HomeMy WebLinkAboutPermit Building 1981-05-08ul
COIUPLETE THIS
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CONSTT )TION/PLACEMENl
PERM IT
PLEASE USE BLACK INK AND PRINT.
FOR OFFICE USE ONLY
Applicat
Permit
I Two Copics of Plans
f]rwo Copies oi Plot Prans
fl t,techanical Checklist
fl etrrlrf i.,q Chec)-.list
fletan Check Info Sheet
zftesident:-al Irndustrial
I commercial Irul:-ic
P
v
#oF WATER SUPPLY roposed
sting
TELEPHOiIE NUMBER
,4a-Fg,*#//
I IIAVE CAREFULLY EXA.I4INED THE COMPLETED APPLICATION EOR PERMIT, and do hcrcby,;r:rtifr' that aIl infcrmatior herccn i:; truc and corrc.t ind I fi)rthcr
certify that any and all work perforred shal.l be done in accordance with the ordiranccs of Lane Courlty and t))e l-ans of thc stirrc of ot.-)tt1i I,,:rtnjrrin,l
to the work described herein, and that NO OCCUPANCY will be made of any structure uithout the permission of the Buildirtg Divislon. f furl-her c(rtify
that registration with the Builder's Board is in full force and effect as required by ORs 701.055, that if exc-mpt the basis for exemption is not.rd
hereon, and lhat on.l-y subcontractors and employees who are j.n compliance with oRs 701.055 will be used on this project. I HAVE READ AI'ID CIIECf-ED ?HIg
APPLICATION THOROUGHLY.
fl o*,..t
DATi ! ager,t
I
IGNATURI
S:g^tt tsfto""'*-.'
NA.ME (pfease
PLANNING ZONING:
al.linimum Sctbacks r L1, front
Comments:
Partition # Parcel *
' r, ., o" 4fr- rn,.", ro, /S'
Parcel *//2k fu
,".r2Ol
fl ff,OOOpf,afnl rn ft-ood hazard ur".: fillo I ves, see atrached sheer
Date:
Date:
Date:fl nuner, AppRESSTNG:GRID COORDINATE Nil,. ,. r 376 2 rnstallatiori Record rssiucd? fl v.= f no
E
SATiITATION:S. I. #
Insrallation
Specificatj-ons:
GaI Ion
Tank
Li-neal Feet
of Drainfietd
Maxlmm Depth
of I'rerrches
Coments
PLANS EXAMINATION: rype
Comments:
Date:
Group Use
Date:
CONSTRUCTION AUTHORIZED BY THfS PERMIT
f ixed Fee,/
Unit Cost
Floodplain Fee
Sq. Ft.Subsurface Fees
Building Fee
Sewer/Storm Drain,/Water
-----,1--e g Fixtures
By:
ion
$
c
$
s
$
)
$
(
$
40
C
DATE
trDBY
ON
LANE C
cl4-L94
,AR'
BY
ENVI
ME
Date
E, EUGENE, OREGON 9740I
ZIP
T
tr
sETBAcKS AND.oTHER coNDITIoNS 0F AppRovAL r4ufigg srRIcrly oBSERVED. vIoLATI0N cAN RESUL.T-IN REVocATIoN oF THrs pERl.tI',,
cf\nTto.r UNDER pRovISIoNs 0F LANE couNTy's INFRAcTToN oRDINANcE, AND/oR orHER REMEDIEs ALLowED By LAt,t.\. ..'
t,lHEN READY FoR INSPECTIoN CALL 687-4065. A MINTMUM 0F AT LEAST 24 HoUR ADVANCE NoTICE FoR INSPECTIoN REQUEST MUST BEGMN. Have the following information ready: Permit number, job address, type of inspection, when it wi] l be ready,your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIRED IIISPECTIONS
r)FOUNDATION INSPECTION To be made after trenches are excavated and forms erected and when all mate-rials for the fQundation,. Where concrete from a central mixing plant (commonly termed "transit mixed") is to be used,are delivered on the
materials need not be on the Job.
?) C0NQBETE SLAB OR UNDER-FL0OR INSPECTI0N: To be made after all in-slab or under-cillary equipment items are in place butor floor sheathing instalIed, including the subfloor.
3) FB4MING &- IrySULAJI0N INSPECTIoNS: To be made after the roof, all framing, fire blocking and bracing are in place andall_pipes, fireplaces and chimneys and vents are complete and alI rough electrical and plumbing are-approved. A'l'lwa1l insulation and vapor barrier are in p1ace.
4) LATH.Ary'D/0R GYPS9M BOARD INSPECTI0N: To be made after al1 lathing and gypsum board, interior and exterior, is in placebut before any plastering is applied or before gypsum board joints and fasteners are taped and finished
5)FINAL INSPECTION To be made after the building is complete and before occupancy.
APPR0VAL REQUIRED. No work shall be done on any part of the building or structure beyond the point indicated in eachsuccessive inspection without first obtaining the approval of the building official. Such approval shall be given onlyafter an inspection shall have been made of each successive step in the construction as inditited by each of itre inspeitions
requi red.
NOTE: A1l building permits require inspections for the work authorized, such as but not limited to:
A. BLOCK WALL: To be made after reinforcing is in place, but before any grout is poured. This inspection lsrequired for each.bond beam pour. There will be no approval until the plumbing'and electrical inspections
have been made and approved.
B. t,l00D ST0VE: To be made after completion of masonry (if applicable) and when installation is qomolete.
Installation shall be in accordance with an approved nationally recognized testrng agency and the manu-
facturer's instal lation instructions.
C. -trl0BILE HOME: An inspection is required after.the mobile home is connected to an approved.sewer orsgptic
system for: setback requirements, blocking, footing connection, tiedowns, skirting, and plumbing
connecti ons.
(f) Footings and piers to comply with State foundation requ'irements for mobile homes or as recomended
by the manufacturer.(2) nt'lobite home minimum finish floor el'evation shall be certified when required by a floodplain
dranagement letter.(3) Mobile home tiedowns, when required, and skirting sha'll be instal'led and ready forinspection.within at least 30 days after occupancy. Tiedo,vns and skirting sha1l be insta'lled per enc'losure.
D. SWIMMING P00L: Below grade when steel is in place and befotre concrete is poured. Above grade when pool
is instaljed. ,y'
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING hIORKING HOURS. THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN
}IITHIN I8O DAYS, OR IF I.IORK IS SUSPENDED OR ABANDONED FOR MORE THAN ]8O DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF IHIS
PERMIT l.lAS ISSUED 0N THE BASIS 0F INCoMPLETE 0R E&R0NEoUS INF0RMATIoN. .t.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS I,JILL DO SO AT HIS OI,IN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
(I) Permits shall be effective for one year from the date of issuance.
(2) Upon completing the construction for which a permit has been issued the permit holder shal'l notify thei i Department by submitting the installation record form. The Department shall inspect the construction tq
determine if it complies with the rules contained in this division. If the cohstruction does comply vrith .t
such ru1es, the Departnent shall issue a certificate of satisfactory completion to the pennit holder. If thel -
construction does not comply with such rules, the Department shall notify the permit holder and shall require
satisfactory completion before issuing the certificate. Failure to meet the requirements for satisfactory
completion within a reasonable time constitutes a violation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface Sewaqe Disposal
From Interior prriperty lines
Edge of road right-of-way
Building foundation
l.lells, other water sources
Seotic Tank Drainfield
-T0r-- -To-r--
floor building service equipment,
before any concrete i s poured
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5'
50'
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TRS, TL Job Locatlon (Add
Pertrlt ,l
Permit
Perni-t
For Permlt #
Perml tlt
Permlt
ForPlot lrlan For For
For For
Subdivision
Lot Block
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APPL]CAII(]N Ii I(.-Br
LOCAT I (jN ';
1 I 0rro 5pn u,re r le rD
Cnr rc BarrlEsoru NAI'1t
ADDRIS S
Sr'it r Hcr rrLD 0n )1
The above app'lication is being held for thr:
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Rr: FtnaneeLAss RooFlr,lG FoR Ho'r rurj:
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**SECOND NOTITICATION OF SECOND HOLD SLIP**
o7-o8-81 oR pERMtT sHALL BE DENTED.
ilLrr,: Ir,r 1.. l,]c0UCr.. ir,r
iluildjnrt ft:es priil ['or 1.rn"rli Ls
accorCing to 1-he itork tllat ha:;
c) srllr('i"t.rr rtji'r rr',rr(.) rili:. {''l:r',lli'i).
{:'Lf,r.sI AD\/rsI Tr'tls, orf i1:I- i "i !:]',ri'.r ','f'lr" r:;lrt..:. ..,::,,i.,,rr .r,.
(,1-i'riIit :jOt_(,] lO:l'ri_\1, t.;,],t 1 t;,) i,,,
3) []i-,ovr,:: 2) T!,'(i :it..'r's c[' ct)r'ra:r-irrf-r.:,:; li i,i.i .. ir. : ', ,' \r;,'.]r.::, i.1!r ,,,,. 1,lali r'r)
Il{ccfil}ctiAT[: INT'cr \',()ut:l t,j:i0,itcl.
PROV IDE REQUESTED I NFCItl'4AT ION BY
OFI.ICI HOURS r i..lt;
'lltis appf icat.it-lrr rvill irr irold urrl.jl li i_ir
above has nr:t i:,r:eri frirni s;liecl iry ilrat 'cl,rt_b' :yirlr a1,;,1 rr-_,r1 j,.r
i: i ir I (,i'lii,l l. i orr t'.:r1u i rr:d
rr r.ri I I brt r,aircel li:d.
canCe I lctl urrrlr:r' t-lrr,t:; ct c ii^cllrirs 1-;rrir:r::; r.i il I l.rr: l;rr_rra ti:iltaken place as o[ 't.lrc riil_r... ril- r].rrrcr.., ll.rlirirr.
BUILDING &
'125 I:ast tlth Avenue / P
SANlTATI0ll i t",NViR0l'lMf i,lTAl- f,lAl,lAGi:1,1[l,it Lri:p,A,tiTl'i[iJT
uir'i ir: Sr:rvice [Ju"ilrJirrq / i:uqr,:nr:, 0r'eqoti 97ti0l / ( f{]3)rJa7-40b1
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n
?111 Orro
)
lane co,rnty
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APPL ] CAI I ()N iI
LOCAT i t)N
'
1 71
, '.j :.- ti
Cirn le Bl'rr I e sor'i
?171 TO
NAMi
ADDRIS 5
The above app'licartion is being held for thr: fol loirinq rcas0n:j:
Rr: F tnetr[G Li\55 Rc.()i.- ir,:ri Foii H(r] t'(.ri, I
S trtc; ()Lr;i C(rt,t\tfi :,r;Ttfii; ,:-t; :,.i/'. :1
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r re Lo o
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Sot.te ruRTr-i firi cL.,.,ii ti: !t;.'i lc,it l. t:[1.-t')i:-n ii,'r,..i1.,,, l':]l i
1 ) ts Tl.tI sl.iIl-1[i?'t'rll,f*$']'.dt;ntl]t' e1r, r,i'ii,.cllf1)
?:) llrao noor,i Rr.(ru tREl.1 [ril s /r,riI I rl rr] r! l i r:; l'l-re H tcit"{(:sr l"o ll,]T sr-i 0\./i.1 or.l \'0lr: i:t.,.tlf t:, i'-,,/ \
f '0 /.T l'liI i-'('] Illi' 'iVI.l f nI T[i [ ,1-r.!1, !:- i_i]'ii;i.::l',,
n) Fia t:r r'frti r?oor -r() \,ii :i:rr ir 'llr':ii'
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PLE,qs[ ,a,gr1, l:;i-' Tt.i l:i ti1. 1. ril] ;i:r 'i1.'r \ ;:.i r ' ,-:lr::. :..,iti .,i- ,,., ',i:- !..-it ,./:.r :i,
0'i'l"iflri l:jOt-l,l'lO;,j i'OLj ti.\Y ' Iti i,) tr':,-.
i l{cOiti,0i'iATi: I t,ll'ct )'cuit Il,i.io,JIc'1""
c) S tltK 'l'!t[ 1ui.r 1!jro ] itt. ,,i:r':r.:;'i),
PROV IDE REQUESTTD I NFORI\4AT ION BY*TSECOND NOT ICATION OT SECOND HOLD SLIP**
o7-o8-8r oR pERMtT SHALL BE DENtED.
iioi,: Ir;l l_. i.i;i]uCr.. i i:
S I GI'lATUR[:
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OFI.ICI I.IOURS
BUIt.ljiNG & SANITATION
125 [asL t]th Avenue / Publ ir: Sorvjcc
I itr,til
i iliV I Rfll'li4t ill Al l'1ANAGIi"lIl'i f I]i: PitilTl4l- ll'i
BuilrJirrq / i:urtr,:r-ir,., 0r.Cr1oI 9740-l,/ i5rl:i)t,ll l-'1i()5'l
-lit1sapp1-icat.i0n\villl:ilitoldLrrt1.jl
abOve has not l:)(ren furnislreci hy tlrat,'r:l;r1-ir'vl,ri: ap1,l ir.,r j ir;rr i,rill irr: rtani rrl lr,:rj.
Bu'ildirrq fees paid for llelt^ttti Ls cance'l lcii undr:r' t-irr::;c c ilcrrirts l.arrcl:; \,,iil I [r,-. l;r0riitr:,,iacc0rrling to'[.he tlorlt t.lrat has taken p1,rco as of tltLr r1,tt.c gf r-,rrr,.-rllal-ic;n.
lana ccunty
APPLICATION #
L0CATI0N 'r 7l
r-c s8lt-Br
0rro SpR rrucr tEEo
Cnn rc Bntr lrsoru NAMT
ADDRESS2111 Orro
.-9_Ln r.!S.i:Elq, onecon 97\77
ZlT, ToDf
The above application is being held for the fol'lowing reasons:
Re: FrnoRecLASs RooF tNc FoR Hor rrlc:
S tNcr ouR coNvERsAT roN or 5-26-8,t , t HAvt BEEN ^Br-E ro GEr Ar.r op rN roN rulAT
THE LATH ENCLOSEO TUB SIIELTER iS NO CONSIDERED ANDENCLCSED STI?UCTURE ANO
THE FTBRfGLASS BOOFING MAY BE IJSED TOR TIIE COI,IPLETI SURTACE.
SoltE TURTHBR ct-ARltitcATloN ts uEEDED xo'yrEVER:
I ) ls rnE sHELTER 'FREE-srlt'lDrtlc' oR ATtAcfr ED To 'niE i,rA ul 3rriucruRE oN Tr,rE pRopERry.
2) llElo noou REeutREhIENTS ARE .A r.,r rri.1 (Jr.r or J' 6" rclr rrJI spAcE r-,nDIi( Tr.{E pooF.
E HtcHEsr potNT sHowN oN t'0rJri pLAhr s rs /'10". CEnTr, rur-y rltERE ts LESS THAN
5" et THE PoINT wl{ERE THE -lUf:i rs ENTErii:o. THEnE /li?E Tt-ritEE opTtoNS:
l) Rn rsE THE RooF 'ro !r/rEf?E TriE:?E ts lt5tt r.BovE .orNT oF ENTRy ro.}.I{E TUB.
s) Re lrovr rHE RooF cr)vER rr'JG.
Tu
1',
c)SII.{K THE TUB II'ITO T}IE GROI'I.ID.
3)
PugnsE ADVTsE THrs 0rFrcE As ro \./rAT y0r,F: ctrorsi: r!4r.y BE oR \trHAr
oTHtR SOLUT lOll YOU r"ti.Y '',r SlJ TO r-rSE.
Pnov toe 2) T\,/o sETS oF cor.rsrRrrcr rcrl oETA rLs oF Ar.iy cnAi{GEs you MAy \./rsr{ To
INCORPOTTATE I NTO YOUR PRO"' E CT.
Rocen L. McGrJCxrru a5-27-81
S iGNATURE
PERMTT No. vHEN LEAVTNc I}iTORF{AT ION OilIiEQUEST ING AN,
DATE
.UOE ELDG.
r"r I NT}.IE N'l-.687-\o6t
PHON I
This appl icatlon wi I I be held until
above has not been furnished by tha
Build'inq fees pa'id for pernrjts
according to the work that has
If the information required
cat'ion w'il I be cancel I ed.
cancelled under these circumstances will be proratecl
taken place as of the date of cance'llation.
,]
t date your appl i
BUILDING & SANITATION / ENVIRONMTNTAL MANAGEMENT DEPARTMTNT
l25 East tlth Avenue / Public Servjce Building / Eugene,Or'eqon 9740.l / (503)687-4061
OFFICE HOURS
lane countY
HOLID SLIP
APPLICATION #Lalft-_O!_
LOCAT I ON
6l!r _--7
(eUYt'e"
!q'l
\wlap
NAME
.
ADDRESS
E
The above application is being held for the following reasons:
FI W wy'* Wf ylry.pynq*i iro,o q p teealper*o' Vfrd$4.o*r,. @ qZ#
t VM!pp, frJ\.oug ae Uwf? ye U* t frv
treqau-(o fOffilV-q,fr4o?1\+e#*' & 70 q,F[' ltr.+<tra.eb t
@11P9 aqzqt2)wTav(s)
W,Et,? LbEg kb +Ltt-llE4,
ttw.t"l v ew FcAt^t\Luwatcu be Fp lEa*uo At*u tt)z?-e
v rtau,-t, c/J(r\Y4v\h AGE fu4EO 4 lJ$ll.@.
cu*tq WHaT Z,t@fuz b,@ Ux>*- Ttle.'HrTT-lB'
W1 1ae- +t"&> o7 liAc AUqy ne,,WTRE
171€ @uqgb. A-JW, NE A(We^>'f4 3u q E-Fhe\\Ztta-,,*cenla*fl Vqn-ne fr&4tt*> Ta tzXrtFlv1 bf 1^€fe*- +wtu1
To *tfllq \*A64prcr'rrJ'
+ lF a,*t,q1Td- aWWW e ?-,* M)$at.lr.v r\rF4,",r,r^rF a\)/ t^r_1u-tp-
?.L,h4,ruu ?zt-v1
S IGNATURE DATE
bbf:{det- PHONE
held unti I G.ll-81 If the information requiredshed by that-Gtelouffiplication wilt be cancelled.
ermits cancelled under these circumstances will be proratedat has taken place as of the date of cancellation.
OFFICE HOURS
This appl ication wi I I
above has not been fur
Building fees paid for
according to the work t
be
ni
p
h
BUTLDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMTNT'125 East 8th Avenue / Public Servjce Building / Eugene, 0regon 97401 I (503)687-4061
-x
,)(,
lc 98[-8r
0rro Spn r ucr r gED
lane countyil
HOLID SLIP
APPLICATION #
L0CATI0N 2l 7l
Cnl re Brrruesor NAME
ADDRESS?171 0rro
I NGF LD On ON Ir
E
The above application is being held for the following reasons:
Re : F rnaREc LAss RooF txo FoR llor ruB:
Strcr ouR cot{vERsATroil oF 5-?6-81, I xlvE BEEN ABLE ro cEr A}r oplNroN'rHAr
TXE LATH ENCLOSEO TUB SHELTER IS XOT CONSIDEREO ANDENCLOSED STRUCTURE ANO
THE FIIREGLASS AOOFINO }IAY BE USED FOR THE COHPLETE SURFACE.
Sour runrH!R cLAR tF tcAT lol't rs f,lEEDEo r{oyEvER:
I) ls rxe 9HELTER trREE-stlt{orxc'oR ATTAcHED To rHE MAi}r srRUcruRE oN THE pRopEnTy.
2l HElo Roox REauTREMENTs ARE a MrNrMurl oF ?'5" ron rHE spacE uNDER rHE RiioF.
Tne nrcHEsr por{T sxouu or{ youR pLANs rs J'lott. C:nratNLy IHERE ts LEss rHAN
lt6t'lr rHE por!{T vHERE THE ruB rs ErarERED. Txene rRE TI{REE oprroNsi
l) Rlrse rHE RooF ro wHERE THERE rs l'5n ABovE Fom{T oF EHTRv ro
THE TUB.
e) Rguove rHE RooF covER rx6.
c)SINK THE TUB INTO THE GROUND.
Puelsg ADvrsc rxrs oFFrcE Ag ro yHAT youR ororrE rlAy BE oR r{HAr
OT}IER gOLUTION YOU I,IAY UTISH TO USE.
3) Provror 2) TUo gETs oF coxsrRucrroN oETATLS oF ANy ctrAncEs you rlAy vrsH To
IHCORFORATE IilTO YOUR PROJECT.
*EvEnv EFFoRT To ALLou, TrxE To AcHtEvE coxpLlANCE HAs BEEN ltAoE. PnovrDE REeutRfD rr{FoRrro N
BY JuuY 21r1981 OR PERtllT APPLICATION WILL BE DENIED wlTH NO FURTIIER EXTENSION.
- \_JC
S IGNATURE
OFFICE HOURS
-1:9DATE
-Br
lrcluor BLDc.
APPO I IITMENT.
AN,
PH(]NE
This application will be held until I ,. : i If the information required
above has not been furnished by that-datEl6uF application will be cancell'ed.
Building fees paid for permits cancelled under these circumstances will be prorated
according to the work that has taken place as of the date of cancellation.
BUILDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMENT
125 East Bth Avenue / Public Servjce Building / Eugene, 0regon 97401 / (503)687-4061
APPLICAT]ON # --.!$-9$!:q!
L0CATi 0N ?.i11 Crrro Spn I r;.,- r rrD
al3arrltsou NAi4I.
AODRES J
LO 0nEcor*l+
The
R
bei ng hel d for the fol l orr,ri ng rcas0n:i
E: FtnsnEeLAss RooFt,.,tG FoR Hor ru[",;
S ttucr oun cot'tvt8sAT ror( o{: 5-26-.[il , I Hnv[ BIrin rri'n i: ro c; II rn r.:p ri,r rofr rir,riT
T,'t[ LATl"l []ICLOSED 1'UE Sl-lE{-Tfili l, l'J0f COIlli l{-r[r?[i] ;r.ti!i;f i,JCl,nri:n :iiit!.rii-Liitii :rr{i)'rltf IrtEReGLr':'3 EOC'rrNG t'lA\'8C UttD F(-1n fr,i- cr:ii'1":il.5lji]i:!.at"
Souf runrli En f,[-/,R tr rcAT tor,j l:, fiEEDID ri()u[vi::l i
1) ls rilt sl'i ELTER 'FRCE*$TAl,:DttlG' oR A'lTicltilD To -ii1: t.1.:. i:t :;r.. lr.-i-ii::: i: r'r)i t'ti ,:. :1 ;:l.ii2:ri |i,
2\ l{Eao noopr REeulRE}.itt',i'ts /rtiE A ririrl.r ui t tr- l ' 6" i'i); 1r,it -i':,".f.,: l,rrr'r-,: ,':ir: .-i)i:.,
THe HrGtlESI' polt'ir gr-io\'ii.l oil \'olFi rt-,r.ir3 tl 'i ''l i)''" llt,t'r.. ir:'.i' .'rrt,'.ir l.r i.!:: lt; iii.;l
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II.$CORPOTTATE INI'O YOUR PROJECT.
SL I P** PROV I DE REQUESTED INFORMATION BY
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S I GNAIURE
tJDE BLDG" PERMlT NO. !./i.i Ct,t t.[A\ril..Ic ttiFOnIlA't'Itil i\i:;ii- l!'r::'i ti'(:, i:i;
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E HOURS
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This applicat.jon lvill be held until L,:. i];_] - If the 'information requireclabove has not L,een furn'ished by that-dat'c ltiur appl ication rvil I 5c cancel lerl.
Building fees paid for pernrits cancellecl uncier these circumstarrces r,.,'ill be nrorateclaccording to the rvork tiiat has taken pl ace as of thr: r1,t te of carrr-L.l'l,rt j on
BUiI.DING
i25 [ast 8th Avenue /
& SANIIATI0N / [NVIR0NM[NTAI f'1ANAGIl'1[i'iI Lri:PAI1TMIi\i
Puirlic Service Bui lrJino / Euqcne, 0reqon 9740.l / 1503)Gill-406'l
lone county
2111 Orro
PERMIT SHALL BE DENIED.
lane county
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APPLICATION #
LOCATION
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ADDRESS
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The above app'licatjon js being held for the following reasons:
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DATE
OMTE-HOuRS
Th'is application will be held until
PHONE
b- ti-rt If the jnformat'ion required
above has not been furni shed by that date your application will be cancelled.
Buildinq fees paid for permits cancelled under these circumstances w'ill be prorated
according to the work that has taken place as of the date of cancellation.
BUILDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMENT
125 East Bth Avenue / Public Service Building / Eugene, 0regon 97401 I (503)687-4061
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APPLICATION #
LOCAT I ON
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NAME
ADDRESS
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The above application is being held for the following reasons:
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rEvEnv ETFoRT To ALLow rrl,rE To AcHrEvE coMpLrANcE HAs BEEN MADE. PnovrDE REeutREo rNFoRtrrD N
By Jut-v 21 ,1981 oR pERl.r rT AppL rcAT roN w rLL BE DEN IED w rrH No ruRTlrER ExrENs loN,
-1:9DATE
CLUOE 8LOG.
PO ! NTMENT.
S IGNATURE
)f .ti ,i.:. ,t'
OFFICE HOURS -?EOtrE
This application will be held until --. If the .information requiredabove has not been furnjshed by that-Z-atir Vour applicat'ion will be cancelled.
Building fees paid for permits cancelled under these circumstances wjll be proratedaccording to the work that has taken place as of the date of cancellation.
BUILDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMTNT
125 East 8th Avenue / Public Serv'ice Building / Eugene, 0regon 97401 / (503)687-4061
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CANCELLATION/REFUND AUTHORI"-'ION PER}4IT #,TZfu
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NAME (PLEASE PRINT)
ADDRESS
APPLTCANT() 0|^INER() c (
REASON FOR CANC IN P T
SI DATE ,"*6 - F,z
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 AND
PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT PROCESSED.
AUTHORIZATION FOR POSSIBLE REFUND:% BUILDING PERMIT TET $
i]c
% MOBILE HOME FEE $
% PLUMBING PERMIT TEE $
% PLAN CHECK FEE $
% STATE SURCHARGE TTT $
% SEPTIC DISPOSAI TTT $
% SITE INSPECTIOH TTE $
MINUS $25.00 FOR PROCESSING FEE $I
BUILDING PERMIT REFUND $
STATE SURCHARGE REFUND $
SEPTIC DISPOSAL REFUND $
SITE INSPECTION REFUND $
TOTAL AMOUNT TO BE REFUNDED
DATE
24-08-24/ACCT 42120/PROG 02.l Receipt #
24-08-24/ACCT 42124lPR0G 021 Receipt #
?4-08-24/ACCT 42I33/PR0G 033 Receipt #
24-OB-24/ACCT 42134/PR0G 031 Rece'ipt #
$
S I GNATURE
: DEPA FINAN
TOTAL AMOUNT REFUNDED $
PLEASE I'IAKE CHECK PAYABLE TO:
NATIE
DEPARTMENT OF ENViRONMENTAL MANAGEMENT
COURTHOUSE/PUBLIC SERViCE BUILDING
I 25 EAST 8TH AVENUE, EUGENE, OREGON 9740i
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