HomeMy WebLinkAboutPermit Plumbing 1980-10-01INSPEC--TION RECO RD FIEL-CARD
TO[^JNSH I P
7
SUBD I V I S I ON/PARTi TI ON
SECTION TAX LOT
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PERMIT NUMBER
LOT/PARCEL BLOCK
OI,/NER'S NAME AND SITE ADDRESS (A -4 J/A,
CONTRACTOR"S NAME AND ADDRESS
# BEDROOMS
Serial Equa 1
SDS INSTALLATION
SPEC I FI CATI ON:Tan k
. Drainfield
rench depth
n. ft
Nevu _ Repair rati on
TELEPHONE NUMBER
"7/o 6
TELEPHONE NUMBER
WATER SUPPLY
Max. t
MINIMUM SETBACK
REQUIREI4ENTS:cL. frontcl-, sioe
I nteri
# PLUMBING FIXTURESI # EMPLOYEES
DIRECTIONS TO SITE
INSPECTION TYPE APV/DISAPV DATE INSPECTOR RET1ARKS
hre ccurty
ACTIV^ fY INFORMATION .-.{EET
COMPLETE THIS SECTION. INCOMPLETE FORMS t,JILL BE REJECTEDI
** r9B STAFF USE ONLY **
BY:
-
DATE : TIME IN: OUT:c:P
NUMBER
DATE
E(,t
eqr2
e-
3
MAILING ADDRESS
s
CITY STATE ZIP CODE
ffi HOME-TETEPHMET BUSINESS TELEPHONE #HOME TELEPHONE #
2 PROPERTY ADDRESS 6+R S {(IF DIFFERENT F
3 ruae B PAFTeEL NUMBEFT (from tax maps in Department ofor from tax statement).2 ^^, 27,t V Z7o
Assessment and Taxation
( REQUIRED INFoRI,IATI0N), 11
trOWNSHIP
frar
MNGEsEeTMN ffi ZONING
TOilNSE-TF MNGE SEETI_ON ffi ZONING
MINSHTF RAN.GE SECTMN
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
ffi ZONING
ACRES
4 SUBDIVISI0N (if applicable)LOT BLOCK
5 REQUEST (s;tate exactly what you plan to do)o
D
6 DIRECTIONS TO SITE:
LAND I'TANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 9740I / 687-4061
1 Crr.r4,tu At/ur*-r:( PROPERTY OI,INER
Z0NE/LAND USEi
,d
t7-ob-6To
lane county U
K T
PTUMBING/MECHANICAT
1ng SS
6l!'
-APPLI CANT INFOR},IATION :
or ease
PLT]NtsING CONTRASTOR Yes Firm
Address
f] uo E s"rr
MEGTANTCAT CONTRACTOR t]Yes Firm
Address
fl No fl serr
cont. osR#\3'r6}
oun 1p
Cont. OSR#
PLT]MBING
R&Loea-t-c,
O^r\d-
,r k)tfCIJ.nJ V...aOt.wX Ll,.ln.,ll-
MEGTANICAL
OFFICIAL USE ONLY
App1i. /
Permit
in*J 2t
Type of Fixture I'hmber of Each Fee On Each Total
Sink $ s.00 5. CID
J-avatory Wash Basin s. 00
Tub (with or without shower)5. 00
Shower. separate 5. 00
ter oset to 5. 00
s .00
Disposer (r 5. 00
l,V s. 00
c;.0
Floor Drain 5.00
Sewer--lst 50ft.15 .0
each additional 100 ft.10.00
lVater Service--lst 100 ft.1s.00t110. 00
Storm and Rain Drain--1st 100 ft.1s.00t1onal 1 t 10. 0t
Special Waste Connection s.00
E e ector s.00r1C0(
Other C1
SUB-TOTAL (Minimum $fO. OOl
TOTAT FEE 5.dD
Type of Equipment N\rmber of Each Fee on Each TotaI
Mechanical Permit Base Fee $ 10.00
Furnace up to 100"000 BTU/H 6. 00 1".(x)
Furnace over 100,000 BTU/H 7. s0
Clothes Drver Vent 3. 00
Bathroom Ventilation Fan & Drcf
Range Hood with Ivlechanical Exhaust 4.50
Wood Stove 6. 0uAir Conditioner Only 6. 00
Heat Pur[t b. u0
Floor Furnace 6.00
Gas Pipi ng System 1 to 4 Outlets
Per Outlet 50
Other (specify)
STJB-TOTAL IG, OD
TOTAL FEE $ nt lDr^.1 ' '
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dr'r'lrcANT ADK INs, cL-firn ADDR t 680 BEst uhi ' , r;u{;HNE ''rL4i 1?0:13?{ SStl?00 ,su$Drv
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