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PROPOSED USE OF PROPERTY
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APPLICATION THOROUGHLY
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rnstallation Record rssued? fl x"" fl uoI saurtetrou:
Maximum Depth
of Trenches
Date:
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COM}lENTS
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Date
TION
FOLLOWING CONDITIONS I t
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Minimum Setbacks:
COT4.\ENTS:
inte rear
Lineal Eeet
of Drainfield
rnstallation Gallon
Soecifications: Tank
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PERMIT APPROVED BY BUILDING OPFIC Der oRs 4 .805
LANE COUNry DEPABTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 6874061,
125 EASTSTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INI'ORMATION cL4-25 R*
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READ THIS SECTION CAREFULLY. YOUR
DATE
[1-os -:.r!-5.1, l% dLANE COUNTY, OREGON
DEPT. OF ENVIRONMENTAL MANAI
JOB ADDRESS
TO
NOTE
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Cc,FIFTECTIc,N
CONSTRUCTION PER IVI ITS
A INSPECTION DIV.
NclTICE
DATE
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Phone eiE T-4o,Ei,E5 FoFl APPFIoVAL INSPECTOR
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Approved D ate
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Correcti on,Da te Insp ector
Correction Date InsPector '
Approved Date
UNDERS PLB G.tr /UNDE RFLR PLBG.NSPE ON
I nsp ectorApproved Da Correcti on Date
Correct'ion Date
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OTHER I NSPECTION Insp ectorApproved Date
ROUGH PLUMBIN OuT)t ttsprcrt onG (ToP
Approved'-Date Correcti on Date I nspe ctor
FRAMING INSPECTIONApproved Date Correcti on Date I nsp ector
ROUGH MECHANICAL
Approved Date Correcti on Date I nspector
U Ti
Approved
V R
Date
IER IN ECT N
/Correcti on Date Inspe ctor
LATH / GYP SUM BOARD INSPECTIONApproved Date /Correcti on Date Inspector
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Approved Da te rrec t i on Date
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Correcti on Date
Inspector
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SETB TCKS AND OTITER CC].:DITIO:;S OF APPROVAL }IUST BE SIRICTL! OBSER'VgD. VIOLATION CAN RI]SULT IN REVO-
C;TIoN oF TIIIS PIRI'IIT, cITATlo:I U}JDgR PROVISIONS Oi,\AN-E }OUTTT.: INERACTION ORDI\ANCE, AND,/OR OTHER
RETIEDIES ALLOHED BY LAW.
WHEN RE.tDy FOR I]-SPECTION, CAL:68?-4065. h Ylr'IllUi1 OP AT LEAST 24 IIOURS ADVAI;CE r'OTICE FOR INSPEC-
TT0S-F€OU-EETS-.i',1-ST-T-GrVE}.-.,.ri:7; Lhe following in:ornation ready: permit number, job address, tyPe
of inspection, when it wrII be !eady, your name and rlioi..umber, and any special directions to site.
BUlLDING DIVISION I
REQUIRED I}"SPECTIONS :
l-. Foundation ll:psgllglt To be made after trenches are excavated and forms erected and when all
naterials for the foundation a!e delivered on the job. lJhere concrete f!on a certral mixj.ng
pLant (comonly termed "transit nixed") is to be used, materials need not be on the job.
2. Concrete Slab or Under-aloor Inspection: To be:Jce a:ler al-I rn-slab or under-f1oor buildtng
sEii-iwqurpmmtl- c6Zurt, pfFinE- alcEssories, and other ancillary equipment items are i.nplace but betore any concrete is poured or floor sheathing installed, including the subfloor.
3. Framing & lnsul,ation InsPections: To be made after the roof, all framing, fire blocking, and
bracing a!e in pl-ace aed al-I pipes, fireplaces, chj.mneys, and vents are complete and all roughelectrica.l- and plumbj-ng are approved. AII wall tnsulation and vapor barrier are in p.Lace.
4. Lath and/or G],psun Board fnspection: To be made after a11 lathing and qypsum board, inCerior
and exterior, is in place but before any plastering is applied and before gypsu board joj.nts
and fasteners are taped and finished.
,5. Fj.nal Inspection: To be made after the building j.s complete and before occupancy.
APPROVAL REQUIRED. No work shall be done on any part of the builCing or stlucture beyond the point
indicated in each successj-ve inspectj-on without firs! obteining the approval of the building offrcial
such approval shall be given cnly after an inspection shall have been nade of each successive stepin the construction as indicated by each of the inspections required.
NOTE:AII building permits require inspections for the work author.ized, such as but not limited to:
Block t^IalL: To be made after reinfolcing is j-n place, but before any grout is poured. Thisii'ilrctI6f, is required f or each bond beam pour. There will be no approval unti-i the plwbing
and electrical j.nspeclions have been made and approved.
t^lood Stove: To be made afLer completion of masonr), (j-f applicable) and when instatlation is
@feta Installation shaIl be in accordance with an appioved, nationally recognized testingagency and the manufacturerrs installation instructions.
C. Mobil-e Home: An j.nspection is requj-red after the mobile home is connected to an approved
iEwEFo--E6ptic system for setbacli requirenents, bl.ocking, footing connection, tiedouns,skirting, and pLNbing connections.
1. Footinqs and piers to comply with state foundation requirements for mobile homes or asrecomended by the manufacturer.
2, Mobile hone ninimum finish floor elevation sha1l be certified when required by a flood-plain management Ietter.
3. Mobile home tiedowns, when required, and skirtj.ng shall be installed and ready for inspec-tion with.in at leas! 30 days after occupancy. Tiedowns and skj.rting shall be installedper enclosure.
D. swimj.ng,PooI: Below grade when steel is in place and before concrete j-s poured. Above grade
when pool is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALI- TrMES DURIN-G WORKING HOURS. THIS PERMTT WrLL EXPIREIE WORK DOES NOT BEGIN WITHIN 1BO DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR }IORE THAN 180 DAYS.
SUSPENSION OR REVOCATION ].lAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POIIIT OI REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
1. Permits shall be effective for one year from the date of issuance.
2. UPon completing the construction for which a permit has been issued, the permit holde! shatlnotify Lhe Lane County Departrent of Planning and Comunity Development by submitling Lheins!aIIati'on record form. The Department shall inspect the constructj.on to determj.ne if itconPlj.es with the ru.Les contained in this division. If the construction does conpLy with suchrules, the Department shaIl issue a certificate of satj.sfactory completion to the p;rnit,i holderIf the construction does not comply wj-th such rules, the Departrent shalt notify the pernitholder and shall require satisfactory conple!ion before issuing the certificate. Fail.ure tomeet the lequirement.s for sat.isfactoly compLetron within a reasonable lime constilutes a vio-lation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurfacc Sewage Disposal
From: rirerior propelty tincs *,.1i,* *T=
Edge oi road rrqirt-of-way I0, 10'
Burldinq foundatron ]0'welLs, other wate! sources 50 100 '
B
hre ccxrrty
ACTI\. iY INFORMATION S,{EET
COMPLETE THIS SECTION. INCOMPLETE FORMS t.JILL BE REJECTEDI
** FoR STAFF USE oNLY **
z0N LAND USE:
BY: DATE:
-
TIME IN:- OUT:
NUMBER
DATE
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BUSINESS TELEPHONE #
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HOME TELEPHONE #H0I4E TELE-IHONE T BUSINESS TELEPHONE #
2 PROPERTY ADDRESS(IF DIFFERENT FRO
3 ruae I PAFIcEL NIJMBEFI
( REQUTREp rNF0RI4ATroN)
(from tax maps,in Department of Assessment and Taxationor from tax statement)
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TOWITSH IP RANGE SECTION
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TAX LOT(S) OR-PARCE-L?
MTNSFTP MNEF SEETI_0ru W ZONING
TOINSETP R-ANGE SMTION W ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:ACRES
+ sUgOIVISI0N (if applicable)
5 REQUEST (s;tate exact'ly what you plan to do)
6D ECTIONS TO SITE:
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LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 9740I / 687.4061
1 t .Q //triraLo iu^ u\e-/1 ,lhn i* # Qaw k/rrroh a A^ br, eaI - PERSON MAKING REQUEST / PROP€RTY OI.JNER
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