HomeMy WebLinkAboutPermit Building 1980-10-21U CON STF. .J CTION/PLAC E M ENl
PERM IT
FOR OFFICE USE ONLY
Applicati
Permit #
Kx
Two Copies i:f Plans
Two Copies of Plot Plans
I ttechanical Check]-ist
fletumt ing Checklist
!etan Check Info Sheet
CO}IPLETE IS BLOCK. PLEASE USE BLACK INK AND PRINT.
n PLANNING ZONING:Zone Partition #Parce.l +i--
Cflinimum Setbacks: L,
Coments:
front C L si-de interior c
27. 5.5SECTION
ITTOO
OUT OI'
t7
TOh'I!SHIP oa
BLOCKI2L}P
S
A srnHr crTY
Zocr+roto- , Ecn r.,r(.E ol.i . C)u*zlPLOCATION ADDRESS
to(oE
PROPOSED USE OF PROPERTY
ffi Residential
! commercial
Irndustrial
flrunrictl), rP I L-r-,n><ryastRaaTL,RES cuRrnf.'.TLY CN PRoF u u.)L)
n
SUPPLY Proposed
Exist
#oF EMPLOYEESooFlsdoRrEs
6n^A-
f oF BEDRoct(r/
l..l a .
A-o
6AND ADDRE
+
, and do herctry ccrtift that all informatiolr hereon i:i true and correct and I furth
certify that any and aLL work perforned shal1 be done irl accordance w-ith Lhe ord.illances of Lane County aild the LaHS of the Stzttc of OreqcD I)crlaining
to the work descrlbed herein, and that No occupANcy wilt be nade of any structure without the pemission of the Buird.ing Division. I further certify
that.regjjLratjon with the Builder's Board is in fult force and effect as required by oRs 701.055, that if exempt the basis for exemption is noted
hereon, and that only subcontractors and employees who are in compliance with ORS 701-055 wiII be used on this project' I HA\"E READ AND CHECI'JD THIS
APPLICATION T1IOROUGHLY.
lo -2
DATE
lrI
NAME (please print)
I TIAVE CAREFULLY NXAMINED THE COMPLETED APPLICATION
f or,.ut
! ao,.,...o.
! agent
ff f'frOOOpf,afNi rn flood hazard areau EI No I v.., see attached sheel:
Date:
Date:
Date:ft nuFar, AppRESSTNG:
[l samrtATreN: s. r
CRI,D COOR.DINATE N E
+,.,.08ffi:6)rnstallation Record rssued? f] v"= f] n"
Installation
Specifications
Comments:
PLANS EXAMINATION:Type
ICCI Gal Ion _:-^-l Feet<o( 4f'fu ii iluinriora
Maximw Depth
of Trenches
Date:
EI Use
Coments:
Date:tt-rt-ffi ffi\
CONSTRUCTION AUTHORIZED BY THIS PERMIT
Description
Fixed Fee,/
Unit cost
Floodplain Eee
Subsurface Fees
Building ree
Sewer/Storm Drain/Water
Plumbing Fixtures
Mechanical
Plans Check Fee
State Surcharge
TOTAL FEE
FEES PATD BY:[[ cr,e"x I casrr
t
$
$
c
$
$
$
$
)
So. Ft.
2fu+5aoO
TOTAL VALUATfON S
By:
Date:
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (PCT ORS 456.80 5 (r) )
LANE COUNIY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, EUGENE,
C74-Lg4 SEE REVERSE
DATE
97401
nu
3/,mWpar-,
.;
sETBACKS AND ,THER c0NDITI'NS 0F AppR,vAL rrrrl, srRrcrly ,BSERVED. vI'LATI.N ro* *rrr,-fiN REV..ATToN oF THrs
'ERMIT,CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAl.l.
WHEN READY FoR INSPECTIoN CALL 687-4065. A MINIMUM 0F AT LEAST 24 H0UR ADVANCE NoTICE FoR INSPECTIoN REQUEST MUST BEGMN. Have the follow'ing information ready: Permit number, job address, type of inspection, when it will be ready,your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIREp il61lqTr0Ns
f) I0UXEATION INSPECTI0N: To be made after trenches are excavated and forms erected and when all materi a'ls for the foundation@ob.Whereconcretefromacentra.Imixingp1ant(corrrmon1ytermed,,transitmixed.,).istobeused,materials need not be on the Job.
2) C0NCRETE SLAB 0R UNDER-FL00R INSPECTION: To be made after all in-slab orco cil lary equipment items are in plor floor sheathing installed, including the subfloor.
3) F$$MIryG & ITiULAJI0N INSP_ECTI0NS: To.be made after the roof, all framing, fire blocking and bracing are in place andall-pipes, fireplaces and chffieys and_vents are complete and alI rough electrical and FtumOing are-approved. Allwall insulation and vapor barrier are in place.
4) !ATH,AryD/OR GYPS9M B0ABD ITSPECTIqN: To be made after aI1 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.
(t )
(2)
' under-floor building serv'ice equipment,
ace but before any concrete is poured
5) FINAL INSPECTIIN: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
appi^ova1 shal'l be given onlyafter an inspection shall have been made of each successive step in the c6nstruction as inaitited by each of ine inspeitionsrequi red.
N0TE: Al1 buildirrE permits require inspections for the work authorized, such as but not'limited to:
A. BLOCK l.lALL: To be made after reinforcing is in place, but before any grout is poured. This inspection isrequired for.each bond beam pour. There wi'll be no approvai until the-plumbing'and electrical inspectionshave been made and approved.
B. t'100D STOVE: To be made after completion of masonry ('if applicable) and when installatjon is comotete.Instal'lation shall be in accordance with an approved nationally recognized testrng agency arrd the manu-facturer's insta l lation instructions.
C. I40BILE H0l'1E: An inspection is required after the mobi1e 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 mobile homes or as recommended
by the manufacturer.(2) Mobile home minimum finish fioor elevation shall be certified when required by a floodplain
rnanagement letter.(3) l4obile home tiedowns, when required, and skirting shall be installed and ready for inspectionwithin 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 I.,ORK DOES NOT BEGIN
WITHIN ]8O DAYS, OR IF I.IORK IS SUSPENDED OR ABANDONED FOR MORE THAN I8O DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERMIT t.lAS ISSUEq ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYoNE PRoCEEDING PAST THE P0INT 0F REqUIRED INSPECTI0NS r,rrLL D0 S0 AT HIS oWN RISK
SUBSURFACE AND ALTERNATIVE SEI^IAGE DISP0SAL 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 shall 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 divis'ion. If the construction does comply vrith
such rules, the Department shall issue a certificate of satisfactory completion to the permit holder. If the
construction does not comply with such rules, the Department shall notify the pbrmit ho'lder and shall requiresatisfactory compietion 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 Sewage Disposal
From:Interior property lines
Edge of road right-of-way
Building foundation
I,le'l ls, other water sources
Septic Tank Drainfie'ld'10' I0'
'I 0'
5'
50'
t0'
l0'
i 00'
RE )RD F]ELD CARD
TOI^INSH I P RANGE SECTION TAX LOT PERMIT NUMBER
SUBD ION/IV ISat/I ION LOT/ PARCEL BLOCKI
MINIMUI''I SETBACK
REQU I REI,IENTS :
OI,JNER'S NAME AND SITE ADDRESS
CONTRACTOR"S NAME AND ADDRESS
# BEDROOMS
New .- Repair
-
ntte.ation
-
Serial Equal - ,
SDS INSTALLATI0N 16t -r'uoz. ,Zl,."r/ab
SPECIFICATI0N:
-
flallon Tank c/
..'--- Ln. ft. Drainfield
Max. trench depth
TELEPHONE NUMBER
TELEPHONE NUMBER
cL, frontcL, rid"
Inleri or
.ea/L-)
</o'
cr/'-'v-
# PLUMBING FIXTURES # EMPLOYEES
DIRECTIONS TO SITE
APV/DISAPV DATE INSPECTOR REMARKS
INSPECTION
SUPPLY
INSPECTION TYPE
//-/g-tu nl ,fl;,1n8&n"
{/ - 2"1- go F(xa ,4re
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t1-03->-7-33-t11(D6l!'--
CON STRUCTION/PLACE M ENT
PERM IT
COMPLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
FOR OFFICE USE ONLY
fitwo Copies of Plans
Qrwo Copies of Plot Plans
fllaechanical Checklist
f el,.rnf ing Checklist
f]e:-an Check fnfo Sheet
TOI.INSHIP RANGE SECTION TAX LOT Eour oF
suBDrvrsloN//pARTrTroN (if applicable)LOT,/PARCEL BLOCK
LOCATION ADDRESS STREET CITY zlP PROPOSED USE OF PROPERTY
I Residential
I commercial
Irndustrial
IeuuricSTRLL-TURES CURMNIT'Y ON PROPERTY
DESCRIPTION OT PROPOSED WORK $ VALUE
# OF BEDROOMS * or sToRrEs # OF EMPLOYEES WATER SUPPLY Proposed
Exi sting
ffi
,
TEIEPHONE NUMBER
CONTRACTORIS NAME AND ADDRESS TE],EPHONE NUMBER
CONTRAC?OR'S OSR #DIBNCTIONS TO SITE
r ltAvE CAFTFULLy EXA-tlrNED THE coMpLETED AppLrcATroN ron:peruqrr, and do hercby certify that all information hereon is true and correct and I further
certify that any and ai1 work performed shall be done in accordance wj.th the Ordilances of Lane County and the Laas of the Stat-e of Oreqcn perlainin'J
to the work described hereiru, and that No occupANcy will be nade of any structure without the pernission of the Building Divisj.on. r further certify
that registration with the Builder's Board is in fult force and effect as required bt- oRs 701.055, that if exempt the basis for exemption is noted
hereon, and that only subcontractors and employees who are in compliance uith ORS 70I.055 will be used on this project. f HAVE READ AND CHECrcD THIS
APPLICATION THOROUGHLY.
NAME (please print)SIGNATURE DATE
fl o*,.ut
I Contractor
f| aeent
ft pr,awNruc/ZoNrNG:zoaa-
, frcnt
Partition #
C L, sade
Parcel #
interior_
Parcel Size
rearMinimum setbacks:
Coments 3
C L
fl rr,oonpr,arm:In flood hazard area?f]r" I v.=see attached sheel:
Date:
Date:
Date:fl nunal AppRESSTNG:GR],D COORDINATE N
tr SANITATION:rnstarl-ation Record rssued? [ v"= f] u"
Maximun Depth
of Trenches
B. P. #
Instal-lation
Specifications:
callon
Tank
Lineaf Feet
of Dralnfield
Date:
I pr.aus EXAMTNATToN:Type.Group-Use
Coments:
Date
CONSTRUCTION AUTHORfZED BY THIS PERMIT
Description Sq. r't Fixetl Fee,/
Unit Cost
Floodplain Fee
Subsurface Fees
Building Fee
Sewer/Storm Drain/Water
Plumbing Fixtures
Mechanical
Plans Check Fee
State Surcharge
TOTAL F'EE
FEES PATD BY:frlcrrect< fl castr
$
$
$
$
$
$
$
;
$
TOTAL VALUATION $
By:
PERMIT APPRoVED BY BUILDING OTFICIAL/DESIGNEE (per ORs 456.80 DATE
LANE COUNTY DEPARTMENT OP ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON 9740L
C74-Lg4 SEE REVERSE
5 (r) )
App Ii ca t i on7'
Permit- f--
T
T
Date,
,.;
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT II,I REVOCATION OF THIS PERMIT,
cITATI0N UNDER PRoVISToNS 0F LANE CoUNTY'S INFRACTIoN oRDINANCE, AND/oR oTHER REMEDIES ALLoWED By LAt,l.
WHEN READY FoR INSPECTIoN CALL 687-406s. A MINIMUM 0F AT LEAST 24 HoUR ADVANCE NoTICE FoR INSPECTI0N REQUEST MUST BEGMN. Have the following information ready: Permit number5 job address, type of inspection, when it wi] I be ready,your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIRED IIISPECTIONS
f) F0UNDATI0N INSPECTI0N: To be made after trenches are excavated and fonns erected and when alI materials for the foundation
are de'livered on the job. Where concrete from a central mixing plant (commonly termed "transit mixed") is to be used,materials need not be on the Job.
2) C0NCRETE slAq 0R UNDER-FLo0R INSPECTIoN: To be made after all in-slab or under-floor building service equiprnent,conduit, piping-accessories and other ancillary equipment items are in place but before any concrete is iouiedor floor sheathing instalIed, 'including the subfloor.
3) F$4MIryG & IryIULAII0N INSPEqT-IQj!!: To be made after the roof, all framing, fire blocking and bracing are in place andsandventsarecomp1eteandal.|rough6iectricaland[tumoingare"a|provea.nttwall insu'lation and vapor barrier are 'in p1ace.
4) !-ATH,AUD/0R GYPsgM B0ABD IrysPEcTigN: To be made after all lathing and gypsum board, interior and exterior, is in placebut before any plastering is appl ied 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 sha:l l be done on any par.t of the building or structure beyond the po'int indicatedsuccessive inspection without first obtaining the approval of the build'ing official. -Such
appi^ova1 shal'l beafter an inspection shalt have been made of each successive step'in the construction as lndiiited by each of
requ i red .
NOTE: All building permits require inspections for the work authorized, such as but not Iimited to:
A. BLOCK I'IALL: To be made after reinforcing is'in p'lace, but before any grout is poured. This inspection isrequired for each bond beam pour. There will be no approval until the-plumbing'and electrical inspectionshave been made and approved.
B. hl00D ST0VE: To be made after completion of masonry (if applicable) and when instal'lation is comotete.Instal'lation shall be in accordance with an approved nationally recognized testrng agency alrd the manu-facturer's instal lation instructions.
C. i4OBILE H0ME: An inspection is required after the mobi'le home is connected to an approved sewer or septic
system for: setback requirements, blocking, footing connection, tiedowns, skirting, and plumbing
connecti ons.
(l) Footings and piers to comply with State foundation requirements for mobile homes or as recommended
by the manufacturer.(?) 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 for inspectionwithin 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 gra{e w_hen pool.is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT I^IILL EXPIRE IF t,lORK DOES NOT BEGIN
I.IITHIN ]8O DAYS, OR IF !,IORK IS SUSPENDED OR ABANDONED FOR MORE THAN ]8O DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERMIT I,IAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS I,IILL DO SO AT HIS OU'N RISK
SUBSURFACE AND ALTERNATIVE SEI,IAGE DISPOSAL SYSTEMS
in each
given only
the inspections
(r )
(2)
Permits shall be effective for one year from the date of issuance.
Upon completing the construction for
Department by submitting the install,
determine if it complies with the ru
such ruies, the Department shall issr
construction does not comply with su,
satisfactory conrpletion before issuir
completion within a reasonable time i
ich a permit has been issued the permit holder shall notify the
on record form. The Department shall inspect the construction to
contained in this division. If the construction does comply vrith
a certificate of satisfactory completion.to the permit holder. If therules, the Department shall notify the permit holder and shall require
the certificate. Failure to meet the requirements for satisfactorystitutes a violation of ORS 454.605 to 454.745 and this rule.
Sepqic Tank Drainfield
-T0--
wh
at'i
'l es
ue
ch
ng
con
Setbacks - Subsurface Sewaqe Disposal
From Interior property lines
Edge of road right-of-way
Building foundation
[,lel Is, other water sources
l0'
l0'
5r
50'
l0''10'
'100'
lone countyH$r,m sLEp
APPLiCATION #
LOCATION
NAME
ADDRESS
ZIP CODE
The Lane County Water Pollution Control Division cannot proceed with
processing your appl ication because:
Incomplete appl ication (items deficient)
Address and/or d'irect'ions to app'l i cati on s j te.
f] ProRosed number of bedrooms in dwe11ing.
Approvable plot plan (see attachment).
JJ notification of date test holes will be ready.
Verification of existing system required (memorandum
explaining this procedure attached).
Two test holes (2'X4'X5' deep) required for expans'ion
or repair of existing sewage disposa'l system in the
area of the proposed drainfields.
l.
2.
3.
4.Other:
DATE
PHONE
If the necessary corrections are not made within
appl i cati on wi I I be deni ed .
days, the
BUILDING & SANITATION / ENVIRONMENTAL MANAGEMENT DEPARTMENT
125 East 8th Avenue / publrc service guilding / -iugene,0regon 97401 / (503)687-4061
4jt
I
waqttd
r8corD of APPRoVAI OF
INUVIDUAI SEWAE* o|SPOSAT SYSTEAA AND
AP?TOVAI' TO OCCUPY NE$DENCE
rsstf,o ro
t{.'r %
TANE COUNTY
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Droarerr fd. tiqsid d+* I d
Itrf DlSl6A[ trfD $oriSurio bor { }r... .ro.
Dir,oru trqlr r.l 4r/ O f/.?<4/ feet; luilding Foun<Jorion
l.ea.d lor lirr: frurr / L' f fr.; rldo /a f ft.; rG.:r
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SUPPL EI.,IENT NO
OI.INER
PROPERTY ADORTSS IOb I
, (Bui ldlng Val uati on )
Signature of Allpllcant
7-.
BUILUiNG PERMIT
Q uorL 5 Tld -
one
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d res s n
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a EP
address
te-e^
Rev lsed () Prior (
addition
correc t i on
i--{*_
p one
tltl #ur,. due
[ ]refund
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ffi^t.paid 3@_tgnt.due aO.Z?_
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Pluntb.
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c74-ll9
Fge-Rgcgived By*;-.=i::r::.:.-::-::-----.- Date l. ]cash
L AN i c 0u NT y D[ pniil r'ir ri T 0l -1, n-vl-ri6Fu r N T nrlfi Nrr r ri r H r
[ ]chec k
CONTRACTOR
)