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FOR OFFICE USE ONLY
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PROPOSED USE OE PROPERTY
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D - BE SPECIFIC
ed
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NUMBER
AND TELEPHONE NWBER
I ttAVE CAREFULLY EXA!.{INED THE CO}.IPLETED APPLICATION }-OR PERMIT, arrd do hereLy c.ttify that alL infomation hereon ls true and correct, ild that I
have the following lega1 interest in the propertrffiorr.. of record; I contracc. prrchaser; f,authorizetl agent.
I f:rther certify that any and all work perfomey'\ll be done in accoldaur:e witll the ordj,trances of Lane Couty and the Laws of the State of oregon
pertaining to the work described herein, and thdt llo b&pAnCy will be made of aii st-xrrcture without the pemission of the Building Divisj.on. I fur-
ther certify that regislration with the Builderrs Board is in full force and effect as required by oRs 701.055. that if exempt the basis for exempti
is noted hereon. and that only subcontractors ild employees who are in compliance with ORS 70I.055 wj.l1 be used on thi.s project. I HAVE READ AI\ID
THIS APPLICA?ION
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SIGNATURE DATE
RaSE
Date:
EXAMINATI
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COMI1ENTS:
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SANITATION: s. I. #B. P. #
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BEEN BASED ON THE FOLLOWING CONDITIONS:
ParceL #Parcel Si-ze
i.nterf,or
Installation
i- fications
Maximun Depth
Installati-on Record Issued?
Lineal Feetca1lon
Tank
t", ,.or. 20 ( t", =ruu 5 |
CAREFULLY. YOUR AUTHOo'"Tl}]agr-RIZATION IIAS
Partition f
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Date: '2-.
READ THIS SECTION
I pnuurnc,zzoNrNG:
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PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (DET ORS DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENTOIVISION, 6874061,
I25 EASTSTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INI'ORMATION
I
cr4..2s R*
! commercial flr,ruri"
r\p" y'- P- croup-H3l-
SETB'ICKS ANO OT:IER CO:iDITIOI]S OE APPROI/.AL MUST BE STRICTLY OBSERVED. VIOLATION CAN RASULT IN REVO.
CATION OF iIIIS PERIIIT, CITATIO:J UNDER PROVISIONS O. LAN.E COUNIY,.J INF.RACTION ORDI]IANCE, AND,/OR OTHER
REUEDIES ALLOhED BY LAW.
!iHEN RE-\DY FOR INSPICTION, CAL: 687-.1055.
@el.lavE tlreJor
of inspection, when it wiIl be ready, you!
BUILDING DIVISION:
Franing & Insulation
bracing are in place
elecLrical and plumb.
rnsoections: To be made afler the roof, aII framing, fire blocking, and
anA;lI pipes, fireplaces, chinneys, and vents are complete and a1l rough
i-ng are approved. A11 wall rnsulation and vapor barrier are in place.
AI\1Il.I}1U}1oFATLEAsT24HoURSADV.\t;CENoTICEFoRINsPEc-.]
Iowing information readyr permit number, job address, tyPe
name and phonc nunber, and any speciaL directions to site.
F.EQUI R'D INSPECTIONS :
L. Foundatj.on Inspection: To be made after trenches are excavated and forns erected and uhen a11
n-aT6ilElIfoi--tlE-toundation are delivered on the lob. lJhere concrete from a central mixing
plan! (comonly termed "transit mixed") is to be used, materials need not be on the job.
2. Concrete Slab or Under-aloo! Inspection: To be made after aLl in-s1ab or under-floor buiLding
iE?illre eq-urpnmc, rcnEurt, pipi;g-a-6rcssories, and other ancillary equipment items are in
pl.ace but before any concrete.is poured or floor sheathing installed, including the subfloor.
4. LaLh and/or cypsum BoarC Inspection: To be made ar-ter aLl lathing and qypsum board, i.nterior
ailer.terl6r-, rollrce-EuE-5ETre any pLastering is applied and beiore gypsm board joints
and fasteners are taped and finished.
5. Fina] Inspection: To be made after the building is complete and before occupancy.
APPROVAL RECUIRED. No work shall be done on any part of the building or structure beyond the point
j.ndicated in each successive j-nspection without first. obtainlng the approval of the building official.
Such approval shal1 be gi.ven cnly after an inspection shal1 have been made of each successive step
in the conslruction as indicated by each of the inspections required.
NOTE: All bu.ilding germits require inspections for the work authorized, such as but not limited to:
A. Block tIaII: To be naie after reinforcing is in place, but before any grout i"s Poured. This
-reprct16;
is required for each bond beam pour. There will be no approval until the plunbing
and electrical j-nsPections have been nade and apProved.
B. Hood Stove: To be made after completion of masonly (if applj.cable) and when installation is
conelet+ Installation shall" be in accordance wj-th an approved, nationalfy recognized tesLing
agency and the manufacturer's installation instructions.
C. Mobile Home: An inspection is required after the mobile home is connected to an apProved
EEwEfoi-G6ptic system fo! setback requirements, blocking, footinE connection, tiedowns,
skirting, and plubrng connectj-ons.
1. Footings and piers to compLy with State foundation requirenents for mobile homes or as
recomended by the manufacturer.
2. Mobj.Ie home ninimum finish floor elevation shall be certified when required by a flood-
plain management Ietter.
3. MobiIe home ciedowns, when required, and skirting shafl be instal,Led and ready for i-nsPec-
tion within at Ieast 3O days ifter occupancy. Tiedowns and ski.rtinq shall be installed
per enclosure.
D. Swiming-pgol: Below grade when steel is in place and before concrete is poured. Above grade
alen pool is insldlled.
AppROvED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURIN-G WORKING HOURS. THIS PERMIT wrLL EXpTRE
IF II'ORK DOES NOT BEGIN WITHIN I8O DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR }IORE THAN ].80 DAYS.
SUSPENSION OR REVOCATION i,:AY OCCUR IF THIS PERMIT I^'AS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFOR}IATION.
ANYONE PROCEEDING PAST TIIE POIIiT OT REQUIRED INSPECTIONS HILL DO SO AT THEIR OWN RISX'
SUBSURFACE AND ALTERNATIVE SEI{AGE DISPOSAL SYSTEflS:
I. Permits shal1 be effective for one year from the Cate of issuance'
2. Upon completing the construction for which a pernit has been rssueil, the permit holder shall
notify ti.. Lan; County Depa!tment of Planning and Comunicy Development by submitting the.
instaIIaLlon record form. The Departient shill inspect the constructi-on to determine if it
conplies with the rules contained in this division. If the construction does comPly with such
rulLs, the Department shall i.ssue a ce!tifi.cate of satisfactory completion to the Permiti holder
If the construction does not comply with such rules, the DePartment shall notj.fy the Permit
holder and shall require satrsficLory completj.on befo!e issuing the certificate. Failu!e to
meet the requirements for satisfacto.y "o.pI"tioa within a reasonable tihe constitutes a vio-
Iation of oRS 454.605 to 454.745 and this ruIe.
setbacks - Subsurface sewage Drsposal
SeDLic Tank Drai'nfield
Faom: lnLerior ProPerti- lines
tdge oi road rrght-of-uay
Burldrng foundation
HeIls. other uAter sources
r0'I0'
50'
t0'
r0,
10',
r00'
bne ccrunty
AC - IVITY INFORMATIGT I SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS t^JILL BE REJECTED!@
1L (SAn"<I ES PROPE OWNER
s
MAI MAILING RESS
SP"
C ITY STATE ZIP CODE
ffi
2 PROPERTY ADDRESS
ffi BUS I NESS TE tEpHorur #ffi
( IF DIFFERENT
e-_
ILING ESS
3 rvlarr B PAFIeEL NLJMEIEFT
( REQUiREp r NFoRI4ATr0N)
(from tax maps in Department of Assessment and Taxationor from tax statement)
==il-- :Q-3- t4 oo\\ ?TOWNSHIP RANGE sEeTmN ffi ZON I NG
TOI^I-NSHTP NANGE SEENON
MWNSETP. MNGE SEETMN
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
ffi ZONING
ffi ZON I NG
ACRES
4 SUBDIVISIoN ( if appl icable)LOT
5 REQUEST (s;tate exactly what you plan to do)L)
a a/
al6 DIRECTIONS TO SiTE:e-s \<-
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Jpratel : QCf
ZONE/LAND USE:
** FOR STAFF USE ONLY **
DATE:_ TIME I N:_ OUT :_
NUMBER
DATE
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BY:
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., LUGENE, OR 9740I / 687-406I
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TRS# 1z-n2 q, Z ,v o- aa- o-a 172 DATE ISSUED: 2113/80 pERMTT# 49./-8G
S
LARRY L. ANDERSON
S
SAME
7 26-0843
NE NUMB
BAC KRE iR TS
,\s
FRONT 20 ' C #P BING FI XTU SLSIDE 5 'INTERIOR 5 I REAR 5 'T IZE Y I
SDS APPROTIAL REQUIRED
I
TO WES?5TH YOLANDA FTRST DRTVEWAY.
I
97 70rove
Uproved Date
E Ete ?-7- 96 /Correct i on_l Da te
E
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Inspector
I
Ap Correction Date Inspector
App roved Da te
ERSLTB PLBG.tr /UN DERFL-R PL BG.D
rrect
iNS PECTT ON
Co ion Date Ins pector
OTHER INS
App ro ved
PECTION
Da te Correction Date Inspector
GH P
Approve OUT )i IONP
Correcti on--..-,Date I nspe c tor
Ap proved Date
Correction_Da te
Correc ti on_Da te
a
Inspector
Ins pector
T
App roved Date Correc ti on_Date
I
TH /G Inspector
YPS UM BOT RD INS PE CT IONApproved Date Correction-.--D ate
F NAL MEC HAN
Inspector
App rove d_=-D D S !i
ate Correction Date
F
A
PE CTTNAL-PL UMB IN INS
Inspector
0rvpprovedDa te Correctf on =.-...-Da te Inspector
ioved Da te E ECorrectionr Date
r47 4 - I97
Da te
AN CY
In sp.T
proved
ERT
Da te Insp.
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TI FI CAIE OCC UPApp ro ved R C iFI CA E C P CY
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Inspector
L,r,rF COUNTY I I'ISPECT I0N xrCORD
OI^JN E R
NUI.4BER
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