ?.e3&71{ BF
BF3q *rF.
BP
1o -qr.' Lc lg?so REF R ?6s6? 1 I s. oo s
0
00*
0
00-
0
48
r'L N0. FIXTURES:3't'tEcH
TURs rcx
45 sDs sDsc
l0
SIFO CFIll 'TAKEN BY sK
EONNHCTI]RS:
HECHAN I CtrL FEE.
.S'TATE ,SLIRIHARGE
F'LAN fiHECK FEE:
HLT.V ADDR FF,
CO}{F.LETED BY
:i. OO EACH =
47.
507.
ENVH
TTITAL FEE*X
N0.
t,PC F LAN
4.72
5?"00
40^00
??t . ?? cK
t!
56
12
il
t0
5E-l
60
52
9rt^tL_
64
q*u.
DEPARTI1ENT OF ENVIRONMENTAL I'IANAGEMENT
PSB, I25 EAST BTH AVENUE
EUGENE, OREGON 9740I
r'3
..sli*+i Spr iel-d,.rb Address
Medow Green a ii[$t::li 1 it.,*Ulti 2
Appl ication for Addi ti on to existi ng horr se .
Structures now on the ProPertY
,l*.ii'uilffiifi l##$i .ti$ils$# $i[i f,i i[$siu*ti$i${i ,i$$.'' #fiil$ /--li$#$i#"i1ii1Jisli$i
Affidavi t: I ,hereby certify that this information is true and accurate
Lane Coun Code Chapter l0 (zoning)and for no other Purpose. I have
pu
the
rposes allowed by the State Building Code and
fo1 1 owi ng 1 egal i nterest i n the property:
holder of an exclusive option to purchase;
If this a lication is for an a cu ra bui lding it will be used forpp
ty
I essee;
U
of record;
authori zed ac
! Signature/Address
l,Jhen
Ot+ner
'ls noti
Contrac tor
Contractor's 05R#2e12+
r&:xl;'ontract purchaser;
the owner who 'ls EfiowlEgeabl e o r-TET-s app I i cation
/o h
Da te
Tr pli /-/ Owner /-7 Contractor !y: /-/ nail f, ohone
Te1 ephone nr
z'l 7
Phonc
enone 689 -8538
t
z1
z1
Plumbing by
," o
^-i*+*:t+ruuii$Utt$uos
If Commercial
Residential:
: #..ofi.,.,!dst|Ill: i
--
:#ii,+#.ii#uffit €2-
# of employees .-#!:..$#ii:ilitfitt*iii
tSl5;lr,:,it ,-r,zr*ist.ing, Bp #,',...'... :/_/ Proprrsed, SI #
r4?:f
SI test holes readY
. frrft.',iiUni iffiitti
.#r,:.rilf::i:l$.lit-tt*ir i :
:,liFo ,
gi$g-I Va l uati on Fee
$
Total Valuation: $$
at
at
$
$.-.--
Subtotal
each
each
t
$t_/
Received by
Water Supply
Proposed _
Year Instal led
o
Exi sti ng _
$
4% State surcharge
Plans check fee
-Ch.fl€€-!,reeerl1r f aYr,($---
$_$y'7 tr
s ar"? lt 72-
PERMIT PR0CESSING Zone
Minimum setbacks:
Part. #Parcel #Parcel Size
_4'/t,, s ide i nt.rearfron t
Comments
Fire Zone
To be typed on permit
cP& i
To be typed on permi t
By Da te
Gro u p.Use Classificationr?
By Da te
PhoneFor plans information call (area inspector)
Directions to site
- Dr .^- to:/ / stt1
,Ifiry
tdwpc
l/ Planning
/-/ Publ ic-zForks
/tfrleuation /-/ n/a
l/ Address
/-/ Facil i ty Permi t
/_/ Envtronmental Heal th
CP& I
t,JPC
".+/"\JU U \ J /
-
set(s)
Da te
Req u i red
Hold Slipto PCCz *(5
Da te
Compl eted
Z -L7
Date to
PCC
FOR INFORI{ATION about progress of your appiication callc74-L7L Permit Control Center 687-HEL1 (
J
TO
FLOOD ?LAIN }'IANAGE}'IENT
Department of Environmental Management
L25 EasE 8th Avenue
Eugene, Oregon
687 -4357
PERMIT PROCESSING PERMIT NIN,IBER
PLANNING PARTITION NI]MBER
PUBLIC WORKS SUBDIVISION
OTHER
t,
APPLICANT' S NA},IE
SITE ADDRESS
tl
/na
4\r"F
Z L*UREL r
PERI"IIT VALUE IS SUBSTANTIAL IMPROVEMENT. YES NO
SITE IN FLOOD HAZARD AREA YES NO
SITE LOCATION IS WITHIN A FLOOD HAZARD APPROXI},IATE STUDY AREA, EXTRA
-PRECAUTIONS
},IAY BE APPROPRIATE TO ASSURE THAT THE BUILDING SI'iE WILLBE REASONABLY SAFE FROM FLOODING. MOBILE HOME TIE DOWNS REQUIRED.
-SITE
LOCATION IS WITHIN A FLOOD HAZARD DETAIL STUDY AREA.
1. MINIMIIM FIRST FLOOR ELEVATION OF
2. MINIMTTM FOUNDATION ELEVATION OF
(M.S.L.) REQUTRED.
(M.S.L.) REQUTRED.
3. MOBILE HOME TIE DOWNS REQUIRED IF GROUND ELEVATION THAT MOBILE
HOME WILL BE PLACED ON IS BELOW THE REQUIRED MINIMTIM FIRST
FLOOR ELEVATION.
SITE LOCATED WITHIN A DESIGNATED FLOOD WAY CHANNEL, BUILDING
-PROHIBITED.RECOMMENDATIONS :
E
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DATE 7 -,q -t90 v
c74-L89
BY
L,
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lane countY
HOLID SLIP
APPLICATION #
6ttt--.-7B?-
Name
Addres s/nq {rl
7 p ode
fh; above application is being held for the following reasons:
trEt
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rlcT ,1,87- il,
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Division
Si gnature
Te1 ephone
4/
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'- 4r%/
Date
This application will be held until _. If the information requiredabove has not been furnished by that-IaTelour -application wili be cancell'ed.
.paid for permits cancelled under these circumstances will be proratedthe work that has taken place as of the date of cancellation.
Building fees
according to
ENVIRONMENTAL MANAGEMENT DEPARTMENT
125 EAST 8TH AVENUE / EUGENE, OREGON 97401
)
form C74-L39
L EPARTIlENT OF ENVIRONi4EiITAL I'lANAGEI'1ENT
PSB, 125 EAST BTH AVENUE
EUGENE, OREGON 9740I Appl ication it
/-
f? n,.-?0)'
Job Address
Township, R1nge, Section, Tax Lot
Subdivision
Ci ty Snrinsfield.Assigned Numbers
dt o
ledrlw (;ra(Lot _ Block _
Appl ication for
Structures now on the property
Proposed use of property: // Residential / / Conmercial // Industrjal /l puUtic
Affidavit: I, -'- .- , hereby certify that this information is true and accurate
If this application is for an agricultural bu.ilding it will be used for purposes allowed by the State Building Code and
Lane County Code Chapter'10 (zoning) and for no other purpose. I have the following legal interest in the p ro pe rty
owner of record ; contract pu
to act for the owner
rchaser;I essee;holder of an exclusive option to purchas
dul y authorized who is lnowlEZgeabl e of-hTi- ppl i cati on .
! Signature/Address {0 6 C^,Acar4 U z1
Te l ephone or Da te
When permit is ready notify: /l Applicant /-/ Owner /_/ Contractor !y: /_/ mail :[/ pnone
PhoneOwne r z1
Con trac tor
Contractor's 0SR# 2qL2+
zi Phone
Plumbing by
If Commercial
Residential:
Code
# of stories
; of bedrooms
---
# of employees # of units
SDS:Existing, BP #
l/ Proposed, SI #
Unit
Cos t
/--L 73
SI test holes ready
Fee Sq. Ft. or
# of SitesDescri ption Valuation Fee
,
/-/ Casn
l_/ CnecX # '
Received by
l.later Supply
Proposed
---Year InstalIed
Total Val uati on: $
Plumbing fixtures at $
Sewer/water conn. at $
$
each
each
$
Su btota I
$
$
$
Existing --
4% State surcharge
PIans check fee
Ihaege-of4eeqarey
$vh '/$__-
TOTAL $2
PERMIT PR0CESSING Zone
Minimum setbacks, t , front
Part. #Parcel #Parcel Si ze
t, side u<i nt.rea r
Comments
To be typed on permit
By Da te
WATER POLLUTION CONTROL
Instal I atjon spec i fications ga1. tank;ft. of drainfield; max h of trenches
Da te
To be typed on it
e l ephone
Direction to +11t
rel'St. then rtAht +id.++
FO P'l ans to CP& I
I"/PC
set
set
Da te
Requi red
S
s
Hold Slip
to PCC
Da te
Conrpl eted
Da te to
PCC
CP& I
/ l,iPC
/ Planning
/ Publ ic Horks
/_/ Elevation /-/ n/a
/7 Address
/-/ Faci 1 i ty Permi t
/ / Env,ironmental Health
s,larupr/ '/lqnz,U aud-tfu/ Brub tq&r-
FOR INF0RiiATi0N about progress of your application call
re
Permit Control Center 687-HELP rc87-4357)
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.'B ADDRESS
POST THIS PERMIT ON MAIN BUILDING AT SITE
CONSTRUCTION PERMIT +
Subdivision:
Telephone:
Telephone:
Telephone:
t0-?82*80
7&f-?.[W
t{& l
t
TRS, TL:
This permit for the referenced property is hereby . . Setbacks and other conditions of approval must be strictly observed. Violation can
result in revocation of this permit, citation under provisions of Lane County's lnfraction Ordinance, and/or other remedies allowed by law.
Applicant/Add ress:
Owner/Address:
Contractor/Address:
Contractor's OS +
aonstruction approved by this permit
Water Supply:
Total Construction Value:
+* Bedrooms: # Plumbing Fixtures: # Employees:
PLANNING DIVISION Zoning: Partitioning # Parcel #
lVlinimum required structural setbacks, from: centerline of road, front:
side exterior: ; interior property lines: ;rear property line:
Special lnstructions:
n& Parcel Size:
{-ttcenterline of road,
7? pttfi,
ffl
For information call 687-4394,Srrtan
WATER POLLUTION
CONTROL DIVISION
Site lnspection + lnstallation specif ications:
lineal feet of drainf ield required; max. depth of trenches:
9peegi_]l$i!s!e$.
Septic Tank Drainfield
10'--lo-
10'10,
gal. min. septic tank capacity;
Setbacks
rteiior property Iines
cdge of road right-of-way
Building foundation "
Wells, other water sources
5', 10',50' 100' For information call E,q between 8:00 - 9:00 a.m., n;6
)
CONSTRUCTION
PERMITS/INSPECTION
DIVISION
Type of Construction: Group: Fire Zone:
lnstructions:
Use Classif ication:$m/aFr)
For plans information call
For inspections (see back of this
between 8:00 a.m. and 9:00 a.m., ruA
it) call 687-4065 between 8:00 a.m. and 5:00 m
lane countyDirections to Site:
Date lssued:
.955-13
6l!'--
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
By: It*ne Httlta/lky
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3Z
SITT INSPECTION
AppRoveo D Drsappnove, D
RrulRxs
Drre I NspectoR
FOUNDATION I NSPTCTION
AppRov eo
RE uaRx s
Dr sappnovro D Darr I ruseecron
FRAM I NG
AppnovEo
Rruanx s
I NSPECT I ON
D Drsrppnovro D Dorr_I NSPEcToR
LATH OR SHEETROCK
Ar pnov r o
Rrurnxs
I NSPECT I ON
Dr sappnoveo I Nsprcron
FINAL. INSPECTION
AP PRov E o
Rruanx s
DtsappRoveo Drr E I rusprcroR
CERTIFICATE OF OCCUPANCY
Reaov ro lssur
REMARx S
D Not Rrrov ro lssuE D Dorr-I NSPEcToR
D Dore-
LJ
FLOOD PLAIN MANAGEMENT
Department of Environmental Management
L25 East 8th Avenue
Eugene, Oregon
687 -4357
TO
PERMIT PROCESSING PERMIT NI]MBER
PLANNING PARTITION NI]MBER
PUBLIC WORKS SUBDIVISION
OTHER
'7
APPLICANT' S NA},{E
SITE ADDRESS Z A*RE L 5r/DQ
PERI'IIT VALUE IS SUBSTANTIAL IMPROVEMENT.
SITE IN FLOOD HAZARD AREA YES
YES ,f---- ttlO
NO t"/""
SITE LOCATION IS WITHIN A FLOOD HAZARD APPROXIMATE STUDY AREA, EXTRA
-PRECAUTToNS
I"IAY BE appnopnrATE ro as-sung IHAT-TH6'nurlor5c srrE I,ITLLBE REASONABLY SAFE FRoM FLooDrNG. MoBTLE HoME-fir DowNS REQSTRED.
-SITE
LOCATION IS WITHIN A FLOOD HAZARD DETAIL STUDY AREA.1. MINIMIIM FIRST FLOOR ELEVATION OF (M.S.L.) REQUIRED.2. MINIMIIM FOUNDATION ELEVATION OF
--(M.S.L.) REQUIRED.3. MOBILE HOME TIE DOWNS REQU_IR-EO
'T CNOUND ELEVATION THAT MOBILEHoME WrLL BE PLACED ON rs eglow run-nuqurRED MrNrMuM FrRSTFLOOR ELEVATION.
-SITE
LOCATED WITHIN A DESIGNATED FLOOD WAY CHANNEL, BUILDINGPROHIBITED.
RECOMMENDATIONS :
DATE
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LANE COUNTY PERMlT FOR PERI\4IT NO
CONSTRUCTION [ ] IVIOBILE HOIVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
CITY ZIP CODENAIVIEADDRESS PHONE
tr Contractor
NAN/ E ADD B ESS CITY ZIP CODE
Census Tract
PHONE
O.S. Reg. +
Twp--- Range-- Section Jnax Lot qzt q Code
Subd ivision Lot B lock Acreage
Access to Property (Road Name)
Width
Depth-
Existing Structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOTVIS)SO. FT VALUATION
SEWAGE D ISPOSAL PLUIVIBI NG INSTALLED BY
PUBLIC [ ] S EPTICTANKI] OTHER[]owNER [ ]OTHER [ ] NA
BUILD ING
PLU N4B ING
3% SURCHARGE
MOBILE HOIVIE...------
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t ]
EXISTING I ]
PUB LIC
COVITVIUNITY - NAME
PRIVATE WELL
OTHER-SPECIFY
CONSTRUCTION PERMITS & INSP ECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GALS IVI IN. DRAINF IELD_-LIN. FT MAX. TRENCH DEPTH- INCHES
STA Y 1OO' FROIVI ALL WELLS
TYPE OF CONSTRUCTION=-=- GROUP FIRE ZON USE CLASSIFF
SETBACKS FT. FROIVI CTR. OF rAV
FRONT SIDE EXT
FT. FROIVI PBOP. LINE
SIDE INT R EAR ZONE
ISSUANCE DATEAUTHORIZED SIGNATURES
BLDG. PERMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PLUMBING _ CANABY .
BUILDING _ GREEN
SANITATION _ GOLDENROD
IMPORTANT
POST THIS PERMIT ON MAIN BLDG. AT SITE
LANE COUNTY. DEPT, OF ENVIRONMENTAL MANAGEMENT
COUBTHOUSE ANNEX, 135 EAST 6Ih, EUGENE, OBEGON 97401
call 687-4065 to schedule all required construclion inspections. call 687-4061 to schedule all required
JJpiil".v"i"i inspeciions. err co-nJtirction shall comply with the Slate Buidling code, o E'Q standards
ioiiuOirrf"ce sdwage Oisposat "nO
tn" Stat" etrrUing Code. All buildings require a certificate of
occupancy belore being occupied.
(See Details on Reverse Side)
c55-l 3
lsl
( )' Bu,tD,Nc pERHtr AppL
( ) strE ,NspEcnoN
PLAilNttrlc 0tVtstoN
8u IL 0,t{G s,UATI ON
CO}II.{ENTS:
TION NO"7,or-7
Not
TAX
tr)
L
APPL
'CAI{TOATE
6.
LOT:sl-
CKID BY:
Setbacks
Front
Side
Setbacks f
Side
Rear
I . Iol ing Ord i nance Cornp t i ance:1, subdivision o.ain.ill'r;;;"
?. Required Access
?. Bu,ilding Site (Area, Width, F5. Other (see conrr,entsi ' - t" '
ecabA llof)()
()
()
()
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)Iatron--_
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rom int
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----
PLAN N ING 0tyts N mn 0M-
BU ILO IN G INS PECT ION D lv ts t0N
Plans Submitted
5oi I Stabil ity (footinss)
Flood Plain
0ther (see conrnents)
Not
Appl icable YesTTTfr()
()
()
Nor)()
()
()lil(")CKID BY:
COMMENTS:
ATER POLUTION CONTR0L Not
,,G/r. 't{eets Department of Envi ronmental
I Quat i ty Standards.
l. Other (see conments)
Appll gab,!e
(I
No Yesr) Gt
() ()()cK'0 BY,au&,-Azzt7DATE
,oll,lENTS:
TO PPLICANT:
w"1b
Your Bui lding / Site lnspection:
(u{ Can be approved.( ) Cannot be approved at this t
ul'COUNTY
th
ime as indicated on item N0.above.
Questlons and further informa tion on items I through 5 contact the
NG DIVISI Que stions and further information on it
LANE.
eilE7q,l 2 conta ct the LANE COU BUILDING
Your buildin ermi t licati
TAT ION D IV N
hrill be held in this office unt you can reso vet e problems cated.
ls being returned.
fe'goftiif'n
135 Sixth Avenue Eas t Eugene Oregon 97401
PHONE:597-4055
LANE COUNTY PLANN ING DlVlSl0N PH0NE: 587-4185
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t*n1!,LE
LANE COUNTY PERMIT FOR:
CONSTRUCTION [ ] IVIOBILE HOME [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
n Owner
NAIVlE ADD R ESS CITY ZIP CODE PHONE
tr Contractor
NAIVIE ADD R ESS CITY ZIP CODE
Census Tract
PHONE
O.S. Reg. +
Tw Range- Section Tax Lot Code
Subd ivision Lot
Access to Property (Road Name)
B lock Acreage Width
Depth
Existing structures on Property:
Directions to Property - Address
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL:
PUBLIC [ ] SEPTICTANK [ ] OTHER [ ]
PLUMBING INSTALLED BY:
OWNERT] OTHERTI NAM E
BUILD ING
3% SURCHARGE
TMOBILE HOTVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t I
EXISTING t ]
PUB LIC
COTVIIViUNITY . NAIVIE
PRIVATE WELL
OTHER.SPECIFY
CONSTRUCTION PEBMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
tVIIN. SEPTIC TANK CAPACITY
GALS.MIN. DRAINFIELD LIN. FT MAX. TRENCH DEPTH I NCH ES
STAY 1OO' FROIVI ALL WELLS
TYPE OF CONSTRUCTION G ROUP FIRE ZON USE CLASSIFF
SETBACKS FT. FROM CTR. OF r,/W
FRONT SIDE EXT
FT. FROM PROP. LINE:
SIDE INT.
-
REAR ZONE
AUTHOB IZED SIGNATURES
lsl
ISSUANCE DATE
BLDG. PERMIT - WHITE
OFFICE COPY _ WHITE
COUNTY TAX - PINK
PLU[4BING - CANABY
BUILDING - GBEEN
SANTTATION - GOLDENROD
IMPORTANT
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
Call 687-4065 to schedule all required construclion inspections. Call 687-4061 to schedule all required
septic system inspections. All construction shall comply with the State Buidling Code, D.E.Q. standards
for subsurface sewage disposal and the State Plumbing Code. All buildings require a certificate of
occupancy belore being occupied.
(See Details on Reverse Side)
PERIVIIT NO.
PLUIVIB ING
I
SITE INSPECTION
AppRovEo D DtsappRove, D
Reuanrs
Dare I ns pEcron
FOUNDATION INSPECTION
APPRovEo
Rruanxs
Dr sAPPRovEo Dar r I xspecron
FRAMING INSPECTION
Appnoveo D DrsrppRovEo D DarE
Reulnr s
I NsPEcroR
LATH OR SHEITROCK
Ap pnov r o
RruaRx s
I NSPECT I ON
Dr slppnovro I uspecton
rINAL INSPECTION
AppRov r o
Rruanxs
D Drsrpenoveo D Dar r I NSPEcToR
CERTIFICATE OF OCCUPANCY
Reaov ro lssur D Nor Rraov ro lssur D
RrnlRx s
Darr I NSPEcToR
D DorE-
pERMrr # ?)E-7 L
NOTE: NO PERMIT WILL ,d ISSUED UNTIL THIS APPLICA.TIO\ AS BEEN APPROVED
APPLICATION FOR:
CONSTRUCTION MOBILE }IOME PLAN REVIEW C}IAJ,IGE OF OCCUPANCY
OWNER F
ztp
CONTRACTOR
Name Address City ztp Phone
o.s. REG. /l
2-s"".1or, 6Tvp.
Subdlvlsion
ACCESS T0 PROPERfi (Road Name)
Property Location - Address/Dlrect.lons:
Tax Lot Code Census Tract
Lot al Bloc k-L-*properry Acreage W tdt\r3Oloepth-Ej
tilL
Existing Structures on Property:
for Offlce Use
Sq Ft ,foa
J
SEWAGE DISPOSAL
Slte Insp ection /l
WATER SUPPLY:
Well Spring
Exlstlng Sewage Dls
0ther
or New System Requlred
of Community or Public SYst
PLI]MBING:
Installed by Owner
PLIJMBING FEES
ll of.
Name1J,o eBlds.
Plunblng
3Z Surcharge
Waste Dlsp.
Plan Revlen
lloblle llone
Fi-xtures Sewage
Connectlon
Water
Connection
PLANS FURNISHED FACILIfi PERUIT
CASH YES
Slgnature of Appl
Fee Received
Drainfleld Requ ired - Lineal Feet
YES NO
TOTAL
Mln. Septlc Tank
3e;74;
-
Da
Maximum
Type of Construc tror -FM Flre Zone *f U".Classiflcatlo" Nla-}ja *f-l-a /
- from Center
Slde Int
of Road Rlght of
. ,, kue.
way:
Slde Exterior
da -/-+-,at-{t
c55-r2 I.ANE COI'NTY DEPAR OF E}WIRONMEN TAL },IANAGM{ENT
Zone f,l4
PIANNING:DATE:DATE:
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