HomeMy WebLinkAboutPermit Building 1974-08-23PERMIT OR MOBITE HO.
tS-lb-
r:16-fl+IANE COUNI
BUTLDTNG :-r
JUI[DING
MHE
USE PERMIT
PERMIT NO.
PROPERTY OWNER
GrrucEny, LtnREr*cE N.
MAILING ADDRESS PHONE
CONTRACTOR MAITING ADDRESS PHONE
PROPERTY LOCA TION _ INCLUDE POST OFFICE
Spn tHar tELD, Onecom
PROPERTY TEGAI. DESCRIPTION _ METES, BOUNDS
Lor lJ Br-ocx 0l I 3r ADo I T r oN Youll{or Prn r
RANGE
o3 :.,3.('yifuSECTION CODE CENSUS TRACT
rT
Llvnenct N. GtxcERy
EXISTING STRUCTURES ON PROPERTY
.l
APPt.
NAME
&
MAITING
ADDRESS
1868 Yexrr Srncer
TEGAL ACCESS TO PROPERTY
. ,t
Spn lxor ttLo, OnecoN
PROPERTY SIZE - FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connect to Existi Sewo e System ! New
TYPE CONSTRUCTION SQ. FT BDRMS VALUATIONSTRUCTURES TO BE BUILT THIS PERMIT
Prrro Roar l[ x 2b 9lto.lrc
Ovcn Erlsrlxs SLle
SEWAGE DISPOSAT PI.UMBING INSTAILED BY
SEPTIC TANK OWNER
WATER SUPPTY
OTHER: NAME
f] OTHER Rt r ueoy
F EESBUIIDING
WASTE DISPOSAT
PtUMEING
PI.AN REVIEW
PARK TRAILER
PUBUC !
TOTAT
COUNTY BUILDING &ITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOX: GAI..
DRAIN FIETD REQUIRED
TIN. FT TRENCH WIDTH FT OR SQ. FT
I
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTIT. EASEMENT
5N
BLDG. SETBACKS
FRONT
FT. FROM CTR. OT ROAD RIGHT OF WAY
stDE tNT. sloe Exl. r..
USE CTASSIFICATION
REAR
AUTHORIZED SIGNATURE _ DATE
J Sxoor,/slN I TAR rAN 8/4/7\DATE
DM
BLDG. PERMIT - WHITE
OFFICE COPY _ WHITE
COUNTY TAX _ PINK
PI.UMBING _ CANARY
BUITDING _ GREEN
SANITATION _ GOTDENROD
roeu*655-13
Coll 687-4065 to schedule oll required inspections. All construc-
r^ p .RTA Nr, i'; . ;[: lJ,""T']lr: U I 5l [::i ] X' ::? "ff *; j;','.,3;,"*1?#;
plumbing. All buildings require o certificotl of-occuponcy beforl
being occupied.
(See Detoils on Reverse Side)
(POST TH|S pERMtT ON MAIN BLDG. AT SITE)
IANE COUNTY, DEPT. OF ENVIRONMENTAT MANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6Th, EUGENE, OREGON 9740I
OTHERE
/
S
1
By
REOE!VEX}
AUG r 3 $74
LANE COUNTY
EI{VIRONMENTAL MGMT./rzd -a/
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BU ILD ING S ITE EVALUAT ION a c#
t n->T I R U-Scilffi TIA',fr
tac
( ) Building Permit App r ication No. /5 /b - )/ iiil'cANr'4 i nq€ r L)
ADDRESS a v
( ) Site lnspection
( ) Pre-Permit lnvestigation
LANE COUNTY PLANNING DEPART}'IENT NOT
"rpfige!-!sI . Zon ing Ord inance Comp I i ance --fT
Zone
PHONE
DATE
NO YES
()
NA}lE DATE
)
(
2
3
4
5
Subdivision 0rdinance Compl iance () () ()
Requ i red Access
Bu ild ing S ite (Area, Width,- Frontage, Setback)
0ther (see comments)
()
()
(
)
()
()
(
()
()
COH}IENTS:
BUILDING INSPECTION SECT!ON
aool icable--Tl-( )WNOTNO DATE
6, Pl ans Submitted
7. Soil Stability (footings)
8. Flood Pl a in
9. Other (see Conments)
COHHENTS:
(()
()
()
()
)
)
)
)ff'?-l '?4
SANITATION SECT!ON
10. Sewage Disposal
I l. Usable Area
12. l{ater Supply
13. Other (see Corments)
NOT NO YES AI'IE
able ,{()
()
()
()
()
))
)
()()
COHI,,IENTS:
TO APPL ICANT:
A
Your Building Permil / Site lnspection:
( i Can be approved.
( ) Cannot be approved at this t ime as ind icated on item N0.-above.
Questions and further information on items I through 5 contact the Lane-_
COUNTY PLANNING DEPARTMENT. Questions and further information on items 5
Count Buildin and San i a ion Division
Will be held in this of ice unt I you can reso vet problems i cated.
ls being returned.
Your building permit application fee is being returned under seParate cover.
/lt
(
(
(
I,ANE COUNTY PI,ANNING DIVISION
135 Sixth Avenue East, Eugene, Oregon 9740L
Phone (503) 687'4186
LANE COUMY ENVIRONMENTAL },IAI.IAGM,IEM
L35 Slxth Avenue East, Eugene, Oregon 9740L
Phone (503) 687-4065
c55-28
(
)
NA}4E
(
(
(
^
t contact t
I.ANE COUNI
BUTLDTNG I
JUILDING PERMIT OR MOBILE HO,
MHI
USE PERMIT
PERMIT NO.
PROPERTY OWNER MAILING ADDRESS PHONE
/
I
CONTRACTOR MAITING ADDRESS PHONE
pRopERTY r.gcaTroN - rNCtuDE POST OFFTCE
PROPERTY LEGAT DESCRIPTION -METES, BOUNDS
)
RANGE SECTION TAX LOT NO CODE CENSUS TRACT
APP[.
NAME
&
MAIIING
ADDRESS
EXISTING STRUCTURES ON PROPERTY
LEGAL ACCESS TO PROPERTY
i
7 tf !.or
PROPERTY SIZE _ FT.
WIDTH DEPTH AREA
FOR MOBILE HOME PERMITS ONLY
No. of Bedrooms Connecl to Existi
TYPE CONSTRUCTION SQ. FT
m New System !
BDR MS VALUATIONSTRUCTURES TO BE BUILT THIS PERMIT
SEWAGE DISPOSAT PLUMBING INSTALTED BY
IIPUBTIC
BU ILDING
WASTE DISPOSAI-
PTUMBING
PtAN REVIEW
PARK TRAITER
TOTAT
SEPTIC TANK
FEES
OWNER OTHER: NAME
WATER SUPPTY
PUBLIC N tr OTHER
$
Y
COUNTY BUILDING & SANITATION SPECIFICATIONS
MIN. SEPTIC TANK CAPACITY
WITH DIST. BOXr GA[.
DRAIN FIETD REQUIRED
I-IN. FT TRENCH WIDTH FT.OR SQ. FT.
TYPE OF STRUCTURE OCCUPANCY ZONE PUBTIC UTII.. EASEMENT
BIDG. SETBACKS
F RONT
FT. FROM CTR. OF ROAD RIGHT OF WAY
SIDE INT. SIDE EXT.
USE CLASSIFICATION
REAR
AUTHORIZED SIGNATURE _ DATE DATE
BLDG. PERMIT _ WH ITE
OFFICE COPY - WHITE
COUNTY TAX _ PINK
PLUMBING _ CANARY
BUIIDING _ GREEN
SANITATION _ GOLDENROD
Coll 687-4065 ro schedule oll required inspections. All construc-
tion sholl comply with Uniform Building Code, D.E.Q. stondords
IMPORTANT: for subsurfoce sewoge disposol ond counry regulorions covering
plumbing. AII buildings require o certificote of occuponcy before
being occupied.
(See Detoils on Reverse Side)
(POST THIS PERMIT ON MAIN BLDG. AT SITE)
TANE COUNTY, DEPT, OF ENVIRONMENTAT MANAGEMENT
COURTHOUSE ANNEX, I35 EAST 6Th, EUGENE, OREGON 9740Ironu=655-13
t/
OTHERfI
SITE INSPECTION
Ar pnov E o
Rruanxs
D t sappRoveo Dare I ruspecloR
FOLINDAT ION I NSP
AppRov E o
Rruanxs
T ION
Dr sappRoveo ,^,,7'//- 7 /I ruspecton
FRAMING INSPECTION
Reuenr s
Dr slppnoveo oo,9-70'il7-
I xserc
LATH OR SHEETROCK INSPECTION
Appnoveo D DrsappRoveo 77
Rrltrnx s
Dat E l nspecton
FINAL INSPECTION
Ap Pnov r o
ReMa nx s
o^r17-? o ' //,.spEcroRDtAVED
CERTIFICATE OF OCCUPANCY
Rerov ro lssuE
ReuaRr s
Nor RrIoy TO I SSUE Dare I NsprctoR
/€ ?o-74 ,V-".",V*7 /rotr re
Appnovro fl
,$^"qf^h
vwl:tr / sZ6_V
raNE ccx,rNrY ;;;*
DEFARIMMTI OF E}WIROIS,IEI{IAL MANAGE}{EIII }4cbile Hcrre
APPLICATION FOR zuII.DI}G PERMIT CR. },XOBIIE HO,IE USE
Ittro permit will be issr-red tntil this applicaticn has been approved.NSIE
PLEA.SE PRINI
PROPERTT I.OCATTON f t n o
2
r\w_12 RAIGE O 3 sEC TAX I.OI /I CM{SUS TRACT
IfI i\xl./ 3 Br.oo(STIBDWISION
ACCESS Tro PRopRTy Ve n*" St muIII /o,i ' DETH )O5 , oR AGREAGE
DESCRTBE H<rsrrrrc sfuucnnus oN rHE pRopRIy pa.t e-LLt pL -fioL S rd e d
APPLICANI
MME G,N I4AILllG
ADDRBSS
ADDRESS
c t e(
MME ( PIIONE
Stnrctr-res to be built/Mobile llcue s(. ft /lbedrocns vah:ation
/q ad
?
Sewage Di-posa1-
Site Iiespection JL1r Exis ting seniage disposal systen A* ne$^7 systsn required D
Water Stqpply' /- \
hrblic E District Nme \\ a^-,*f-t *,,e I,[e11 D Spring lll other
Brdg.
Waste Dis.
Plunbing
Plan Revier^r
Ttailer
17" strcharge
/O,oO Fees
Pfurbing
Pfurbing
-tt
Installed by G^arer Other I{ane:Fees Ser,rcr connection i^Iffi
of fixtwes inspection fee inspection fee
,oBusY
Wdeck
Plans fr:r'nished Facility
Yes E No
t
YesEl}{o
Signattre of Applican
Dt
TUIAL / d, to
i^rith dist. box: Gallons
Fee received
Lineal Fee t____!tanch Dep rh
date
or
Tlpe of Stnrctrxe 5i U Occupancy --A Fi-rE Zcrne_Tse Classification
8-1
center \^lay
c55-L2
Side let E:<terior 1 n rr S* zry,;re
2 -7
PHCNE 7 / Z 7 2/J
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Sq. Ft
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Ir[:(:! {:ft i F I ft EIrA l,jA LiE
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Ht..HfqNUFt GINSEitY '74?*72L3
LfJdSl YENTFT
$tlH:tNGt'IE.Llrr UR V'7477
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
*ffiDll+
DATE:2-18'97
TO:
FROl''l:
SUBJECT:
Bu'il di ng Deoa rtrnent
Springfield Fire 0epartment
Structural Damage to Bui 1d'ing
Address or'location of building
itlame of or./ner
Type of building
Es tir,rated va I ue of bui l di ng 5 D o
Estimated I oss to bui lding s 4oo
Date of fire
l-ccation of damage in building
(Dweliing, Stor [,iarehouse, etc. )
^A9L-
OO
( Roof ,i^Jal I , Exterior, Interior, etc. )
Structural weakness as a result of the f ire '-71.V?-L
(3urned rafters , Seams , "lci sts , e;c. )
ACd'itjonal pertinent jnfcrmation
El ectrical ilazard
(i,/i ri nq, 0utl ets , etc. )
Siqned
i
CONTROL
District of Incident
2 INCIDEN-'I'ADDRESS
NA]\IE (t rrst. MI)
{ BUSINI]SS (list, FiEt, fvll)
5 Ofrh\UR NANTE (Last' Firsr. Ntl)*.t
6 l'lRE RIIPORTIID tsY (Last, l'irsr, lvll)
++
,JO NOT WITITE IN TIIIS SPACE
r:xP
NO,
STATE OF OREGON FIRE REPORT
STATE FIRE NIARSIIAL
9l I ('f ie Linel
Voice Signal Muni Alarm
E Nu eh.- Rc'd E Not Classified Above
I OtherlList)
I ( /
-r ) I /''-L','t/',//--i ', l'C )(-Qi-t.IIIE I)EPT.i
-rLAItNl NO.
NO.
ALARM !
D
S , On rlttC sCnVlCE PER-SOI-NEL
RESPoNDED
Structure Fire
Outside Struct. w/value
,Ei.t'f Y
Telephone bttct
Municipal Alarm SYsteE
Prilat€ AIam Sysbm
z st0tles
fl vehicle Fire
! Brush.Grass,l*ave
! Trash,Rubbish
l0 to l9 fet
?0 to 29 fet
I Aummtic Ext. Sysum
! Pre-connect ho*lmnk onlY
! Pre-connect hose/hvdrant. sundpipe
30 to 49 teet
I 50 ro 70 teet
lladro
Verbal
o
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4'
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zt.
9 TYPEOT'SITUATIONFOUND
,atr
IO NTETHODOF
EXTIn-(iUISHltlENT
! Self-Ertrnguished
)<l
D
Make-shift aids
Portable Extinzuisher
f] Hand-iaid hose/h]'drant. standpipe
I llasur Stream Device
I Not Classified Above
! f)ndetermined
Over ?0 fet ftel,level Lindetermined
! ObiecLr in Flisht Not ('lassified
l:l to Z{ slorles iu stotles or more
D 25t.49.tories
[: nprotect. i\'lason r] l}t. & !l urd I nt.Unprotected Wqrd Frame
Wood l rame Not Classified Above
I
\t t,E
PIi0PERTY
12 ROOI\I/AREA OF
E EQUII'l\,lliNT
In'VOL\-FlD
IN IGNI'I'ION
l3 lGNn'loh\ FACTOR
or'T OT'IG
lr !'
IJ
l5
'6 veLUE
LOSS
OT- FIRE ORIGIN
(lrade ievel to
HEIT OF S1'ORIES
f] 3trt.m.i""
; !0 b su)tles
? t() l2 str)ries
I9 (]ONS'TITUCTION
Steel &
!:XTEN1' OF DAMAGE CONI'INED TO:
I Thet,hjectofr,rigin
2 Pan of rmm or area of origin
3 Roomoforigin20 4 Fi.e-."t"dcomp.oforigin
5 Flmr ol origin
6 Structu.eoforigin
7 Ext€nded be!,ond struclure of orifin
g Nrr damage of the tYPe { N/A)
2I RE:\IARKS W,Conditions (optx,nal)
Steel
e!
N --X If )-es. who will inveitisak
IE I]UILDING AGE {
22 Folkr* t lnvesttgatr-m
23 Numberol lnjurre
Fire Seruice
24 lllembcr Making
25 Additrrnallnlormaturn
Heavy'I rnrber Unprottct. Stel Bldg
t; N(:
R1a-Adn-1n /R-841
,E
Flxt. & l\I nt.
Smokef'lame x
E!
D
En
DEtr
D
Co!
I
2
4
5
0
llequestcd Y
tRespondineC0untv
SERvICE\ 2r3 11
TIt\IEtsAcK lNARRIVAL 1'I\IT]
)r J-r t r?
ALARI\I'TI]!IE
I r.lrl r'l
I sun
! ltun
ITue n
q. w"d tr
Thur
Fri
fl Sut,'DAY OT'
lt'EEK
I]A\YI]ARI,l0
o ISO CLASSvCF]NSUS TRACT
ra Qia-Lz10 t\flfl
ZIP
1q1 -lltZTELEPHONED0B (optiotral)
TELEPHONEDOB ioptional)ADDRESS
TELEPHONE,\I)Ots (optional)AIJDRF]SS
TELEPHONE
t(
DOts (option8l)ADDRESS
or lnlestlSate only,
E N/A! Given! Reeived
I CIT EENTEU IgPAIIATI-]S RESPOh*DT]D
DI
t OF ENGINES RESI,O\.DED
! Saltage
f] Not Classiired
TYPE OT'ACTION T.{KEN
! Removed HaardI Ertinguish
Stand By
Itl Y lComPlcElrne\IOBILE
t.tclt.\sE,SE,RIAL
'\IODEL.{KIi\.E.{R
N (Compiere Line E)\1U\T IN,\.EI)IGNITIOIPvol-EQU
L(L<-,/
VOLTAGE
YEAR t\,1.{KE
I'IED:FIRSl'FIRST IGNI'I'I]I) \IAS \IAIJE OT-
.{)0Other
.00vehicle and Conteno
.OO.00oo.00
oo -Ou.00.00.00.00
500,()u0 sq fr50.U)0-99.999 sq ftl0u)-4999 sq ft I0.{)0t)-19.999 sq ft
rilx)o-9999 ItIJUILDINC SIZE (Grnd Flr OnlY)
fr-999
f) !4uipment oPerated
D ftuip. 'hould have .per.-did not
n [kuip. present fire too small tl oper'
I Nrlclassifiedatxrve
! ttodetermrned or nrtr rePorted
D No qurpment Present tN/A)
Sprinkle.scootrolledFire: yg5 ! NO D
SI'Itl \' KLl:R t'ERl'Oh l\1A NCE
# of Heads Opened
DFITIICTOlt I'lll{} OR\'lAr-(lE
trtr
U
tr
D!
D
tr
tr
I Inroomoforigtn-opr.
2 Not in rstm of origin-rrPer.
3 In rm of origin-not op€r-fire t(D small
4 Not in rm of origio-not oper' fire trrl small
5 ln room of origin-not olEr'Fx)werdisconnect
6 Not in rmol origin-notoper'powerdiscon'
7 ln room oforigrn- nrrt op€r. dead batkry
8 Not in roomof origin-notoper'de8d battery
9 N() detstor prc*nt D l0 Lindetermined
Numbe. ul IaEliti6
I)aE
[)ate'l'itle tl
()ther
! cnnt. ut b""k
I OTHER VEHICLES RFISPON"DED
(do not include PA's) ,
l rtle
l'nn l/^t*