HomeMy WebLinkAboutPermit Building 1977-11-06c PERN4IT #tr?0
TRS, TL
Acreage or Lot Size
Contractor's O.S. #
t t JOB LOCATIO
Partitioning #
LANE COUNTY PERMIT
Lot--- Bloc
APPLICANT'S NAIVIE AND ADDRE qq Phone
Phone
Phone
OWNER'S NATVIE AND ADDRESS
CONTRACTOR'S NAMIE AND ADDRES s
i ;rRucruRrs ruow oN THE pRopERTy
THlSPERMlTlsFoR#BEDRoolV]S-#PLUMBlNGcoNNEcTloNL-
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when readY
WATER supply- SEWAGE DtsposAl_...... --.- s.l. #
THlSPRoPERTYlSWlTHlNoNEIVllLEoFTHEClTYoF.PLUIVlBlNGBY
I hereby certi{V that the above statements are true and accurate, and that I have the following legal interest in the property:
-ourner
o{ record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I lurther certify that (if not the owner) I am authorized to act for the owner ot
record, and that said owner is aware and approves of this action. t h;reby agree to comply with all applicable Codes relating to this permit.
687Fee Paid $Signatu re
NEWAODBESS FACILITY PERIV] IT TO T RANSPO RTATION DEPT,- () SPECIAL PIV]T. AREA. MIN.ELEVATION:-
SAN ITATION BUILDING
Type of Construction
-Group -Fire
ZonelVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet Use Classification
Maximum Depth Comments
Comments
Date
Date
-
By Date:
PLANN ING R EOUI R EMENTS SATISFI ED By Date Date lssued
LAN E COUNTY DEPARTIVIENT OF ENVIRONIMENTAL I\4ANAG EI\4ENT, 125 EAST 8TH AVE., EUG ENE, O REGON 97401 PHON E: 687'439,
POST THIS PERMIT ON MAIN BUILDING AT 5ITE
c55'13
B
ZON E:SIDE FACING STREET (F ROIVI C/L)INT. SIDE YARD REARSETBACKS: FRONT (F ROIVI P/L)
Dote 4-7-77 Permit No. 658-77
CURB CUT
PERMIT
IN THE BOARD OF COUNTY COMMISSIONERS OF LANE COUNTY
WHEREAS, the qtfoched opplicotion hos been fully considered by the Boqrd of County Com-
missioners of Lqne County, ond'ii is the opinion ond judgmentof the Boord thot the.soid opplicotion
should be gronted, ond ihot o permit should be issued, now, therefore, it is hereby.
ORDERED, thot o permit be ond is hereby issued t6 Warner llerzelolrrpnt
1430 Bhnal-for plocing, building
or constructing the following focility,
upon the right-of-woy of County Rood No.Mile Post
in strict conformity to the exhibits ottoched hereto, on d subiect to oll terms, conditions, ogreements,
stipulotions ond provisi ons contoined in the opplicotion ond permit, lhe Rules ond Regulotions Gov-
hts-of-Woy, os set forth by the Lone Mon-Rood Rigerning Focilities to be Permitted u
uol 50.190(.2) ony omendments tl
Speciol Provisions:
ony other opplicoble regulotions, low or ordinonce.
I. Drivewoy will be constructed in occordonce with the ottoched drivewoy oPProoch specifico-
tions (Drowing M98-50).
2. Permittee will be responsible for the immediote removol of oll mud, dirt ond debris from the
roodwoy ond right of woy coused by his operotion, leoving the roodwoyond oreo in o neot,
occeptoble condition.
3. Sidewalks will be constructed in accordance with the attached s'idewalk
specificat'ions and drawing M98-49. The Standard Curb Type shall be
constructed unless otherwise specif ied.
This permit is revocoble ot ony time, ond will be strictly odhered to ond no work other thon
thot specificolly mentioned obove is hereby quthorized.
This permit sholl be void unless the work herein contemploted sholl hove been completed be-
fore April 7 19 77 Expires 19_.
lnspected ond Approved Approved by Boord of County Commissioners
By
Dote
By
PINK - PERMITTEE
ORANGE _ BUITDING & SANITATION DEPT
rpon County
hereto, ond
WHITE - OFFICE FIIE
YETTOW _ REAI. ESTATE c74-129
AI Eivpr hqz SUean XpllPr
Direclor of Public Works
-'
,l @ CON STRU CTION/ PLACEM ENTPERMIT Fn, ,* eg
THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
ft pr,axxruc/ZoNrNG:
CO}IPLETE
Zone Partition #
c_L, STdE
Parcel #Parcel Size
rearMilimum Se t in terior_
POR OFFICE USE ONLY
/
TOI{NSHIP t7 RANGEo3
Irro Copics of Plans
f rwo Copies of PLot Pians
f] l.lechanicaf CheckList
! elumf inq Ci:ec}:1ist
Plan Check lnfo Sheet
1Applicat
Permit {
BLOCK
,--,
SUBDIVISIoN,iPARTITION (if applicable)LOTIPARCEL
PROPOSLD USE OF PROPERTY
! Residential
[-l comnercial
Irndustrj-a1
f]ruulic
zIP
S
,fu,S VATUE
trtr Proposed
Exi sting
WATER SUPPLY
;*;Br'
;F.fif,Zr..?,Z"Wryr LffiW V,f7
{roru.ouru""ir**r*"o @rr(rr.J;r@*r;" uo^ oo*.r, t;"/.,i, ,:crtirt. ,n^n urT*-^i^K-
certify that any and all work f#rforned shala/tre done in accorddnce with,/r-he irdirrar;cs of Lane Courrt.y arrd tli^ t,rrs
to the work described herein, and that NO OCCUPANCY will be made of any structure without the permi!;sion of the Building Division, f furt:her cicrtifi'
that registralion with the Builder's Board is in fu1l force and effect as required by oRs 701..055, that if exe.mpt the basis for exemption is notr,d
hereon, and that onl.y subcontractors and employees who are in corPliance with ORS 70I.055 will- be used on this project, I HAVE READ ANe CilEClt-ED THIS
APPLICATION THOROUGHLY.
ase print)SIGNATURE I aso.t
7
iJI,ME DATE
E6,,,",
&K, fi$ i]concr3c:.r:
is true "fnd correct ind I fl)rfi)(,r
of the State of Or,:9.r\ I,,trtainin',
tr FLOODPLAIN: rn f tood hazard area?
EI Bqnal ADDRESSTNG: .RID cooRDrNArE N
tr SAIJITATION: s. 1. {
D ^o ! ves, see at*.ached sheet
Date:
Date:
Date:E
B. P. #Installation Record rssued? [ v.. f] n"
Maximm Depth
of Trenches
Installation
Specifications r
Comments:
ca.l-Ion
Tank
Lineaf Peet
of Drainfield
te:
PLANS EXAMINATION:TYPE.
Comnents :
CrouV W Use
CONSTRUCTION AUTHORTZED BY THIS PERMIT
De Sq. Ft
TOTAL FEE
TOTAL VALUATION $PEES PATD
By:
Da
PERMIT APPROVED BY BUILDING oFFTCTAL/DES oRs .80s(1))
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL II.IANAGE},1ENT / 125 EAST EIGHTH AVENUE, EUGENE,
Fixed Fee/
Unit Cost
Floodplain Fee S
Subsurface Fees $
Building Fee $
Sewer/Storm Drain/Water S
Plumbing Fixtures $
Mechanical $
Plans Check Fee S
State Surcharge S
ck sh
DATE
OREGON
c74-L94 SEE REVERSE
97 407
Z nour or'
rn
tr
T
"*., 7-?-0?z 1
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF THIS PERI,IIT,CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OI}IER REMEDIES ALLOWED BY LAt.l.
WHEN READY FoR INSPECTIoN CALL 687-4065. A MINIMUM OF AT LEAST 24 HoUR ADVANCE NOTICE FoR INSPECTION REQUEST MUST BEGIVEN. Have the following information ready:. permit numberi job address, type of inspection, when it witi Ue reaai,your name and phone number, and any speciai directions to site.
BUILDING DIVISION:
REQUIRED IIISPECTIONS
I ) FOUNDATION INSPJQ]ION To be made after trenches are excavated and forms erected and when all materials for the foundation
2)
@job.Whereconcretefromacentra.|mixingp1ant(corrnon1ytermed.,transitmixed.')istobeused,materials need not be on the Job.
C0NCRETE SLAB 0R UNDER-FL00R INSPECTION: To be made after aIl in-slab or under-floor building service equipment,
ci1laryequipmentitemsareinp1aiebutbeforeanyc6ncreteis$oui.edor floor sheathing installed, including the subfloor.
3) fIAUlNq & IlLslJ!{IIQ{ ItrSPlGlllx9: To be made after the roof, all frami n9, fire blocking and bracing are in place and
4)
sandventsarecomp,leteandallroughe1ectrica.landp1umbingareapproved.
waII insulation and vapor barrier are in place.
LATH AND/OR GYPSUM BOAB!INPEQIIQI'{: To be made after all lath'ing and gypsum board, interior and exterior, is
orbeforegypsumboardjoinisand-iastenersaietapedandfinished.
A'l'l
in place
5) FIN,AL INSPECTION To be made after the building is complete and 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 building official. Such approval sha'll be given only
after an inspection shall have been made of each successive step in the construction as indicated by each of the inspections
requi red.
NOTE: A11 building permits reguire inspect'ions 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 is
required for each bond beam pour. There will be no approval unti'l the plumbing and e'lectrical inspections
have been made and approved.
B. tJ00D ST0VE: To be made after completion of masonry (if applicable) and when installation is comolete,
Installation shatl be in accordance with an approved nationally recognized testrng agency arrd the manu-
facturer's instal lation instructions.
C. i40BILE H0ME: An inspection is required after the mobile home is connected to an.approvqd 9ew91 or septic
system for: setback requirements, blocking, footing connection, tiedowns, skirting, and plumb'ing
connecti ons.
(f) Footings and piers to comply with State foundation requirements for mobile homes or as recommended
bY the manufacturer.(Z) N-oUite home minimum finish floor elevation shall be certified when required by a floodplain
management letter.(3) l4obiie home tiedowns, when required, and skirting shall be installed and ready-for inspection
with.in at least 30 days after'occupancy. Tiedowns and skirting sha'lI be installed per enclosure.
D. SWiMMING p00L: Below grade when steel is in place and before concrete is poured. Above grade when pool
'i s instal led.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING I,IORKING HOURS. THIS PERMIT I^IILL EXPIRE IF I'IORK DOES NOT BEGIN
I^IITHIN t8O DAvS, 0R IF w0RK IS SUSPENDED 0R ABAND0NED FOR I'I0RE-THAN ]80 DAYS. SUSPENSI0N 0R REV0CATI0N MAY 0CCUR IF THIS
ijiRriii t^tAS tSsuto oN rHE BASIS 0F INcoIIPLETE 0R ERRoNEoUS INFoRMATIoN.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS I'JILL DO SO AT HIS OI'IN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
(1)
(?)
permits shall be effective for one year from the date of issuance.
Upon complet.ing the construction for which a permit has been^issued the permit holder sha11 notify the
D[;;ril";i-6v iuurittini-tn!-i.ituiiaiion "ec6.a form. The Department sha'I1 inspect the construct'ion to
determine if it complies with the rules.oniuin.o in this diviiion., If the construction does comply vtith
,
such rules, the Depariment snati jssue a c.riiiiiat. oi satisfactgry completion to.the permit holder. If the
construction aoes not-cimirv -iin irin irr.t, tn",oepirtment-shall irotify the permit holder and sha'll require
Hii;ir;#; iliirliii."-uliirre issuing the-i6riiif caie. Failure to meet the requirements. ror satisfactorv
completion with.in u ".itonuoi" time c5nstitri"i u violation of ORS 454.605 to 454.745 and this rule' .
Setbacks - Subsurface Sewaqe Di sposal
From: Interior ProPertY lines
Edge of road right-of-way
Bui lding foundation
l.lelIs, other water sources
Septic Tank Drainfield
-TOT-'I 0''10'
5'
50'
'I 0'
l0''100'
hne county:- ,,NNING&COMMUNITYDEVELOPMENT
ACTIVITY INFORMATION SHEET
COMPI,ETE THIS SECTION. INCOMPLETE FORMS WTLL BE REJECTED:
6l!'
-o h,,r,ck Da ur,,,
PERSON MAKTNG
LtLl qS Pr,^-^-Q 43t R
Eu gl/..f
CITY
PROPERTY OWNER
ngr
ADDRESSMAILING ADDRESS
6 v'1*-^ a cR q?qoS OR
CITY STATE ZIP CODE STATE ZIP CODE
u{ g tl- ct ti OS S.* ^^*3q z- tz3 I 1 Zl"--?(Y ?
BUSINESS'I'ELEPIIONE NUMBER HOI'4E TALEPHONE NUMBER BUSINESS TELEPHONE NUMBER HOME TELEPHONE NUMBER
@ tax MAP/PROPERTY DESCRIPTTON NUMBER (from tax maps in Department of Assessment & Taxation or fron tax statement):
l'lap & Parce1 Number:
Tax Map & Parcel Number of Adjoining Property in Same Ownership:
Townshrp R""q. s."ti..
Tax Lot(s):
I None ! unknown
@ SUnOfVfSfOn (if appl-icable):
@ negUesf (briefly describe information needed):
Township Range sectJon
D orrt of TL
7ao
#By Partition #_
BLOCK:LOT:
COMPLETE THIS SECTION FOR
ION APPLICATIONS
LAND USE,
OR PROPOSALS SEE *NOTE BELOW.**FOR STAFF ONLY* *
NUMBER:
,orr, f-L7 H
rIME INrrr oruo, ?25i
CHECKED BY:
ATTACHED EXHIBITS
! erot ptans (2)
! constr. Plans (2)
! site nla.,
Dcopy of Tax Map
flo*,.r-
SCREENING VERIFTCATION :
By:
Date
Time In: Out:_
! ac..pt I neiect
Routed to:
rNOTE: ATTACH A COPY OF
iEx-uep; sHow EXrsrrNG
STRUCTURES AND TAX LOTS
IN YOUR OWNERSHIP. OB-
TAIN TAX MAP IN SEi,F
HELP AF.EA OF A & 1"
O ToTAL CoNTIGUoUS PRoPERTY IN SAME oWNERSHIP
@ NuMeen oF sTRUcTUREs oN pRopERTy: standard home vl
Modular home RV in use as residence
)Garage v Shop
Other ,*".rrr,
acres
O pnesrur usE oF PRoPERTY:
@ rrne DrsrRrcr:
Barn
l.Iidrh
Mobile home
Storage
@ eenornc PERMrrs oN PRoPERTY:
O naren DrsrRrcr:
Pnivate Road Name
/Y\-a.n-
*ot
Users
O accsss To PRoPERTy: pubric Road Name
Road 'Easenent
@ orsnn EASEr'TENTS ovER PRoPERTY:
@ pnopeRrv ADDRESS: U3 t (
9/81 REV (OVER)
COMPLETE 'IHIS SECTION FOR I.A}*USE OR CONSTRUCTION APPLICATIOT._ **FOR
O pnoposll usE or pRopERTv rN DETATL:
By:
STAFF USE ONLYT *
Datr::
Time fn:lr.rt
@ nurlorNG REeuESTS:
contractor's # 2l.rYXg (for mobile home setup also)
D.irections to Site: Ects[ On [sl"t e ",r,, o't CJ ef I 5 B r\ d
l--l Commercial: use Floor Area
NUMRER OF STORII]S
ArUr.et^f ,8(f()
fl accept f ncject
I nlanning Apnlication
f Construction permit App.
fl lnformation only
Zoninq:
Comp. PIan DesignaLion
SANITATION:
Rr' _
Date:
Time fn:_ Out:_
f] accept f neject
I Constr. Permit fssue
f sttc ttval uation tssuc
PERMIT ISSUED (SAME DAY ONLY)
Permit #
By:
Date
Time fn:out:
o'4 0r^&lrs.rn Dil ket\R;N bI4
R"t ^er tt ev\d i,r <u,\-clQ.'sr.a tJliife 2-s1ot.1, blB.Ltrirr,
Check the type of permj-t requestccl:
[-l owelling: I New f Replacement ! aaaitionat;
fl naaitlon ! alteration;
I uodular Home ! uoUire Home - Model year_
Iov Istandard Construction;
f] nr.., Check only
[-l agricultural: use_
n Othotr: Use Floor Area
[-l cn"ng. of t]se - Hor?_
@ lrultnun orr IrtrDRo()MS
@ senrrarroN RE9uESTS:
L
f, site evaluation for SDS feasibi lity
! uew system instal-fation
I nePair,/rePlacement
fl atteration,/re location
!Hoot to existing
ADDTTToNAL rNFoRMArroN: J@"t
L{ c-pJ.ilor,.+
IQNE/LANp rrsE:
I
Ftl
Lc-r4trd
/? -oS 53.4i*,?d/
LANE COUNTY INSPECTION RECORD
NE N
CO /4
T BACK ENTS
SIDE I NTERI OR REAR
DiRECTIONS TO SI
ul4-z
S ITE ADDRESS PERMIT NUMBER
J
FomtNG Z-roUNonrroN nr up rnsprcrtor\l -Approved Correcti on Di sapproved Date Inspector
App roved Correcti on__Di sapproved_Date I ns pec tor
UNDER SLAB / PLUMBING GROUNDWORK INSPECTION
Approved Correct'ion D'isapproved_-Date I nsp ector
ROUGH PLUMBING INSPECTIONApproved Correct'ion Disapproved Da te I nspector
FRAMING INSPECTION
Approved-.-*-Correction-=-.Disapproved lDa te I nspector
INSULATION / VAPOR BARRIER INSPECTIONApproved Correcti on__Di sapproved Da te I nspector
LATH / GYPSUM BOARD INSPECTION
Approved ._ Correction Disapproved Date.-----.--_--___Inspector.
FINAL PLUMBING INSPECTION
Approved-_---Correcti on- Di sapproved_ Da te i nspector
FINAL I^JASTE DISPOSAL SYSTEM INSPECTiONApproved Correction_ Di p ved Dates I nspector
I L INSPE N BUILD LE
Correction sapproved Date Z-App ved
T
d
M--t
D 7 -8 z-lns pec tor
N
rection/)-?
-h
Form C74-197
W
Di sa proved Date
CERTI
Inspector
/{//
?/x],(
/Ztz
/-d /r9'tt-4-$\Ll 1/,
/rt
.//u
&(% fou**rr1L/<a -Zzry',-d
//r f /r'U ll't
CONCRETE SLAB / UNDER-FLOOR INSPECTION