HomeMy WebLinkAboutPermit Mechanical 1986-06-20- RURAL ADDRESSING CHECKED .}@rdtzzzu A lcK 6-/?$il9
OFFICE USE ONLY
L_--La,ne Count Auttrorization fon Application/
Permit #
ZATION I{AS BEEN BASED ON THE FOLLOWING CONDITIONS:
Installation !,laximum DepthSpecifications: Tank of Trenches
COM}IENTS:
Date
u,u(.-J S
GoMI',ENTS: frO t 1 furc
c"
Date
No
callon
D
tr
PLANS EXA},IINATION:
|Pecrto^l -
,G-
SANITATION: s. I. *B. P. #
I IBFD t k)
?o-8Q -4O
Installation Record Issued? ! v"= f]
interior
Parcel *fl plauuruc,zzoNrNG
rear
ParceI
Minimun Setba
COI{YENTS
Lineal Feet
of tlrainfie l-d
Partition #
"", =id"
READ THIS SECTION CAREFULLY. YOUR
7 *""' dS
I,OTIPARC]EL
PROPOSED USE OF PROPERTY
[-l Residential T rndustrial
! e,luri"Commercial
CITY
tl z4
- BE SPECIFIC
OF EES SUPPLY Proposed
st
AND ADDRESS
NAME AND OSR NUMBER
DATE
racrt.f:rther
Coi{PLETED APPLICATION !'OR
in the propertr,ffi"r,
work perfomed /6aI1 be ,
HAVEI EXA}4INEDCAREF'ULLY THE doPERMIAalrd h rt thatrel:v all nfoma onri.fy AShereon andtrue ctcorre and IthattheIeinterestfollowinggalofcOrr trecord TTpurchase autho!izedT agentcertithatandfyaI1anyandonew1accordal)ce rh the Ordlnance Laneof Cou andty Lawsthe theof teSta of Oregontoworkthengpertai.ni de here i. ncribed and that NO OCCUPANCY madebe o :rrrct ure wi thout th ofPemassf on Bui.Di r fur-lding visionqhecetherrtithatfyregistraEionrhBuildertheBoardfnfuIandforceefeca5trequired'10ORS 0551by that t e basthexempt for exemptiishenotedonreandthatonSedubcontractors1ywhoINaIeemployeeswa701oRs055conplianceusedbethonlsREADHAVEect.ANDprojCHECKEDAPPLICAlIONTHOROUGHLY
4-
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PERMIT APPROVED BY BUILDING OFF IGNEE Der ORS DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 6874061,
I25 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INI'ORMATION ct4..25 R*
size ,U/f
SETBi.CKS AND oTIIER Co}iDITIOSS OF'APPROI/AL MUST BE STRICTLY OESERVED. VIOLATION CAI. RDSULT IN REVO-
CATION OF TltIS pER!1IT, CITATIO:l UNDER PROVISIONS OF TANE aOJ]:TY'; INFRT1CTION ORDIr'ANCE, AND./OR OTHER
REIIEDIES ALLOWED BY LAW.
I]OURS ADVA:.:CE NOTICE FOR INSPEC-87-1 5. h rlINItlU)'1 OF iT Li;'ST 21WHEN
of inspec
FOR I^"SPECTION, CAL j.ng infornatron ready : permit number,
anC any speciaL Ci
lob address, type
rectsions to si!e.rion, when it will be ready, your name and phone nunber,
BUILDING DIVISION:
PEOUIIiED lNSPECTIONS :
l. Foundatj.on Inspectlon: To be made after trenches are excavated and forms erected and shen alL
;#i;6traffi[ncation are.]cLivered on Ehe.rob. l{here concrete from a central mixj'ng
piint {comon)-y teimea',transj-t mrxed,,) is to be uied, naterials need not be on the iob.
2.ConcletesLaborUnder:iloorlnsPection:Tobemadeafteral].in.slaborunder-floorbuilding
se!viceequrpmenL,conou!ts,prPrngaccessories,andotherancilla:yequiPmentitemsare-in
prace bur uuro." ..]-"Ji"il.!-I" i..."a ".-ii""r .r."ititi"q instalr;d, -iniluding the subfloor'
.1. !'ramlng & lnsula!ron In:-Pe:Jrel:: r?.b: Tade after the roof' aIl framing' fire blocking' arrd
bracrng are rn 1rr-6 aid-afT-FlFes, fireplaces, chimneys, and vencs are complete and a11 rough
electrrcal.ra pfr.Ui"g ure uppiored. Ail wa!] insulalion and vapor barrier are in pLace.
4. LaLh andlgr GyPsuT Board lit:?.:!:?!: ^1: !t t"uu arter all Iathing and qvpsum boald' interi"or
and exterlor, rs rn place but Detole any plastering is applied and beiore gypsM board joints
ind fasteners are taped and fj'nished'
5. Final Inspectignr To be made after the buildinq is comPlete and before occupancy'
.\PPROVAL REQUIRED. \o work shall be done on any paru of the building or structure beyond the point
indica.ed in each successive rnspection wiLhout firsr obtainrng the;pprovaL of the building offrciar'
such approval shalL be ri;;;;;i; after an-inspecricn shall have.been nace of each successive step
I"-tn"'!on"tr"ction as indicated-by each of the inspections required.
NoTE:AlIbui}dj'ngpermitSrequireinSpectionsfortheworkauthori.zed,suchasbucnotlimitedto:
A. Block 1^IaII: tO be made after reinforcing is in place' but before any grout is.Poured'- This
ffi.f i" -i.t"ii.a
f or each bond bean pour. There wilr be no aPproval until the olumbing
and electrical insPect-ions have been nade and approved'
B.!{oocSlove:TobemadeafterconPletionofmascnri(i-fapplicable)andUheninstallatronis
ffirff'rn"iuii"aion shatr be in accordance viti an appiovea, nationarly recognized testing
agency and the manufaclurer's installation instructions'
C, MobiIe Home: An lnspection is required after the mobile home is connected to an approl'ed
dffioi:*ptj...i,;;;" ior setback requirements, blocking, footing connecrion, tiedouns,
skirttng, and plubrng cornectrons'
t. Footings and piers to comPLy with State foundation requi'rements for mobile homes or as
recomended bY tne manufacturer.
2.Mobilehomemin}mufinishf].ooreleyationshallbecertifiedUhenrequiredbyaflood-
plaj-n management ldtter-
3. )lobile hoDe Liedowns, when requj.red, and sklrting shafl be insLalled and ready for inspec-
tion within at l-east 3o days ifte. occrp..cy. Tiedowns and skirting sha11 be instsal-led
per enclosure.
D- Swrminq Pooll Below grade when steel is in place and before concrete is poured' Above grade
;IE; p@I is inslallcd.
APPROVED PLANS MUST BE ON THE JOB STTE AT ALL TIMES DURING WORKING IIOURS' THIS PERMIT WILL EXPIRE
IE WORK DOES NOT BEGIN IIIT}IIN 180 DAYS, OR IF T'IORK IS SUSPENDED OR AB'\NDONED FOR }IORE THAN 180 DAYS'
SUSPENSION OR REVOCATION i.LqY OCCUR IF THIS PERMIT !'I.CS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATI ON .
ANYoNEPRoCEEDINGPITSTTHEPoIIiToTREQUIREDINSPDCTIoNSHILLDoSoATTI{EIRowNnIsK.
SUBSURFACE AND ALTERNATIVE SEh'AGE DISPOSAL SYSTEMS:
I- Permits shall be effective for one year from Lhe date of issuance'
2,UponcompletlnglheconstructionforUhichapermi!hasbeen.iSsued,thepermitholdershall
norify lhe r,.n. co..ly Depart*rent of planning'and comunity Deveropment by submitting the
lnstallatlon record form. The Department sh;11 inspect th' construction to detemine if it
complies with tne iuies contained'in uhis division. rf the construction does comply with such
rules, the Departren! shall issue a certificate of satisfactory completi.on to.the Permiti hol'der'
If lhe constructrcn does not comply vith such rules, the Departsent shal'I noti'fy the Pernit
holder and shal'I requlre satrsfaclory comPletion before issuing the certificate' Failure to
meet the requiremeni, for satisfactoay ""aplntio^ wrthin a reasonable time constiLutes a vio-
LaEion of oRs 454.605 to {54.745 and this ruLe'
Setbacks - subsurfacc Sewage DisPosal
lircrior Profjert'/' Irnes
Edg6 oi road rlqht-of-uaY
Burldrnq foundation
lieIIs, other waEer sources
Scptic
i0
L0
,5
50
DrainfieLd
13'
r00 '
't'ini
l ron
t7
an€
- o3 -Z<e. [. / 32 -
Woo* Stove
?
Pe rmit ,.pplication
JNTIL A COPY OF THE MANUFACTURER'S
* NAME
ntg A PERMTT cANNor BE APPRovED t
INSTALLATION INSTRUCTIONS IS SUBMITTED
PHONE
e* ADDRESS FOR INSTALLATION
* NAME OF MANUFACTURER
* IIISTALLER
C ITY
.oRs #_
MODE
CIRCLE THE SKETCH I,IOST
CLOSELY RESEMBLING YOUR PROPOSAL
11
I
I
I
I
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B. The floor protection is -l- inches thick. (Material)
C. The wal I protection will be: (Material )
* D. Type of chimney:ffira.rorv [uuron.y (lined? f]y., f[n.)
CONSTRUCTION !
* A. The unit is listed uv: flul
(8)
(e)
noilrer (name)
I
ICBO
0ther
tL
I
I
I
Type o.f stove pipe : . fitu.oory(vent connector)flzogu (or heavier) salv. sht. mt1E
oTurnstons: (i n i nches )
l. Stde of unlt to protected vall I I /4unpr?tected wall /5 )
z. Rear of unir to protected ,"rrffitn{k"rruo*rl Jg li
,
3: Ftoor protection at stde o, un, @"r r* Affii!' lb -
4. Length of wall protection at rear ol unit P(J at slde
5. Hetght of wall protection_f)_ .r, /
6. Edge of rall protection to nearest door or r'inao/Lf-
7. Air space between wall protectlon and wall-
8. Diameter of chimney and stove pipe(vent connecto
NOTES:
(l) outside combustion air is reouired for a'll fuel burninq {nctallations-. A 7-Sq. inch (min. area).closable vent'loc' ' iila within 24r'of ttre fiieplace or appliance on the floor or base of a wall'
(2) A copy of the approved manufacturer's installation instructions must be on iob site at the tim of lnspection. ln-
spection cannot be trlade with out these instructlons'(l) the 'Approved' p'lan/appllcation shall be kept on the Job site for use at the time of lnspectlon.
ili troi ati untis ai-e a'ppibvea for corner instai'latlons oi reduced clearances with wall protection. (Refer to manufac-
tul il'ilrl"llt:Li'.L1, rr to be used, itrus-t be uned (Required by Law) Exisiins flues must 6e approved by inspector
,rior tQ use- Ygu musf Drovitt acieic lor tie insDector
[O) it fireplace lnsert is to be installed, verii:catron ol rrll header locatlon ln relationship lto breast of fireplace
is required by law.(7) Flreplace lnserts are not permltted In factory-built or prefaDricated clearance fireplaces, unless
speclflcally tested and listed,
Fireplace inserts are not pemitted ln masonry fireplaces with existlng heat forrn type mtal fireboxes unless
speclfically tested and Ilsted.
Uilistea unlts shal'l be lnstalled ln accord wlth th€ State llechanlcal Code, utilizlng the materla'ls and clear.nces
set forth ln Chapter 5.
e-L4-32 APPROVED AS NOTED
By
I
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Lr
L,!lI
l-
3
Date L- - c-L/ -- r*)'.-r2
,
PERMIT #
L
I
IF YOUR INSTALLATION DIFFERS
FROM THESE EXAMPLES OR IF THE
INSTALLATION IS A FIREPLACE
INSERT, PROVIDE A PLAN AND
ELEVATION DRAWINq l.lITH DIMEN
SIONS OF YOUR PROPOSAL.
I
LAND MANAGEMENT DIV. / PUBLIC l'lORKS DEPT. / 1?5 E. 8th Ave Eug. 0R 97401 (503)687-4061
)I 6ne
Z
T
riLL- <Fe lrsrtpq
lIJ SPFCTO P U
/ac-C - t
ACTIVI.Y INFORMATION S IEET 63:COT{PLETE THIS SECTION. INCOMPLETE FORMS t.lILL BE REJECTED!
I llarL ( 4 {et-h {Lrfi € L, I q1t €-,t/l(14,K .* <-
2-3tt Fas< B/ztsvra A,
PERSON MAKING REQUEST
)S
ILI RESS
os<
MAILING ADDRESS
- uz--rl.L €-
C ITY m
3zm (-ffi BUSINESS TELEPHONE # HOME TELEPHONE #
2 PROPERTY ADDRESS
( TF DTFFERENT TnO
3 ruae B PAFIeEL NUMBEFI (from tax maps in Department of Assessment and Taxationor from tax statement)(B UIRE D I NFORI4ATION )
milmHIP RANGE M,
Mu,_NSMP RTNGE SMTMN
MENSHIP MNGE smTT_ON
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
W ZONING
W ZON I NG
O ,rrrrr-ON (if appl icable)LOT BLOCK
5 REQUEST (state exactly what you plan to do)
7)(' 2s zc
HOME TELEPHONE #
o(
ZON I NG
ACRES
6 DIRECTIONS TO SITE
FOR STAFF USE ONLY **
14-33
LAND MNAGEMENT DIVISIoN / 125 E. 8th AVE., EUGENE, 0R 97401 / 687-4061
----
<-a
Z0NE/LAND USEI
6L!'
-
CONSTRUC] JN/PLACEMENT
PERM IT
Lzc
COIUPLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
FOR OFFICN USE ONLY
Applicarro"( r: aPermlt , I()( ,'V7,
!r*o Copics of Plans
Itro Copies of Plot P]ans
f] tlechanical Checklist
f| r,tumuinq Checklist
-Erfan Check Info Sheet
TAXa7
app
STREET
F(4esiaentiat
! comrnercial
Irndustrial
!rurrtc
Propos edsting
,ffiry2*
)'ff?lwrp
SITE
that.reglstration with the Builder's Board is j-n full force and effect as required by ORS
hereon, and that onLy subcontractors and enployees who are in comPliance with
APPLICATION THOROUGHLY
SIGNATURI DATE
trZ
NA.[{E (please pri-nt)
I shall be done
NO OCCUPANCY Wi
doand a:cr tha a1 1 nformatioi trIS ue ctcorre and fUrFORherobyffherconndNEDAPPLICATIONCAREFULLYPERMIAEXA}.lI
Ordir rance Laneof Lawsthe theof Lal Lc It)LaofaccordancenththeandCountyI4 tl ngOl e(J?rlthatandworktyanyalI
s truct ure thethoutbe1ofnade fythatandanytoworkthescribeddehe re in
701 - 055
fl o*.ur
ft.to..o.
! eg..t
permission of the Building Div.isj.on. f fu!ther ccrt
055, lhat if exempt the basis for exemption i.s not.rd
be used on this project. I HAVE READ AND CIIECT.ED THIS
! pr,aNurxc,/ZoNrNG:z Partition #/03k 7.r/Parcel +D.r^a1 qi,6
reartrtilimumcr-interior
Lineaf Feet
of Drainfi-e
tr N:Inf haz
tr ADDRESSING:CRlD
n SANITATION: s. r. #
Installation
specifj.cations l
Co[unents r
PLANS E I
Corunents:
fl ves, see attached sheet Date
Date
No
E
B tallation kecord Issued? [ v.. I n"
Maximum Depth
of Trenches
Date:
ryp" 5N n,",n 7-? "="1F.? INTE&top
AUTHORI
Fixed
CONS lo€
s
S
ture
FEE
$
$
$
ckTOTAL VALUATION $
By:
Date:
T lYloftAr.s z
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (PCT I DATE
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON
C74-I94 SEE REVERSE
97 40L
7
a
_(/4
D
tr
tr
SETBACKS AND OTHER CONDITIONS OF APPKdVAL MUST BE STRICTLY OBSERVED. VIOLATION CIN RESULT IN REVOCATION OF THIS PERMIT,cITATIoN UNDER PRoVISIoNS 0F LANE CoUNTY'S TNFRACTToN oRDTNANCE, AND/oR oTttER REMEDIES ALLoWED By LAlt.
I.IHEN READY FoR INSPECTIoN CALL 687-4065. A MINIMUM 0F AT LEAST 24 HoUR ADVANCE NoTICE FoR INSPECTION REQUGIVEN. Have the following information ready: Permit number, job address, type of inspection, when it wilyour name and phone number, and any special direct.ions to site.
BUILDING DIVISION:
REQUIRED IIISPECTIONS
2)
FOUNDATION INSPECTI0N: To be made after trenches are excavated and forms erected and when all materia'ls for the foundationare delivered on the job. Hhere concrete from a central mixing plant (commonly termed "transit mixed") is to be used,materials need not be on the Job.
CONCRETE SLAB 0R UNDER-FL00R INSPECTION: To be made after al'l in-slab or under-floor building service equipnent,ci11ary9ouipmeniitemsareinplacebutbeioreanyconcreteispouredor floor sheathing installed, including the subfloor.
EST MUST BE'I be ready,
1)
3)FRAMING & INSULATI0N INSpECT_I0NS: To be made after the roof, al framing, fire blocking and bracing are in pafipipe,@sand-ventsarecomp1eteanda1.trougtl6iectri.ui_ina[1umbingare-approved.
wall *r,-ulation and vapor bamier are in p1ace,
(r )
(2)
'lace and
A1'l
4) LATH AND/0R GYPSUM B0ARD INSPECI[0]',1: To be made after a]1 lathing and gypsum board, intepior and exterior, is in placeorbeforegypsumboardjoin[sand-iistenersaretapedandf.inished.
5) FINAL INSPECTI0N: 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 eachsuccessive inspection without first obtaining the approval of the OuitA'ing official. Such approval shall be given onlyafter an inspection shall have been made of each successive step in the c6nstruction as inOititea uy Jich of itre inifettionsrequi red.
N0TEI All 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 isrequired for.each.bond beam pour. There will be no approval until the-plumbing'and electr{ca1 inspectionshave been made and approved.
B. w00D ST0VE: To be made after completion of masonry (if applicable) and when installation is comolete.Installation shall be in accordance with an approved nationally recognized testrng agency arrd the manu-facturer's instal lation instructions.
C. l"l0BILE H0ME: 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
connecti ons.
(f) Footings and piers to comply with State foundation requirements for mob'ile homes or as recommendedby the manufacturer.(2) Mobile home minimum finish floor elevation shall be certified when required by a floodplain
management letter.(3) l4obile home tiedowns, when required, and skirting shall be installed and ready forinspectionwithin at least 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure.
D. SWIMMING P00L: Below grade when steel is in place and before concrete is poured. Above grade when poolis installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT I^IILL EXPIRE IF WORK DOES NOT BEGIN
WITHIN]8O DAYS, OR IF l^lORK IS SUSPENDED OR ABANDONED FOR MORE THAN]8O DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERiqIT [^IAS ISSUED ON THE BASIS OF INCOI1PLETE OR ERRONEOUS INFORMATION.
ANYoNE PRoCEEDING PAST THE P0INT 0F REQUIRED INSPECTI0NS WILL D0 S0 AT HIS ol,IN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
Permits shall be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued the permit holder shali notify the
Department by submitting the installation record form. The Department shall inspect the construction to
determine if it complies with the rules contained in this division. If the construction does comply vrith
such ru1es, the Department,shall issue a certificate of satisfactory completion.to the perm'it holder. If the
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 sat'isfactory
completion within a reasonable time constitutes a violation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface Sewage Disposal
From 'I0'
'I 0'
5'
50'
Interior property lines
Edge of road right-of-way,
Building foundationllells, other water sourdes
Seplie lank Drainfield
-To---'I 0'
'l 0'.l00'
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€
$
/a*il ctried,L-. &ttQ luu*f -
PROPOSAL
2182 Minnesota St.
Eugene, OR 97402
5031689-7498Richard Dein 0ns
$
t.
ltu*,[,JNAMEu
STREET
CITY
JOB LOCATION
h4__
s60r oerc l-Z't-{:EJ-
lt-E
Richard Dein€s Construction, proposes lo lumish labor, equipment, and materials lo:t?fNoV*tL Z o' 1ZS'f4t^^rL n _la1rtt -
AS FOLLOWS:
t. ?er.lotrJ" A^trl $r,i[ !*ll
f
Tlmts ' *
, , f.x?r^r(L nUJ*rJ=- t [,I A. e.tul.6t ! slo^
B, tira r,iru*.{ Z&q
(rDh,r Ftt* Af ?
P'f,//*,
tt opf ,n"i
' # uloas
e. lrruougunt (,u.*ui^ta ,2. r-rer+a,/) 3
Gr fe
b. N(rr ?FpE& !,r7f4e
E. Nlr-LL Pr^J€L,iK -{1 oO@
';If"*'ffi"L riJ,1),*L A,JJ Jo *n7 ,tl-'A^,,[
*ffi *,*r^$arJryu
^^d
4. il.*" o
5,
NE"J t 1 975
for the sum of :dollars ($o __) with paymant
to be as follows:
All malerial is guarenteod to b€ as specifisd. All work lo be in a workmanlike manrrer according to standard practices. Any alteration or devialion trom above Epocltbs.
tions involving extra costs, will b€ oxecuted only upon written orders. and will become an over and above th€ estimate. Alt agreements contingent upon strikes,
accid€nts or delays beyond our control. Owner to carry fire, tornado and lully covered by Workmen's Comp€ngalion lnsurance. ln tho
6vent logal proce€dingg ere instituted by the Company to enforce any to tees and costs as set by the court in such proceedino or a,ty
8pp€al thereot.
Authorized Signature
NOTE: This proposal may be withdrawn by us if not accepted ()
Acceptance of Proposal
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specilied. Payment will be made as outlined above
Date Sisnature-- € -,. A" "
7
ll
5
-days.
NAME (PL
ADDRESS
70 4
?
EASE PRINT)
APPLTCANT() 0WNER()
RTASON FOR CANCELLING PERMIT
-7
ELLATION/RIFUND AUTHORIZATION - DERMIT #
CONTRACTOR K
za
0v
1
fi {,
I
S I GNATURE DATE {.
FEES PAID FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR APPLICATIOITS TO IT{5
TANK AND DRAINFIELD) ARE ORD{NARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE BU
PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT PROCESSED. I
AUTHORIZATION FOR POSSIELE REFUND:% BUILDING PERMIT FEE $
% MOBILE HOME FEE $
% PLUMBING PERI'IIT FEE $
% PLAN CHECK FEE I t
a
(u/;_z srATE SURCHARGE FEE $
ol SEPTIC DISPOSAL FEE $
% SITE INSPECTION FEE $
MrNUS $25.00 FoR PRoCESSING FEE $
,[cr*t TorAL AMouNT To BE REFUNDED $
SIGNATURE
TO: DEPARTMENT OF FINANCE
BUILDING PERI'IIT REruND $
STATE SURCHARGE REFUND $
SIPTIC DiSPOSAL REFUNO $
SITE INSPECTION REFUND $
TOTAL AMOUNT REFUNDED $
CK AY
ADDRESS
24-0844/ACCT 42120/PR0G Ofl ;Receipt #
24-OB-7/1/A.CCT 42124IPR0G 041 Recelpt *
24-08-'/41ACCT 421331PROG 01'3 Receipt #
24-08-74/ACCT 421341PROG 0{3 Receipt #
{q
-24n r
4-.<9 /"
Pt-EASE
NAME
"y/{-/
":'..-'t /' ' /
DEPARTMENT OF ENVINOIUTruTNI MANAGEMEfIT
COURTHOUSE/PUBLiC SERVICE BUILDING
I25 EAST 8TH AVENUE, EUGENE, OREGON 97401
t
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DATE _ l-r,- --:t---{j*-;
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ABLE
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TRS#17-03-26.1.7-3204 DATE ISSUED. 6-23-86 PERMIT# / EAA -6IG
0l,JNER'S NAME MARK & KATHRYNEL TIMMERMAN PHONE ER 726-9276
CONTRA CTOR'S NAME PHONE NUMBE R
BAC K REQUIRE TS J!It LUMBING FIXT URESFRONTSIDELI NTER I OR REAR
WO THORI PERM
IlJOOD STOVE INSPECTION
Hwy. 105 to Center St. exit - right - then left at
SDS APPRO\XAL REQUIRED
C SI
sth & Q St. - right on Hayden Bridge
TE 2311 Rose Bloom Dr. Springfield
FOOTI NG
Approve d Date
/ FOUNDATION tr /MOBILE PLACEMENT D INSPECTION
Correcti on Date I n specto r
PLUPIBI G GROUNDWORK NSPECTIONApproved--Da te Correcti on Da te Ins pe ctor
UNDERS AB PLBG:EJ NDERFLRITBE I NSPE CTI ONApproved Da te Correcti on Date I nspector
OTHER INSPECTIONApproved Date Co rrec ti on Date Inspector
ROUGH PLU MBrNG (T0P 0UT)I NSPECTIONApproved Date Correcti on Date Ins pector
FRAM ING INSPECTI0NApproved Date Correcti on Date Ins pector
ROUGH M ECHAN I CAL
Approved Date Correcti on Date Inspector
INSULATI ON / VAPOR BARR IER INSPECTIONApproved Date Correcti on Date Ins p ector
LATH / G YPSUM BOARD INSP ECTI ON
Approved Date Correcti on Date Inspector
FI CHANi
roved Da
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Approved Date Correcti on Da te Inspector
te L-z{*tGrrecti o I nspe ctor
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Da te
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Insp.proved--Date Ins p.
FINAL INS PECTION BUI LDING /MOBILE HOM /AG PI.ACEMENT
Approved Da te Correcti on Date Inspector
CERTIFI CATE OF OCCUP PORARY CERTIF ICATE OF OCCUP ANCY EApproved
LANt COUNTY INSPICTION RECORD