HomeMy WebLinkAboutPermit Building 1986-10-03G6 7-d
L County hori zatio*- for'FOR OFFICE USE ONLY;:;w/-f/Applica
Permit
[--]OUT OF'baRANGE
a G "xH//
apP \rD
PROPOSED USE OF PROPERTY
fi,&r:siaential
[-l commercial
n lndustrral
PubIic
ZIP
- BE SPECIFICPROPOSED
WA?ER SUPPLY Proposed
Exi s ti
AND ADDRESS TELEPHONE NUMBER
IS NAME AND
certify that a]l infomation hereon is true
p,,r.h"""ffi(rthori zed agenr.
the or{ilfanc-Nq! Lane Cowty and the Lawsstructure without-tne pemission of the Bui
Q.^l/-#
DATE
IIAVE CAR.EFULLY (loalrd rChcEXA.}4I THE APPLICATIONCOMPLETED PERMIT!'oR Ly and ctcorre and that
thehave tinteres thern owne of iordre)-egalfollowing ropep rty conDrf:rthe tha t aI1and work drfome hal"1 becertifyanyPe done n WIaccordauce of the ofState Oregon!na to the descwork dribe herein thatand NOpertan9 oCCUPANcY be onade arti I fur-Idi 'r slonDivn9certitherthatthethBuilderBoardsfyregis tration tnI5 fu1 orce eitn d fec ast 701oRs 055 tha t.fbyrequired basisthe forexehpt xempti
1S noted he reon thatand edonly arewho n1 wa th 70ORS 055 11employeescompliance usedbe thison I READHAVEproject AND
CHECXED THI APPLICATIONS THOROUGHLY
S:
Date
EXA},IINATION:
COIO1ENTS:
R
a_
fl Ins No
of
+
P Use 7-.
Date
{r
#
I
k rs1
L, sI
:s B. P. #
E-3
IiAS BEEN BASED ON THE FOLLOWING CONDITIONS !
interi
Parcel #Parcel Si
coMIlEN?S
Specifications: Tank
tion GaIIon
READ THIS SECTION CAREFU
f) pLaNnrnc,zzoNrNG:
Minimum
cor'$1
Lineal Eeet
of Drainfield
Record Issued? f] v"=
llaximun Depth
Itq3c,l
PERMIT APPROVED BY BUILDING OFFIC r oRs 455.805 (1) )DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061,
125 EASTSTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR fNSPECTION INI'ORMATION
srr P
cL4-.25 R*
RURAL ADDRESSII\G
ci-:KED $EP o ,r
L
r
n€P MBING AND MECHANICAL PEBr',, f
CHECK LIST
OlYNER
PLUMBING BY: Contractorp Name
Owner tr
E New Building
no. of fixtures
no. of bathrooms
fr,r Iteration, Addition, Rem
no. of new fixtures
no. of existing fixtu w
[Put Number of Fixtures in Blankl
{ Sink (kitchen, laundry, etc.)
3 Lavatory (wash basin)
7- Tub (with or without shower)
/ Shower (separate)
A Water Closet (toitet or urinal)
Special \Yaste Connection
Drinking Fountain
Ln ND Mn NAG€MrNT OtVtStON
O.o,rrr,rr.'nt ol Ptrbllc \r(rtt
c
Ztn.t/ w a r- r( P/u >rr,/rale OSR #
I.-ss /3r.r>k<OSR #85 3 7
no. of fixtures
Underground Water and Sewer Lines
no. of feet in building sewer
no. of feet in water service
no. of feet in rain/storm sewer
MECHANICAL BY: Contractor [t Name
Owner tr
/
la ,, , /./c t
PLUMBINQ
EIRESIDENTIAL(SingleFamilyDwelling/Duplex) ENON-nTSIDENTIAL
/
Number Fee
BASE FEE: AII Permits $10.00
6.00
7.50
6.00
6.00
6.00
4.50
3.00
2.00
.50
9.00
6.00
6.00
Dishwasher
Disposer (garbage grinder)
lYashing Machine
Water Heater
Floor Drain
Sewage and Sump Pump (ejector)
Other (specify
so,@
MECHANICAL
Total
$10.00
Furnace/Boiler/Compressor up to
100000 Btu/h
Furnace over 100000 Btu/h
Heat Pump
Air Conditioner
Suspended or Unit Heater
Range Hood with Mechanical Exhaust
Exhaust Fans (other than range hood)
Gas Piping System
gas piping outlets (more than 4)
Wood Stove with New Yent
\Yood Stove with Existing Yent
Fireplace Insert
j
4,ona
SUBTOTAL (Does not include State Surcharge or Plan Review)
t19B-246 Land Management Division 125 E 8th Ave Eugene, Oregon 97401
PERMIT #
-
I
Y
B,A
ACTI\/ITY INFORN{ATION SHEET 6wI L_-_
't:@COMPLETE THIS SECTION. INCOMPLETE FORMS t^,ILL BE REJECTED!
I ./-e. = = 13 roo l( -s R a r llz-b--------PEIStrl[mAR]N6 REOL'E-sT
-
Po.l-5ar t/b.-mDRESr-
S,,"tilef,ad or-e,
tllt
, CITY I ,
STATE ZIP CODE
.tgz - .<ao ?
BUSINESS TELEPI-IONE #
MilN-SFTtr FANGE SEETMN
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
Rr le-rf F' JZa n' A. fra c I t 1(b
R'vryz /t)a-ust/e lrooreLI{IG-TDD-RESS-
o 3 aee
ZON I NG
ACRES
97y77
32 >n ,o
HOME TELEPHONE #BUSINESS TELEPHONE #m-
2 PROPERTY ADDRESS
( IF DIFFERENT F
3 rvlep ei pAncEL NIJMEIEFI (from tax maps in Department of Assessment and Taxat'ior
( REQU I RED I NFORI4AT I 0+)or from s tatement )
r1- o-4
TOI,INSH I P RANGE TITI0T(S) on pnncEl +
ZON I NG
TAX LOT(S) OR PARCEL #
4 SUBDIVISION (if appl icabl e) t{d_ll/loa B*za, /r'st*L}T.'leoo BLOCK
5 REQUEST (s;tate exactly what you plan to do)
6 DIRECTI0NS T0 SITE: fuzd-M /ay-Ze <' zSrr{f - -&aa/---=:
** FOR STAFF USE ONLY **
ZONE/LAND USE:
L4-33
LAND MANAGEMENT DIVISI0N / 125 E. Bth AVE., t-uGENE, 0R 97401 / 687-4061
CITtr STATE ZIP CODE
q?q?7
##-
TOI^IN.$iIP RNI\IGE SEITI-ON ffi
,h l/;./7;., . fi --zuZoo-, /.--4:' A e -t o /u / Ltn r' z'</, :*
-1u4 11-03- zz-4,t /zw
lar,e county
Sfl@H"HD SH"EP
Alpr rcATroN tt bt4 - aA
Lor-IT ioN Z"l
NAI'1E
ADDRESS
ZTP )E
LfuP
B
o
The above appl icati n is being heid for the follorving reasons:
_d_aruEM _@E8_tLOy4ru-wrIH _
kt) - tNt DOIN -S/-AAS.- -E-rcIkL_
€.NW{_
eZ_t&o_O(&__W)NpAW,4rE4=
TO _s Ys ne&L /a/wu. H+<1ra E aL _ klla_ _ruLL
E_o/_vr*_w=DtNlNbt __suwtlT _sr._{u
m.*MtNL oaelaN Ur)4
*ruO OOM HilDEtrZ,
nltr&,lao?tL A/Q.
5e/4 Stze* ffi. _/.17-SLtBMr_ rutkl?il_ 7.: otNtNq
__ __V 8-SuEuLtT_tuo4e K*lvl ff{t4N ffi_tdtI4lDJMQ Wuo.o_W
HfuOUA
NOA_o^l NtlKY_
S I Gi,iATURE DATE
687- 406 I
H liL H
This appl ication wjll be held until _. If the information requiredabove has not been furnished Uy tnaT-Oafi,offiiplliution ,iil be cancelled.
RETURN Ti{IS SLIP l^lI'iH THE ABOVE REQUESTED INFORI,IATIOi,I.
BUILDIiIG & SANITATION / PLANNING & COI'IMUNITY DEVELOPI"IENT DEPARTI.IENT125 East 8th Avenue / Pubtic Service Buitding / Eugene,-0;;;;n 97401 / (5C3)6g7_at5t
WMISI
furu%HWD-sf/W--ru8rue *?a.
Y_
_t-_
H/14/F-7I
PAqt-'U
&fl@H,M SH"EP
lar,e ccunty
Ar,r,r rcATroN / 614 - Sb
LOCAT I ON
B NAI,lE
ADDRESS
he above application is being held for the follorving reasons:
lL0Z&__rutfLsES to FT,ET
_N"4^LauffiiD_A__WUJI-,-_VEMtf__lW_
tuxsmN4 @p. _
C
VJ
I
____ u7+os kr
-- r'ru.-su1utT-
_ _ __ _. _4- . [?A.fi?.(.T _ K$QL?-EA)E._
S I Gi.iATURE umz E
6 B7- 406 I
PH liL OL
This app'ljcat'ion wiI be held untilZs SIOP Ul. If the information requiredabove has not been furnished by that OatG-VouFTFpl'icatjon will be cancelled.
RETURN Ti.IIS SLIP l,JI'iH THE ABOVE REQUESTED INFORiIATIOi,I.
BUILDIiIG & SANITAIION / PLANNING & COI'IMUNITY DEVELOPI"IENT DEPARTI,IENI125 East 8th Avenue / Public Serv'ice Building / Eugene,-Orugon 97401 / (5C3)637_ct5l
RA47I
bnt
__a{441W
TRS/TAXLOT
OI^INER
APPLICATI ON # 26I<{ -
ADD SS PHONE
APPL I CANT
( tr orrrE
JOB ADDRESS
VALUATI ON
bltfieto) " L5,1g,S.@
aoa(n,a)" bngao
.6sQts,s)o l4o,Db
I
REV Itltl
SED
Ad on
Correcti on
PRIORi I DEF.-T-n],
Refu nd
Amt. Due
tltl
Bi dg.
I nves t/
Dbl Fee
t46 ,@ Lq,@I
Mech -
Pl mb.
F'ixtures
SI.JR FTI{TR-FT
RAiN--FT
LS ,@ SO
s,e*,oo 5e,oo
REVISIONS CALCULATED BY:
DATE:
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