HomeMy WebLinkAboutPermit Building 1981-10-15b ro'' toN srRU-#?V,tiAC E M ENr
CO}IPLETE THIS BLOCK.PLEASE USE BLACK INK AND PRINT.
tr PLANNING,/ZONING:Zone ijartition n Parce I tr----Parce t Srze
FOFI OFFICE USE ONLY
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f,rwo Copies of Piot Plans
f] laechan ical checklist
f elrrmbrrq Chec]:1ist
Applica
Permi-t
Two Copics of Plans
Plan Check Info Sheet
PROIOTEIT USL L)F II{OPER
KResiaentiar [-lrndustrial
'flcommercial Iruntic
S VALUE4
SUPPLY &r/ E&:::;:3#oF
ry;'iFfl
TELEPHOI{E itU}]!EK%
that reqistration with the Builder,s Board.is in ful.I force and effect as required by ORS 701.055, that if exenPt the basis for exemPtion is n,rt'rd
hcreon, and that only subcontractors and employees who are in corp.Iiance with oRs 701,055 will be used on Ehis Project. I HAVE READ AIID CIIECTJD THrs
APPLICATION THOROUGTILY.
DATEFEFmTRE
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1S co r r.l atnd and urf thcrtr'c rh 1nalI 10nformatPERMI'roR T andEXAMINEDYCOMPLETEDTHEAPPLICATIONCAREFULL
ordthe Laneof and the of S L.rthe ofl:e LaL)re (r:)nCounty n.JworkaI1shformeda1donebeaccordancelntha!and pefyany
wire thethout 10n o Buithe td v1Di ons1 fur l-heIINhereandNOtha t wi.1IOCCUPANCY made of rucSt pe mr ss 1 llgbetoworktheibedanydescr
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Comment
Installation
speci fications
Comments:
L s ide
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fl f'frOOOpfrefN! rn flood hazard area? D *o f, v"=, see at'-a:i1ed sl,eer.
fl nunar,ADDRESSING: cRlD cooB.DlNArE N
tr SI,NITATION: s. r. #
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Date:
Date:
Date:
B. P. #rnstallation Record rssued? [ v.= [ H"
Maximw Depth
of Treriahes
Date:
Ga 1 Ion
Tank
Lf rlea.t .b eet
of Drai;rfi-el-d
Elpr,aus/EXAMINATION:,rr" 6k) e,oue-@-.Use
CONSTRUCTION AUTHORTZED BY THIS PERMIT
Coments:
scr].Sq. Ft
Pixed Fee,/
Unit
.Cost
Floodplain Fee
surface
lding
Date:
ter
Fixtures
s
s
(
+
$
$
s
$
$XO,6qAL FEE
TOTAL VALUATION $
P ID
PERMIT APPROVED BY IC (per ons 456.805(1
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, E
C74-I94 SEE REVERSE
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, oREGON 97401
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SETBACKS AND oTHER'CoNDITIoNS 0F APPROVAL MUST BE STRICTLY 0BSERVED. VIOLATION CAN n-srJLT IN REVOCATIgN 0F THrS pERMIT,cITATIoN UNDER PROVISIONS 0F LANE C0UNTY'S INFRACTION oRDINANca, AND/OR Ortien nellrorls rulOwro By LAw.-
I'IHEN READY FoR INSPECTIoN CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NoTICE FoR INSPECTION REQUEST MUST BEGIVEN. Have the following information ready:. Permit numberr-5ob addresi, trfi;i inspectlon, when it will be ready,your name and phone number, and any special-direct.ions to siiel
BUILDING DIVISION:
REQUIRED IIISPECTIONS
l) F0UNDAIIoN INSPECTIoN: To be made after trenches are excavated and forms erected and when all materials for the foundationare delivered on the job. Where concrete from a central mixing plant (commonly termed ,'transit mixed,,j-it-to-6" r;;J;-- -
materials need not be on the Job.
2) CoNqRETE SIAP 0R UNDER-FLooR INSPICTI0I: To be made after al] in-slab or under-ftoor building serv.ice equipment,.oc-i11ary.equip,eniiiemsareinplacebutbeforeanyconcreteispoured
or floor sheath'ing installed, including the su6floor.
3) FRAMING & INSULATIoN INSPECTI0NS: To be made after the roof, all framing, fire btocking and bracing are.in place and;Ti--pipes@sand.ventsarecomp1eteanda.lIroughelectrica.landi.lumbingare"approved.A11
wal'l insulation and vapor barrier are in place.
4) LIiTtl AND/0R GYPSUM BOARD INSPECTION: To be made after al1 lathing and gypsum board, interior and exter.ior, is in placeorbeforegypsumboard-jo.inisano"ilsienei-aretapedandfin.ished.
5) FINAL INSPECTION: To be made after the building is complete and before occupancy.
APPRoVAL REQUIRED. No work shall be done on any part of the building or structure beyond the point indicated in eachsuccessive inspection without first obtaining the approval of the building oifiiiat.--suctr approval shal'l be given onlyafter an inspection shall have been made of each suttessive step in the c6nstruction as indicated by each of the inspectionsrequi red.
N0TE: A1l building permits reguire inspections for the work authorized, such as but not limited to:
A. BLOCK WALL: To be made after reinforcing is in p1ace, but before any grout is poured. This inspection isrequired for.each.bond beam pour. There will be no approval until t6e-plumbing'and electrical iirspectionshave been made and approved.
B. ld00D ST0VE: To be made after completion of masonry (if applicable) and when insta'llation is comotete.Installation shall be in accordance with an approved nationally recognized testrng agency arrd the manu-facturer's'instal lation instruct'ions.
C. I40BILE H0ME: An inspection is required after the mobile home is connected to an approved sewer or septic
system for: setback requirements, blocking, footing connection, tiedowns, skirtinb', and plumbing
connecti ons.
(1) Footings and piers to comply with State foundation requirements for mobile homes or as recommendedby the manufacturer.(2) Mobile home minimum finish floor elevation shall be certified when required by a floodplain
management Ietter.(3) l4ob'iie home tiedowns, when required, and skirting shall be installed and ready for inspectionwithin at least 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure.
D. SWIMMING P00L: Below grade when steel is in place and before concrete is poured. Above grade when pool
'i s instalIed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING I.IORKING HOURS. THIS PERMIT WILL EXPIRE IF h,ORK DOES NOT BEGIN
I.IITHIN I8O DAYS, OR IF l'lORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERMIT }lAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANY0NE PRoCEEDING PAST THE P0INT 0F REQUIRED INSPECTI0NS WILL D0 50 AT HIS 0t'tN RISK
.., :
SUBSURFACE AND ALTERNATIVE SEWAGE 0ISPOSAL SYSTEMS
(r )
(2)
Permits shal l be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued the permit holder shal'l notify the
Department by submitting the insta'llation record form. The Department shall inspect the construction to
determine if it complies with the rules contained in this division. If the construction does comply vrith
such rules, the Depirtment sha'll'issue a certificate of satisfactory conpletion to the permit holhei. If the
construction does not comp'ly with such rules,'the Department shal'l notify the perqit holder and shal'l requiregatisfactory completion.before issuing the'certificate. Fai,lure to m'eet thrlr requi'rements for satisfactory
completion within a reasonable time constitutes.A violation of ORS 454.605 to 454.745 and this rule.
Set!3qksr. r l@sqrfase Jggff._9jipg.Sgl_
--T_.-_
From: Interior property lines
Edge of road right-of-way
Bui ldinq foundation
l,lells, other water sources
Septic Tank Drai nfi el d
-T6T-'10'
l0'
5'
50'
t0'
l0'
'I 00'
Environmental Management
ITY INFORMATION JHEET
I
ldne county
ACTI-@COWLETE THIS SECTION, INCOWLETE TORMS WILL BE REJECTED:
o
PERSON REQUEST PROPERTY OWNER
2 tob -SNAO I l'\avb{
^)
3(])h
MAILING ADDiTNSS MAILING ADDRESS
(A re q-t411 t
CITY STATE ZIP CODE CI STATE ZIP CODE
-4b- 3 q )?
BUSINESS TELEPHONE NUMBER HOIvIE TELEPHONE NUMBER HOME TELEPHOIJE NUMBER
@ tax MAp,/pROpERTy DESCRIpTION NUMBER (from tax maps in Department of Assessment & Taxation or from tax statement):
lrap&ParcerNumber, )1 03 ?t {' raxLot(s):
Township nange Section
I O,rt of TL
Tax Map & Parcel Number of Adjoining Property in Same ownership
3 +6o
If,By Partition +--
tax Lot(s):
Tor"shfp R*ge Secti"n
! uone l--l unkt'own
@ SueorVrSroN (if aPplj-cable):BLOCK LOT:
@ ngQUgSf (briefly describe information needed):€
@ rotar, coNTrcuous PRoPERTY .rN SAME oWNERSHTP:
@ enoreRrv ADDRESS 5n v.r,€
acres
O pnnssNt usE oF PRoPERTY:n t CLL
@ NuMern oF STRUCTURES oN PRoPERTY: standard home X
Modular home RV in use as residence-
Garage X shoP-
Mobile home-
Storage-.-
Barn
J11 I r-)
@ eccnss TO PRoPERTY: Public Road Name
Private Road Name
Road Easement
#of
wialth Users
@ orsen EASEMENTS ovER PRoPERTY:
@ wetnn DrsrRrcr:Rni n\r^tr)@ rrna DrsrRrcr:
@ euuortlc PERMrrs oN PRoPERTY:
COMPLETE THI
CONSTRUCTION
S SECTION FOR
APPLICATIONS
LAND USE,
OR PROPOSALS SEE *NOTE BELOW.**FOR STATF USE ONLY**
NUMBER:
DATE:E Fl
F
U)
FltrtlTIME INITIATED:
CI1ECKED BY:
ATTACHED EXHIBITS:
flerot plans (2)
! constr. Plans (2)
I sit. rt..,
fl copy of rax MaP
f oth"t
SCREEN ING VERIFICATION:
By:
Date:
Time In: Out z
-I accept f] neiect
Routed to
*NOTE: ATTACH A COPY OF
ier-uep ; sHCl{ EXTSTTN'i
STF.UCTURNS AND TAii LOTS
IN YOUR Oh'}.IERST]IP. OB-
TAIN TAX MAP IN SELI
HELP AR-EA OF A & 1..9/81 REV (OVER)
Cnrr-tV N rN1',\6cA)
BUSINESS TELEPHONE NUMBER
NIP \.\A it t: irr <pr b +i ^l C" t-
<id,"
COMPIJTE TIIIS SECTION FOR LANT^'SE OR CONSTRUCTION APPLICATION9--**FOR STAFF USE i r,Y tr
@ enorosrD usE or PRoIERTY rN DETATL esidenticr-Lr
By:
Date:
Time In:-- Out
@ aurr.orNG REoUESTS:
Contractor I s #Se. L€(for mobile home setup also)
ft accept I neject
I etanning Application
I Construction permit App
I lnformation only
Zoning:
SANITATTON:
By:
Date:
Time In:Out:
I accept f] neject
fl Constr. permit Issue
fl si.te Evaluation rssue
PERMTT ISSUED (SAME DAY oNLY):
Permit #
By:
Date:
'l'1me -tn Out
Directions to Site:h/4 -n {
04-.rL
Z_
IL,
l\4-, rL 4L/L .€AuJ Comp. Plan Designation:n-
Check the type of reguested:
DweIling:I uew
I aaaition
I ltodular uome
flnv
I neplacement I additional;
fl alteration;
! uoUite Home - Model year_
I Standard Construction ;
Ief.r, Check only {"4"-fr* L(...-- u;44*l
[-l Commercial: Use
Iagricultural: Use
fl otr,.r": use Floor Area
I cf,u.,gu of, use - How?
@ uur.rean oF BEDR..MT ,'- i NUMBER oF sroRrES
@ salrrarroN REouESrr, i I A
f, Slte evaluation for SoS feasibili.ty
f, new system installation
! nepair/replacement
f] alterat ion,/re location
IHoot to existing
ADDITf ONAL INFORIT4ATTON :
ZONE/LAND USE:
--qEq
.ANcELLATIoN/REFUND AUTHoRTzATT- pERMrr #
^?/7/-
f/
NAME (PLEASE PRINT)
ADDRESS /s-
APPLI CANT N owrlrn ( )
REASON FOR CANCELLING PERMIT
RACTOR
S I GNATURE DATE r/
FEES PAID FOR WASTE DiSPOSAL SYSTEMS (SiTE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE SEPTIC
TANK AND onntilrtit-ol-nnr oRDINARIT-y uonnrruNDABLE. soME REFUND MAY BE 0N THE BUILDING AND
pLUMglNe pORTioNS RICOnOtne T0 THE AMoUNT 0F THE PERMIT PRoCESSED.
AUTHORIZATION FOR POS SIBLE RIFUND:% BUILDING PERMIT TTT $
x
% MOBILE HOME FEE $
PLUMBING PERMIT TTT $
% PLAN CHECK FEE $
% STATE SURCHARGE TTT $
% SEPTIC DISPOSAI TTT $
% SITE INSPECTION FEE
MINUS $25.00 FOR PROCESSING FEE
TOTAL AMOUNT TO BE REFUNDED
p 4l $
$
$
f D
S I GNATURE
: DEPAR FI
BUILDING PERMIT REFUND $
STATE SURCHARGE REFUND $
SEPTIC DISPOSAL REFUND $
SITE INSPECTION REFUND $
TOTAL AMOUNT REFUNDED $
PLEASE l,1A 0
NAME
DATE
24-08:74/ACCT 42120/PROG OVl Receipt #
24-OB:f4/ACCT 42124IPR0G 0,/l Receipt #
?4-08-14/ACCT 42133/PROG 0{3 Receipt #
24-aB-74/ACCT 42134/PR0G 0q, Rece'ipt #
E
7
DEPARTMENT OF ENVi
C,OURTHOUSE/ PUBLI
I 25 EAST BTH AVENUE
C SERVICE BUILD
, EUGENE, OREGO
ING
N9
NT
740i
ADDRESS
YABL
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