HomeMy WebLinkAboutPermit Building 1979-03-059t#gfuir*tGZt)POST THIS PERMIT ON MAIN BUILDING AT SITE
UqB,PL
JOB ADDRESS
Applicant/Address:
Owner/Address:
Contractor/Address:
Contractor's OS +
Construction approved by this permit:
Water Supply:
CONSTRUCTION PERMIT +r
TRS, TL: Sugivision:
This permit for the refeYenced 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 lntraction Ordinance, and/or other remedie6 allowed by law.
Telephone:
Telephone:
Telephone:
Total Construction Value
+ Bedrooms + Plumbing Fixtures:+ Employees
PLANNING DIVISION Zoning: Partitioning + Parcel +
Minimum required structural setbacks, from: centerline of road, front:
side exterior: ; interior property lines: ;rear property line:
Special lnstructions:
For information call 687-4394,
WATER POLLUTION
CONTROL DIVISION
Site lnspection # lnstallation specifications:
lineal feet of drainfield required; max. depth of trenches
Special lnstructions:
gal. min. septic tank capacity;
Setbacks
I ntEiior property lines
Edge of road right-of-way
Building foundation
Wells, other water sources
Septic Tank
10'
10'
5',
50'
Drainf ield--10-
10'
10'
1 00'For information call between 8:00 - 9:00 a.m.,
CONSTRUCTION
PERMITS/INSPECTION
DIVISION
Type of Construction:
I nstructions:
Group Fire Zone
For plans information call between 8:00 a.m. and 9:00 a.m.,
For inspections (see back of this permit) call 687-4065 between 8:00 a.m. and 5:00 p.m
Directions to Site:
Date lssued:
c55-1 3
lane county
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SEBVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
By o
I
Parcel Size:
; centerline of road,
(
\
Use Classification:
i
7I
S ITE INSPECTION
APPRov E D
REua nx s
DI SAPPROVED Dare I Nspecton
TOUNDATION INSPECTION
APPRov E o
REMARK S
D r saepnoveo Dar e I Hspecton
FRAMI NG
APPRovEo
Reuanr s
I NSPECT I ON
D DrsappRove o e/Dare I NSPEcToR
LATH OR SHEETROCK I NSPECT I ON
Dr sappRoveo I xseectonAPPRov E D
REM ARK S
FINAL INSPECTION
APPRov E o
Reuaax s
DrsAPPRovEo Drr e I xspecron
CERTIF!CATE OF OCCUPANCY
Rceov ro lssuE D Nor Rerov ro lssuE
Reuanxs
Dare I Hspecron
D
D Dore-
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Vlclnlty Hap N
Job Locatloo
Permlt il
Permlt
Perult
)TRS,. TL
Lot
For Perntt #For
Pernlt #For
Pernlt t-ForPlcrt Plan For
For
Subdivision
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13-Mar-1990
AI,AN JONHSON
OR CURRENT OWNER3155 oRroLE
EUGENE, oR 97477_7586
RE: PERMTT #429-79
1LP_lIgANr/owNER: Ar,AN roNHsoNCONTRACTOR: A. ,fonnson -'
ADDRESS JOBSfTE: gf55 OrioLeDATE oF rSSUE: s trarch-iizgTypE oF pERMIT: n"=iJ"nliat accessory Building
This letter is.youR NOTrFrcATroN that the.above listed buildingpermit has extrli""a u"a-i= ,,...nuti--""a void...r, per oreg,onBuilding code s""ii."r,-s6j, f at tossscl .
section 30s rb) , osssc, states rrrt sha11^b" ifrg autr of the person*itg' :l".ffi ;i= :!Fiik:l= ;i":";:;ri:, ::,::tifl .
the bu i ia i,,! -- - -"
our records indicate that the rast activity on this project is inexcess of more than on" v"ar ago. The ';...iiiur"iTinl"tion andapproval 0f arl buildingi c stiuctui"=....,,^rgg.rired-prior to foroccupancy as required rf secti;;-;;;-i;), osssc.
Recentlyr €lD-agreement was made between- Lane county and the citiesof Eusene and Sprinsii"iJ-r"=,r:.tins in"tn"-'"=J#i;; l, .r, ,urbanIil:"3t:i:""?'3:""X16*rlll";;::iiiY"i""itv ;il;-;;;i, .= wel, as
ff your address is within the Urban Transition Area, dDy permit;:f]ffi:*:: '"=t re maae- to vour respecrive city r,,irai,q
When applying for a_ new pgTi:., you may brlng this letter, as arecords referral, along iritt the-"or"iir"tioi ao"rrrlit=, i.e.,prans, details, "!"., irra-.rry previo.r= do"rrents related to permit#+zg-zg to your city' ,r"irAi"g-d"p"ifi"it,.
Roger I'IcGuckin
Building official
cc: file
Springfield Building DePt'
/
LAND MANAGEMENT DIV.'PUBLIC WORKS DEP'' / 125 EAST STH AVENUE / EUGENE' OREGON 974O-I '
(5O3) 687-4061 / FAX # (5O3) 6S/'3947
(!!',l.tDrnrgo
FOR OFFICE USE ONLY
Two Copies of Plans
Three Copies of Plot Plans
Mech/Plumbingr Checklis t
Legal fnterest Document
!ef"r, Check fnfo Sheet
Applica
Permit
STRUCTURES CURR.ENTLY ON PROPERTY
^"*43 //,3 TAX LOT OUT OF
,PARCEL BLOCK
/
CITY ztPADDRNSS PROPOSED USE OE PROPERTY
XLReside-ntia1
f]commercial
I ndus tr ial
f r,-,uri.
I
wo oJ sJ-^c-
DECI,ARED S VALUE
OE- BEDROG{S -' I # OF STORIES3ll # OP EMPLoYEES
-
SUPP Proposed
xi s ting
TELEPHONE NUMBER
74?-L ^ \ 2TELEPHONE NL]MBER
PiR.!1
NAME
s(Or>
AND OSR
TELEPHoNE I'MMBER
SIGNATURE
C
f:rther F"iu:
I HAVE EXAMINEDCAREFULLY THE COMPLETED FORAPPLICATION PERM IT ce rti thatdoandhe reby fy all fomatIN on 1Shereon uetr correctand and th I
nterest INthe1egal thefollowing ofrtyprope record;con!ract rpurchase authorized wlagent evidencerh of authori attachetyce rti that and aI1fyany work fome dper fndone accordance therh Ordinance Laneof Cou theand Laws ofty the teSta o onOregrtai.ni theLo dework dscri-bepeng herein thatand NO OCCUPANCY bewill ofmade stxuctureany thoutwf th of thepemrssaon D.i on urBui ldingcetherrtithatrhwafyregis tration Builderthe fBoard forcefull eand ctffe AS oRs 70 055requiredby Ithat e thexempt forbasis xe npti on1SnotedheonreandthatonlymdsubcontractorswhoenployeesINarethcompliance055'loL wl be edUS on this ct I READHAVEprole ANDTHICHECKXDAPPI,ICATION THOROUGHLY
NAME (pLease
t>
Parce]' Size
rear
fl lr,oooplaru 'In flood hazard area?YEs, SEE ATTACHED SHEET.
Installation Record rssued? [ v"" I N"
Date:
l.rate:
ilul
No
#
,fr
tr SANITATION: s. I B. P. #
COI'j.I.1EI.ITS :
col"t\ENTs
READ THIS SECTION CAREFULLY
I pr,aunrllc/zoNrNG: zone
Minimurrr Setbacks, cL, front
Partition #
c", .id"
Parcel #
interior
Date:
Date:
caIlon
Tank Maximum Depth
of Trenches
InstaLlation
Specifications:
TOTAL VALUATION $
tE FeDescriptionSq.
e
k Fee
te Surcharge
DEQ Surcharge
TOTAL FEE
S
s
$
s
$$
,/
LANE COUNTY DEPABTMENT OF P UBLIC WORKS LAND MANAGEMEN
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
DATE
T DlvtstoN, 687_4061,
SEE REVERSE F'OR INSPECTION INFORMATION
7
(if 4pplicable))l Uao-e-I I )
ffi#?/',{:EIX,fi,L/.J
n
PLANS
COM.TlENTS
Lineal Feet
of Drainfield
. \"-:,. t I t
SETBACKS AND OTHER CONDITIONS OF APPROVAL.MUST BE STRICTLY OBSERVED.
CATION OF THIS PERMIT, CITATION UNDER PROVISIONS OI LANE COUNTY'S INF
REMEDIES ALLOWED BY LAW
vroLATroN cAN RESULT ru Rnvol
RACTION ORDINANCp,, AN,D,/OR .OTHER
WHEN READY FOR INSPECTIONi. CALL 68T:4065.
@N.---nE7E-EhETorof inspection, when it wiII be ready, your
: A, !,IINIMUM OF AT LEAST 2
loq^ri.hd .Information ready
name and phone number,
4 HOURS ADVANCE NOTICE ,FOR INSPEC-
r p"i.il-""*u'a., ' iobl address, type
and any specJ-al directions to site.
.. 1
BUILDING DIVISION
REQUIRED INSPECTIOT.IS :
2
il
L Foundation Inspection: To be made after trenches are excavated and forms erected and when aII
*ffirffi"dationaredeIiveredonthejob.Whereconcretefromacentra1mixing
plant (commonly termed "transit mixed") is to be used, materialP neep not be on tfre'job;,. ,. ".
concrete slab or under-Floor fnsPection: -llo be made after aII in-stab or under-floor building
#d#.fr...ip*#tffiiffi."."9s6ries,-.,9otheranciIIaryequiDmentitemsareinprace'but berore any concrete is poul;;:;-;i;;'-;;";tiii;s-r;;a"ii6a,'inttuhi''s the subrroor' i
Frbmihq\ &' Insulation ,Inbpect'ions: To be made'aftey' the roof ' a'!-I f5atninq' f ire blocRing' "and ':--bracing are l-n place and aII pl-pes, fireplaces, chj.mneys, and vents'are complete and alI rough'
electrical ano prumning are approvea. AiI wali insulalio.t and vapor barrier are..'in place'
Lath and/or Gypsum Board Inspection: To be made after aII Iathing and qvpsum board' interior
anE-exE-erior;;".i"tH"ffiuro'"anyp1asteringis"ppri.a..,6u.roi..sypsui{boatdjoints
and fasteners are taped and finished'
4
5. Final InsPe ction: To be made after the building is complete arfii 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 buildj-ng officiar'
such approvar shari u.-gir"" onr-y. after an inspection shal1 have been made of each successive step
in the construct1"" ir indicated-by each of the inspections required'
No.TE, AII building permits require inspections for the work authorized, such as but not limited to:
A. Block waII: To be made after reinforcing is in place, bY!-before any grout is.poured' This
Inspectlon is required for each bond beam pour. - There wilr be no approval untir the plumbing
and electrical i-rispections have been made and approved'
B. wood stove: To be made after compretion of masonry (if appricable) and when instal-lation is
Eomplete. rnstalration shalr be in accordance wit-h an appioved, nationalry recognlzed testing
ug.rray and the manufacturerts instalfation 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. Foot-inqs and piers to comply with state foundation requirements for mobile homes or as
recommended bY the manufacturer'
'\ 2. Mobire hcme minimum finish floor elevation sharl be certified when required by a frood-
plain mciagement letter '
3. Mobile home tiedowns, when required, and skirting shall be-installed and ready for inspec-
tion within at reast 30 days after occup-r"i.--rieaow.,s and skirting shalr be inst-arled
per enclosure-
D.SwimmingPool:BelowgradewhensteelisinpJ-aceandbeforeConcreteispoured.Abovegrade
wEen Poof--iFi nstalled'
APPRoVEDPLAI{SMUSTBEoNTHEJOBSITEATALLTIMESDURINGWoRKINGHoURS.THISPERMITWILLEXPIRE
rF woRK D.ES Nor BEGrN wrrHrN r8o DAys, oR fF woRK rs suspnuono oR ABAND.NED FoR M.RE THAN 180 DAYS'
suspENsroN oR REVocATToN nAy occuR ir inrs pERMTT was isiuuo oN THE BASrs oF TNCOMPLETE oR ERRoNEous
INFORMATION.
ANYONE PROCEEDING PAST TI{E POINT OT REQUIRED INSPECTIONS WILL DO SO AT THETR OWN RISK'
SUryIII4IE AND ALLIRNATIVE SEWAGE DISPOSAL SYSTEYS:
L Permits shall be effective for one year from the date of issuance'
2.Uponcompler-ingtheconstructionforwhichapermithasbeenissued,thepermitholdershallnorify the Lane County Depar;ent of Planning u;;-a"n*unity Development by submitting the
installatio,',-t".*a t;rm'- r#-o"piit"tent shiIl i'''tp""t th-e construction to determine if it
complies wi.ih the ruies containla'in this division.' rf the construction does comply with such
rules, the Department shalr i;;;;. certificate of satisfactory compretion to the permitihorder'
rf tlre constrr:ction does not comply with such tt''i"t, t1't o"p'rlment' sha11 notif y the permit
holcler anrt shail requrre .."iIil.toiy "o*pt"tior',-L"t"." issuing the certificate' Pailure to
meer rhe requi-rements f'r =";;;;;;t;ii ""*'p:'"tion within a reasonable time constitutes a vio-
ration "t oii asa-'oos to 454'745 and this rule'
Setbackq -,subsurfece Sewage Disposal
SeP'tic Tank
From: Interigr ProirertY Iines 19:
Edge of toua'qig'1.'t-of -waY I0 r
Buildinq foundalion 5 r
WeIIs, other watbf sources 50'
Drainfield
c t+-zs
10r
10r
10 !
100 |
bne counLy
ACTI .ITY INFORMATION JHEET 6l!l-\I7COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
I ')Atntl c. @LUg^t
N E
e
MAILING ADDRESS
-,2?:g
C ITY STATE ZIP CODE
747- 4772-
BUSINESS TETEPHONE_?HOMtrTEIEPHONEI-BUSINESS TELEPHONE # HOME TELEPHONE #
2. PROPERTY ADDRESS
( IF DIFFERENT TnO
3 rvtae B FAFTeEL NTJMBEEI
( REQUTRED INFoRMATI0N)
(from tax maps in Department of Assessment and Taxationor from tax statement)
*#* ## ##-3 /0@d MTAX LOT(S) OR PARCEL #
MINSE-IP MNGE SEETION M ZONING
MINSHTP MNCE SMTIO"N ffi ZON I NG
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP ACRES
4 SUBDIViSI0N ( if appl jcabte BLocK fL _
5 REQUEST (state exactly what you plan to do)
6 DIRECTI0NS T0 SITE G,r1^C Fn*.nn PD 70 ,-,lcqXz t) .A^AKA4LD TO
C{Zr c-
** FOR STAFF USE ONLY **
ZONE/LAND USE:
BY:
-
DATE:- TIME IN: OUT:
NUMBER
DATE
-{n
tJ-,
{t-
LAND MANAGEMENT DIVISION / 125 E. Bth AVE., EUGENE, OR 97401 / 687-4A61
MAITINGIDDRESS--
SPpc D _(X€ Q z4 zt
CITY STATE _ -7TP-TOM-
LOT II
tl
AF.F.I..IfiAi{T .JOHN,SON, A[-AN
Tr.-+ { 703??{ 310:t00 "sLJrrt}rvNE:I' NIDG TYFE U,ST. R
{ ll,J}'lf:. fi }.!l'iE:
f nnH AF F'1... Nn Afi'f I nll nH-(. f Fi:t F T.t tlN
I{ f:'
rJF'
f{f}
Ffi
BF,
t_At{r::iltlt.ltll'Y nF-Fl' til'lV 1461' F:H:[:E].f'T * ?0,]d'$3 DATt.
ANN'H :515:5 NR:TI.-H, "!F'ItINIF:IHI.,.D, I]RHGNN
1.fi'r
EDRr.l,S 0 UNrr,S 00r STUhrE,s +HL..DGS 001 FH0NH 747
ADr)rt
s'rl r-'T
{ I 0?fr:
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ftT}NNHCTOItS:
MF-CHANICAL FHF.
STATI: SURCHAITG[i
I.'I.. AN CHE:{:H FEF.
F'CK
1
15.00 E:ACH =
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lone countyflOLID SLIP fi!r-!-
AI'Pt ICATION #
I-OCAT I ON 7u,t:gfr
- NAME
ADDRESS
ZIP CODE
The above application is being held for the followinB reasons:
\,/ Asw l\,Q 3i- tu"toDt L ',-/ zW-*,x':'
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tlbwrry S:ZE a;r At*eg+t Eg*,n.D LvotL ftaf*pail - I
44ryff1 .1*4W WNq b"4 Lr4ypffiypa fiyg V"qEt tt?.> frl&t
Rf,te *aA @ c,t+tt,.t&1 Fe*,Du) YA+ -:;w<r ?1 I'ir-1ur*rrcr-,1 W Lp,Ar;, {d/L fu>t* f.P qtqg ft "reOU
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SI E
A V A ILABLE BY AP POINTMENT ONL Y (NO WALK-rrus)687-406 I
E U
Th'i s appl i cati on wi I I be hel d unti I
above has not been furnished by tha
If the information requiredate your appf i cation will be cancelled.
4ll
RETURN THIS SLIP I.{ITH THE ABOVE REQUESTED INFORMATION.
BUILDING & SANiTATION / PLANNING & COMMUNITY DEVELOPMENT DEPARTMENT
I 25 East 8th Avenue / Publ 'ic Serv j ce Bu j 1di ng / Eugene, 0regon 97401 / - (SO: )68l -r,.),,1,
'1
TI REF ORIZATION
NAME (PLEASE PRINT)TR L#z *24-r*
ADDRESS
RpplrcRrur (0WNER ( )
REAS ELL I IT APPL I CAT
SIGNATURE DATE
FEES PAID FOR HASTE 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
D
)
N)
(
%trU %
Iw%
J!.-w*5b
rAllfl) %Flood Plain Fee
Building Permit Fee
Mobile Honn Fee
Plumbing Permit Fee
Mechanical Fee
Plan Check Fee
State Surcharge Fee
Septic Disposal Fee
Site Inspection Fee
DEQ Surcharge
Land Use Application
Plannjng Director
Recording Fees
Pa rti ti ons
Copies & 0rdinances
Surveyors
Minus $25. for Processing Fee
TOTAL AMOUNT TO BE REFUNDED
DATE
24-17 -88/ Ac
$
$ - L/;
$
$
$
$
$
$
---n
/o
$
lo $
/o
$lo
$
$
$t.l)
$
$
S I GNATURE
TO DEPARTMENT OF E
Bui 'l di ng Permi t Ref und-
State Surcharge Refund
Septic Disposal RefundSite Inspection Refund
Land Use Applications
Planning Director
Recording Fees
Parti tions
Copies & Ordinances
Surveyors
TOTAL AMOUNT RE $
PLEASE MAKE CHECK PAYABLE TO:
NAME
-17 -BB/
17-t. 42133/P
ct.42134/P
42
42120/Prog
42124/Prog
. 060 Rece'i. %d Recei
. /c#xecei
L6o Recei. 660 Rece'i. boo Rece'i
Recei pt
pt#
p
pt#
pt#
7 / Acct.0 I
17 -88/21 060
060
060
010
Prog.Recei p
P p
p
4-17
24-17
5
74/Prog
1 9/Prog
44451 /Prog.
Recei p
Rece i p
ADDRESS
LAND MANAGEMENT DIVISI0N / Prrblic Works Dept. / 125 E. 8th Ave., Eug. 0R 97401 (503)687-4061
PERMTT nja/AXf
ol
lo_---q
b
Hf/
lt
POST THIS PERMIT ON MAIN BUILDING AT SITE
JOB AODRESS639 orlol.' Eutoc' (n. CoNSTRUCTION pEBMtT + t,'{.zg-tg
TRS, TL: l7-O3-22-l-3 lL l0r500 Subdivision: c.rblrd Vtll.t., 2!d .ddLt ll, ELcL 12
This p€rmit for the referenced property is hereby .gt tovqlo Setbrcks and other conditions of approval must be strictly observed. Violation can
result in revocation of this permit, citation under provisions of Lane County's lntraction Ordinance, and/or other remedie6 allowed by law.
Applicant/Address: Alan Johneoa, 639 Orlole, Eugene, OR 97401 *
Owner/Address: a&
Contractor/Address: na
Contractor's OS +r na Total Construction Value: $IO0O.OO
Construction approved by this permit Nev roof on garege and prt door oo.
Strructures rou on property: houee,
# Bedrooms:Water Supply: na
Telephone: 7474722
Telephone:
Telephone:
gAfageo
tre + Plumbing Fixtures DE + Employees:ne
PLANNING DIVISION Zoning: ''"Partitioning + Da Parcel +* na Parcel Size
; centerline of road,
na
Minimum required structural setbacks, from: centerline of road, front
side exterior: a ; interior property lines: na ;rear property line
Special lnstructions: nonc
DA
na
WATER POLLUTION
CONTROL DIVISION
For information call 687-4394,KeLler
Site lnspection +t na lation specif ications:
n8 lineal feet of drainfield required; max. depth of trenches
Special I nstructions:mne
Septic Tank
10'
10'
5',
50'
n.e gal. min. septic tank capacity;
DA
Setbacks-'teiiffiroperty lines
-rge of road right-of-way
Building foundation
Wells, other water sources
Drainfield-T0--
10'
10'
100'For information call between 8:00 - 9:00 a.m.,,ro
CONSTRUCTION
PE RMITS/INSPECTION
DIVISION
Type of Construction: 5il Group: R3 Fire Zone: 3
lnstructions See bacl of peruLt for requlred lnapectlon lnfor:nation.
Use Classification SFD/Gar reood
For plans information call 6gl-3?61 between 8:00 a.m. and 9:00 a.m., Jtn LnbFor inspections (see back of this permit) call 687-4065 between 8:00 a.m. and-5:00-prn-.
hne countyDirections to Site:
Date lssued: 03-05-79
c55- 1 3
Fron Belt Llne turn south oato Garrefatlo l{est on Mallard, north on Orlole"
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE / PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
0!'
-
BY: Haae Etrltn/Uf
fiE
Rccelpt I
,lob Address
Tornshlp. Rangc, Sectlon, Tat Lot -_
Subdlvlslon
App) ication for
Structures now on the property
loroporrd ucc of property: M
3
Rartdtntl!'l 17 Coonrcrchl
DEPARTTIENT OF ENVIRONI.'IENTAL ITANAGEMENT
PS8, l?5 tAST STll AVINI't
EUGENE, OREGON 9740I
Ci ty
Lot
Arrlgrcd !$cn
8l ock L
ndustrlr /-/ hrblfa
{ll:!cv]-!t, 6YAvJ -:tr>t/ rw-<r)4
I f thi s app'l ication i
Lane County Code Chap
owner of reco---duly authori z
s for an
, hereby certify that thls informatlon is true and accurate.
l-pEase prmTI-
agricultural building it will be used for purposes allowed by the State Bulldl ng Code and
property:
to purchase;
ter l0 (ing) and for no other purpose. I have the following legal-interest in therd;t purchaser;I essee ;holder of an excluslve opti on
ac who is Inowi edSeaul e of-TfiI!-ffi I ication.r
5 l gna ture/Address
Tel e
Nhen permit is ready noti
i,rner
Con trac tor
Contractor's 0SRl Ll-A,
2- or Date
licant /-/ Orner l7 Contractor !a: {rafl /-/ pnone
z1 Phone
Phone
Pl umb'lng by
If Conmercial: , of itorlcs
Resldential: f of bedroom
SI test holes ready
Fcc
Lot e.
# of employees _ I of unltr
.4.SOS:Exlsting, BP #
LJ Proposed, 5l t _
thlr .
Oescrl ptlcn
0+t/
Sq, Ft. orI of Sttcl Valuation Fee
/-
$
Total Valuatlon:
Plumbtng flxturer at
Sarer/xatcr conn. at
4X State surcharge
Plans check fee
Change of Occupancy
$$
z!(casrr
1t Cncct t
$
$
Su lbtota'l
TOTAL
each $
each $
Recei ved
$
t
g
/d,rct
PERMIT PROCESSING
Minimum setbacks:
Connrents
To be typed on it
CP&l Ty pe.sLl
To be typed on permit
E> Fire Zone 5
Parcel #_ Parcel 5i
i nt.
Date
Use Classification
Zone
t, front
Part, rl
t, sro rea r
By
Group rur4o?
By
Ior plans jnformation c
Di s to site
a ins tor
l_ / stF0
f ceu
/l / iJPc
Plans to: CP&l set(s)
I'IPC
-
set(s)
Da te
Requ i red
Hold Sl ipto PCC
Date toDate*Y'2202 )'j>E
/7 Planning
/-/ Public llorks
/ / Elevation /-l nla
I Address
f / F acil l ty Permi t
/7 Environmental Health
(q1
z-Da te
Phone
C74-L7 L
L{..,WilA
I
Job Locatlon (Add
Pertrlt ,l
Pernl Ell
Permi t. lt
TLTRS,For Permlt /l
Permlt
Pennit
For
Plot Plan For For
For For
Subdivision
Lot Block I 7
a
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i#
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33
t
c74 - 150
Vlcintty Map N
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