HomeMy WebLinkAboutPermit Building 1985-10-17Ga
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FANGE
2 3,ITION LAT/
PRCPOSED USE OF PROPERTY
FGesidential I lndustrral
ZTP
BLOCK
Cc,mmercial Public
SUPPLY ,6aa Proposedxisting
NUI.lBERBAND ADDRESS
ce rti
of
55an
CHECKED
DATE
, arrd do
ty
}IAVEI EXAMINED THECAREFULLY
re tthehaveintelegalfollowing
f:rther that andcertifyany
hereon and correct, and that I
APPLICATION
of the State of Oregon
if exempt the basis for exemptj,
pertaining to the work described herein, and that NO oCCUPANcy
this project. I HAVE READ AND
tfle Building Division, I fur-
ther certify that registration with the Buj-Iderrs Board is
is noted hereon, and that only subcontractors ild employees
READ THIS SECTION CAREFULLY
I puxNruc,zZoNrNG:
Minimum Setbacks:cL
cot[\lENTS
"t
\)cP.ION:9c.--
SANITAT r. #
COM.[lENTS
d(PLANS E TION: rype
ORI ZATION qAS N BASED ON (t- ""Tfirs; coNDrrroNs :
Parcef # (3.<eS Parcel size
b rear
Date:
Installation Record Issued?
Partition #
C , si interior
B. P. #
'\-]flY"= flN"
Installati-on I Ca11on
specifications:
-
Tank
Lineal Eeet
of t)r'ai.nfield
llaximum D€pth
of Trenches
Date:
G Use
Date :
/o -/7-*
BY BUILDING
E COUNTY DEPARTMENT
125 EAST
oRS 456 DATE
OF UBLIC
AVENUE, EUGENE, OREGON 97401
LAND MANAGEMENT DIVISION, 687.4061,
COMI'IENTS:
SEE REVERSE FOR I.NSPECTION INI'ORMATION cL4-25 R*
I
I
(
;
SETB|ICKS AND OT:ILR CCIiDITIO}iS OF APPROI./AL.IIUST BE STRIC?LY OBSERVED. VIOLATION CAN RESULT IN REVO-
C,i?ION OF TIIIS P[R!11T, CITATIO:i UNDSR PROVISIONS OF LAN-E aOUNTy'.'; INFRACTION ORDINANCE, AND,/OR OTHER
RE}IEDIES ALLOWED 8I LAW.
WHEN RE.\Dy FOR lNSPDCTION, CALI 687-.1065. A liIN-IllU:,l OF AT L'AS? 2{ IiOURS ADVAi.:CE NOTICE FOR INSPEC-
TLN-imarsTS-LISf r! uVs:*.- advE--Ene tol.Iowing j.nf o.nat-ion ready: permit number, job address, typeof inspection, when it urII be ready, your nane and phoic nunber, and any speciat Circctions to site.
BUILDING DIVISION:
RgQUIAED I:iSPDCTIONS :
L. FoundaLion ]n.pect]s, To be made after trenches are excavated and forns erected and when aIInaterj.al.s for the foundatj,on are delivered on t.he job. l{here concrete from a centraL mixingplant (comonly termed "transit mixedr') is to be used, materi.als need not be on the job.
2. concrete Slab or Under-lIoor Inspection: To be nade after aII in-slab or under-floor buildingiEIvTre-eqlilrpmot, conIitrt, plflitflEZEEssories, and other ancillaly equipmenL irems are inpl.ace but before any concrete j.s poured or floor sheathing install-ed, including the subfLoor.
Franing & Insulation Impections: To be made after the roof, all framing, fire blocking, andb=reffif are-In-lTre and-l-I-pi-pes, f ireplaces, chimneys, ani vents are iomplete anct aIi'roughelectrical and plunbing are apProved. AII waLl j-nsulation and vapor barrier are in place.
Lach and/or cypsum Board Inspection: To be made after all IaLhing and c,ypsum board, i.nterioranilexuforf-IE-in-pTade-ElE-SEToie any plastering is applied ana netoii-gypsu board joinrsand fasteners are taped and finished.
5. Final Inspeclion: To be made a the building is conpleEe and before occupancy.
APPROVAL REQUIRED. No work on any par!
firstlnindicated in each succe
Suc,}I approval shalt
in the consLruc
1y
UI t
bond
n
of the building or Slructure beyond the pointobtaining the approval of the building officialshall have been naCe of each successive steptions required.st tnsDec
for the work authorized, such as buC not Iimited tor
in place, but before any grout is poured. ThisI the plunbinqThere uiIl be no approval unti
approved .
f applicable) and when installation isapproved, nationalLy recognized lesLj.ng
is connected to an approved
Sooting connection, tiedouns,
for mobile homes or as
required by a flood-
and
NOTE; Al1 buiLding
Block l^Ial1:
ts
e Iec tr ica I
S tove :
for
rel
ryIl bes ins ta
skirting,
Foo to th State
by
Mobile home minimum finish fLoor elevati,on sha be ce
,r:&
1.
2.
plain management letter.
$obile home tiedowns, uhen required, and skirting shaIl,Lj.on within at Least 30 days afte! occupancy. Tiedownsper enclosure.
and ready for inspec-
shall be installed
Swiming PooI: Below grade when steel is in place and before;fren p@I-TE-instaLled.is poured. Above grade
APPROVED PLANS )IUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT TIILL EXPTREIE WORK DOES NOT BEGIN VIITHIN ].80 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR IIORE THAN 180 DAYS.SUSPENSION OR REVOCATION I4AY OCCUR IF THIS PERMIT !.IAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POIIIT OT REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISX.
SUBSURFACE AND ALTERNATM SEWAGE DISPOSAL SYSTEMS!
l. Permits shall be effective for one year fron t'he CaCe of issuance.
2. Upon conpleting the construction for which a iermit has been issued, the permit holder shal,lnotify the Lane county Departrent of Planning and Comunity Development bi subnitting theinstal"l'aLi.on record form. The Department shaII inspect the construction Lo determin; if itcomplies with the rules contained i.n this divisj.on, If the construct.ion does comply with suchrules, the Departmen! shaLl j.ssue a certificate of satj.sfactory completion to the'parni,ti holderrf the constructlon does not comply uj.th such ruLes, the Depar-tlent-shall noti.fy the pernitholder and shall require satisfactory complebion before issuing the certifi,cat;. FaiLure toneet the requirenents for satisfactory completion within a reasonable tj.me constj,tutes a vio-lation of ORS 454.605 to 45{.'745 and rhis rule.
Setbicks - Subsurficc Sewage Disposal
Septic Tank - Drainfield
From: Interior properti, Iines IO, I0,Edge of road rlght-of-uay LO' lO'Buildinq foundation LO'hells. other uater soulces 50' foq'
3
4
B.
c.
D.
hne cornty
ACTI .,TY INFORMATION CHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS t^JILL BE REJECTED!
6lI'
-t Rove€ oSBoRtrE' PERSON MAKING REQUEST
@ r_A? S,oAitrc0Ar€ fruE
MAILING ADDRESS
SPr\i ryCr !'E!o o l<
CITY STATE ZIP CODE
7zo-?2c c
3 rvrae B PAneEL NUMBEFI
( REQUIRED I NFORI,IATION)
MAILING ADDRESS
Srl rnt-
PROPERTY OWNER
sfi1*f,
VzYzz
7zc-33Y/ffi
2 PROPERTY ADDRESS
-_( IF DIFFERENT FRO
HOME TELEPHONE # BUSINESS TELEPHONE # HOME TELEPHONE #
(from tax maps in Department of Assessment and Taxat'ion
or from tax statement)
t7
TowNSl{rP
C3 2,4 Z
MNGE SEENTN T
TMN.SHTP- RNNGE SEETI-ON
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if app licable) FAAUOAtE
EST (s;tate exactly what you plan to do)
L T P EL ZON I NG
TOI^J-NSFTP RN-NGE SEETMN TIX-r-or(S) OR PIRC-E-L #ZON I NG
ffi ZON I NG
LOT /O BLOCK .f
5
6 DIRECTI0NS T0 SITE: No. oPs HAA t,e Rb oN PlEAitl,vT [3tVo, u) a.v
gPAi*oo 4*e AuE.
** FOR STAFF USE ONLY **
ZONE/LAND USE:
BY :
-
DATE:- TIME I N:- 0UT:-
NUMBER
DATE
--.|nt/,
I
LAND MANAGEMENT DIVISI0N / 1?5 E. Bth AVE., tuGENE, 0R 97401 / 687-4061
C ITY STATE ZIP CODE
ACRES
t3
TRS# 17-03-22-4-2 5200 DATE ISSUED:1 0117 / B5 PERMIT#273O -8s-
Ol^JN ER'S NAME NE NUMBER
/zo-o041
IRE
FRONT C1
PH
#
926-9766
IN FI TUR
SIDE INTERIOR 5 'REAR 7 I PI]E
THOR P
C ITE
SDS APPROVAL REQUIRED
ON PHEASANT BLVD. ON SPR TNGDALE.
E
E AVENUE SPRTNGFTELD, 0R 97477
BIL
Correcti on Date
NS
VC I n spector
PLUMB-TNG GROUNDI^JORR NSPECTION
Approved Date Correcti on Date Inspector
UNDE RS LAB PLBG. f] /UNDE RFLR PLBG. D I NSPECTI ON
App roved Date Correction Date I nspector
OTHER INSPECTIONApproved Date Correcti on Date I n s pector
HP P
Approved Date
proved Date
UApproved Date
ULA RB
Approved Date
LA GYPSApproved IDate
Correcti on Date (In
Correcti on
Correcti on Date
ECTI ON
Correcti on Date In
Correcti on Date
ECTION
I NSPECTI O
Inspe ctor
spec
FINAL ME CHANICALD /HOO D STOVE DApproved Date Correcti on Da te Inspector
FINAL PL UI4B I N G INSPECTiApproved lDa te Correcti on Da te ins pector
MOB PLA
Date
ENteCorrecti on Inspector
M74-Ig7
CYN
Insp.
T
p ro ved Date Ins p.
CERTIFI
Approve
CATE OF OCCUPd Date
PORARY CENTTF ICATE OF-OEEUPANCY E
I
ADDRESS
NAME (PLEASE PRI
APPLTCANT( )owNER ( )
REASON FOR CANCELLTNG PERMIT(OR APPLTCATTON)
CANCELLATION'REFUND AUTHORIZATI^\ PERMIT#-
TRSffL#-
ooNTRACTOR( )
SIGNATURE
FEES PAID FOR WASTE DISPOSAL SYSTEMS (StrE TNSPECTTONS AND/OR APPLICATIONS TO TNSTAL!_ THE
SEPTIC TANK AND DRAINFIELD) ARE ORDINARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE
BUILDING, PLANNING, OR PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION
PROCESSED.
FEES PAID % REFUND
o/o
%
%
oh
%
o/o
%
Flood Plain Fee
Building Permit Fee
Mobile Home Fee
Plumbing Permit Fee
Mechanical Fee
Plan Check Fee
State Surcharge Fee
Septic Disposal Fee
Site lnspection Fee
DEQ Surcharge
Land Use Application
Planning Director
Recording Fees
Partitions
Copies & Ordinances
Surveyors
Minus $25. for Processing Fee $
TOTAL AMOUNT TO BE REFUNDED $
o/o
%
oh
%
o/o
%
$
$
$
$
$
$
$
$
$
SIGNATURE
TO DEPARTMENT OF FINANGE:
Building Permit Refund $
State Surcharge Refund $
Septic Disposal Refund $
Site lnspection Refund $
Land Use Applications $
Planning Director $
Recording Fees $Partitions $
Copies & Ordinances $Surveyors $
TOTAL AMOUNT REFUNDED $
NA
7-88/Acct. 42'1201 Prog. 060 Recei
1 7-88/Acct. 421 241 P r og. 060 Recei pt
1 7-88/Acct. 421331 P rog. 060 Recei
1 7-88/Acct. 42134lProg. 060 Receipt
1 7-88/Acct. 42'l 501 Prog. 060 Recei pt #-
1 7-88/Acct. 462021 Prog. 060 Rece i pt#-
1 7-88/Acct. 4621 O/Prog. 060 Receipt
1 7-88/Acct. 4847 4lProg. 060 Recei
1 7-88/Acct. 444191 Pr og. 060 Recei
41
.rA
4'
it
NA
25-06-74/Acct. 44451 lP rog. 01 0 Recei pt
PLEASE MAKE CHECK PAYABLE TO:
NAME
ADDRESS
LAND MANAGEMENT DIVISION / Public Works Department I '125 E. 8th Ave., Eugene, OR 97401 (503) 687-4061
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