HomeMy WebLinkAboutPermit Mechanical 1982-03-22mV
-7
CON STK:' CT ION/PLAC E M EN' "PERMTT 3_/A
COI{PLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
FOR OFFICE USE ONLY
TOWNSHIPt7 ov A,4Z M
SUBDIVISION//PARTITION (if applicable)LOT,/PARCEL BLOCK
LOCATION ADDRESS Nr. zl5r-d,ztPO
PROPOSED USE OF PROPERTY
ffiesidential
[-l commercial
I rndustrial
flrruric
Ct-t tx*
f OF BEDROOMS3 UF STORIES
I
#oF W}I.ER SUPPLY,TKtq*t,t 01 E Proposedffr.xisting
TELEPHONE NUMBER
5W-',ffiru- uFilEffiIGF=--*5aqb4 DI ONS
'{
I IIAVE CARETULLY EXA_I4INED THE COMPLETED APPLICATION FOR PERMIT, and do hcrcrby ':crtifi that all inforration hercon is true and corre.t ar).i I furt]rcr
certify that any and aII work lrerforred shal1 be done in accordance with Lhe ordirarccs of Lane County and the LaBs of thc stat-e of Ore,)]rr !,,-'rtaining
to the work described herein, and thaL No oCCUpANcy will be made of any structure without the permission of the Buildirrg Division. r furth.r (.rlrfy
that registration wlth the Builder's Eoard is in fu11 force and effect as requ.irc,f by ORS 701.055, that if exenpt the basis for exemPtiorr is not'd
hereon, and lhat only
APPLICATION THOROUGHLI
subcontractors and employees who are in compli th oRs 701.055 will b.e used on this project' I HAVE READ AND cllECruD THIS
t
t l-'l or,r"t
ffontrrrt",
fl eeentNAMEDAIE
tr PLANNIN ZONING 3 zone Partition #Parcel #.
interior
I arcel Srze--
trllru.mw Setbacks: CL,front_CL, .rd.. .re ar
CoIrutrents:
I f'frOOOpf,ef U 3 rn flood hazard area?
fl nunal ADDRESSTNG' cRrD cooRDrNArE
tr SAIiITATION: s. r. +
(*"! ves, see attaclred sheet
EN
Date:
Date I
Date:
B. P. #rnstallation Record lssucd? ! v.= fl lr"
Maximun Depth
of arenches
Insca 1 Iation Gal 1on
Tank
Lineal Feet
of DrainfieldSpeci fications :
Co[unents
Date:
d PLANS EXAMINATION: rype 5U ",o,n R- 4 Use
Coments:
Date:tu?- L2:81-
CONSTRUCTION AUTI{ORIZED BY THIS PERMIT
Des Sq. Ft
- t l't tia,-A-
Fixed Fee,/
Unit Cost
Floodplain Fee S
Subsurface Fees I
Bui J-dlng Fee $
Sewer/Storm Drai.n/Water $
Plumbing Fixtures $
Mechanical $
Plans Check Fee S
State Surcharge $
TOTAL FEE $
q
halll-wzr,rfP .J o
FEES PA
By:
Date:
Check flcasrrrBY:
TOTAL VALUATION S
A-n >8L
DATE
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEIT,IENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON 9740L
C74-I94 SEE REVERSE
iip,:^:ii'"4:/)-8?
fl rro Copics of Pl-ans
flrwo Copies of Plot Plans
f] l,techanical Checklist
felu*Ui.,g Checklist
Ie:-an Check rnfo Sheet
T
tr
-fT V\oP-?+=
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (per ORS 456.805(I))
SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT,
CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, ANDIOR OTHER REMEDIES ALLOWED BY LAH.
I,IHEN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST MUST BE
GIVEN. Have the following information ready: Permit number, job address, type of inspection, when it will be ready,
your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIRED IIISPECTIONS
l) FOUNoATION INSPECTI0N: To be made after trenches are excavated and forms erected and when all materials for the foundation,ffiob.Whereconcretefromacentra.lmixingp1ant(common1ytermed..transitmjxed..)istobeused,
materials need not be on the Job.
?)C0NCRETE SLAB 0R UNDER-FL00R INSPECTION: To be made after all in-slab or under-floor building service equipnent'
ary equipnent items are' il p'lace but before any concrete is poured
subfl oor.
3) FRAMING & INSULATIoN INSPECTIoNS: To be made after the roof, a'l'l framing, fire blocking and bracing are in p'
sandventSarecomp.leteanda.llroughe1ectrica.landp1umb.ingareapproved.
wall insulation and vapor barrier are in p1ace..
4)LATH AND/oR GYPSUM BoARD INSPECTIoN: To be made after all lathing and gypsum board, interior and exterior, is in place
orbeforegypsumboardjointsandfastenerSaretapedandfinished.
(1)
(2)
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
Permits shall be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued the permit holder sha1l notify.the
Dbpartmeht by iubmitting the installation recbrd form. The Department shall inspect the construction to
determine ii it compliei,with theirules contarlned i4 this division. If the construction does comply vtith
such ru'les, the Department shall issue.a certificate of satisfactory completion to the permit ho'lder. If the
constrqction does not comply with guch-t"ules, the Department_shal1'notify the permit holder and shall require
satisfdctory completion. befbre'jssuing the certifigate. Failure to meet the requilements for qatisfactory
comp'letion,within a rea'sonable time constitutes a violation of ORS 454.605 to 454;745 and this rule.
conduit, piping accessories and other ancill
or floor sheathing instal Ied, including the
From:Interior property lines
Edge of road right-of-way
Building foundation
l.lells, other water sources
'lace and
An
5)FINAL INSPECTI0N: To be nlade after the buj_lding is complete and before occupancy.
APPR0VAL REQUIRED. No work shall be done on any part of the building or structure beyond the point indicated in each
successive inspection without first obtaining the approval of the bui'lding official. Such approval shall be given on'ly
after an inspection sha1l have been made of each successive step in the construction as indicated by each of the inspections
requ i red.
N0TE: A11 building permits require inspections for the work authorized, such as but not limited to:
A. BLOCK l,lALL: To be made after reinforcing is in p1ace, but before any grout is poured. This inspection is
required for each bond beam pour. There will be no approval until the plumbing and electrical inspections
have been made and approved.
B. l,I00D ST0VE: To be made after completion of masonry (if applicable) and when'installation is comolete.
Insta]lation shall be in accordance with an approved nationally recognized testrng agency arrd the manu-
facturer's instal lation'instructions.
C. I40BILE H0ME: An inspection'is required afttir.tlr€'mobile home is connected to an approved sewer or septic'
system for: setback requirements, blocking, footing connection, tiedov{ns, skirting, and plumbing
connect i ons .
(f) Footings and piers to comply lvith State foundation requirements for mobile homes or as recommended
by the manufacturer.(2) Mobile home minimum finish floor elevation shall be certified when required by a floodplain
management letter.(3) l4obile home tiedowns, when required, and skirting shall be installed and ready folinspection
within at ieast 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure.
D. S}IIMMING P00L: Below grade when steel is in place and bef,ore concrete is poured. Above grade when pool
is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT tlJILL EXPIRE IF WORK DOES NOT BEGIN
}IITHIN I8O DAYS, OR IF I,IORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERTIIT t^lAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS I,JILL DO SO AT HIS OI,IN RISK
Sept'ic Tank Dra'i nf iel d
-T0''-10.
'I 0'
5',
50'
l0'
I0'
I 00'
TRS,
lane county
TL l({3-ru,1 ,-*zrzg
z_ADDRESS
n2
PTUMBING/MECHANICAL
tQ
e1 <T
1ng SS or
At
6t!'.t-
CHECKTIST
APPLI CANT INFORIVIATION :
OI 1
t
OI.^ln
Cont. OSR#
1p
PLIIMBING CONTRACIOR ! Ves Firm
Address
E No D s"rr
MEGIANICAL CONTRACTOR fi VCs Firm
Address
ont. OSR#ufl uo fl serr directions to site
PLTJMBING
OFFICIAT USE ONLY
App1i. /
Permit #
Type of Fixture Ntmber of Each Fee On Each Total
Sink $ s.oo
vato 1n 5. 00
Tub (with or without shower)5. 00
Shower, separate 5.00
to 1 5. 00
Dishwasher 5.00rs. 00
Washing Machine 5.00
5.00
s. 00
Sewer--1st 50ft 15.00
10. 00
Water Service--1st 100 ft.15. 00
each additional 100 ft.10. 00
Storm t 100 ft.15.00
each additi-onal 100 ft.10. 00
Special Waste Connection s.00
Sewage and Sump Pr-unp ei ector 5.00
Wate 10.00
Other (specify)
SIIB-TOTAI (Minimum $10. 00)
TOTAL FEE
MEGIANICAL
I certify tha
accordance wi
Revised Statu
unless l
t
th
all p
appl
s Chp
I umbi ng work wi] I be done i n
icable provisions of Oregon
appl i cabl e ,a
liurnber of Each Fee on Each TotalType of Equipment
$ 10.00Mechanical Permit Base Fee
BFurnaceto 116r\$ 6.00
Furnace over 7. 50
Clothes Dryer Vent 3. 00
tent1on 3. 00
4.50Ranse Hood with }Gchanical Exhaust ,
6. 0L)Wood Stove
Air Conditioner Only 6. 00
t 6.00
6.00Floor Furnace
Gas Piping System 1 to 4 Outlets
Per Outlet .50
Other I
'specify)
S[D.TOTAL
TOTAL FEE
Signa
"u
s. 447 & 693 and
out@""*i t issued by
I
I
-
lry
WateT C
Water t e,
Fl oor Dra n
t nno 100 t
a
Itlobi 1e
um)
lane county
PLANNING & COMMUNITY DEVELOPMFilIT
ACT IVITY INFORMATIC^J SHEET ilv.-,
COI4PLETE THIS SECTION.FORMS WILL BE REJECTED:
o
PERSON PROPERTY OMJER
MAII,ING ADDiTESS MAILING ADDRESS
CITY STATE ZIP CODE CITY STATE ZIP CODE
HOME 'TELEPHONE NUMBER I-IOME TELEPHONE NUMBER
@ TAX MAP/PROPERTY DESCRIPTION NUMBER (from tax maps in Dcpartment of Assessment & Taxation or from tax statement)
llap & Parcel Number: ..- Tax Lot(s):
Township Range Scction
I out of rL
Tax Map & Parcel Number of Adjoining Property in Same Ownership
Tax Lot (s) :
T""/"s] 'rrp Ra"S" Se.tio"
I uone I unkno*n
#By Partition f--
BLOCK I,OT
@ neeunst (urier describe inforrnation
THIS SECTION FOR
CONSTRUCTION APPLICATIONS ORP
E
SEE *NOTE BELOW **FOR STAFF USE ONLY**
NUI,IBNR:
DATE
t-:
Fln
F:ltrTIME INITIATED:
CTIECKED BY:
ATTACHED EXHIBITS
@ TorAL coNTrcuous PRoPERTY rN SAME oWNERSHTP:
@ NUMESN OE STRUCTURES ON PROPERTY: StANdATd hOMC-
Modular home RV in use as residence-
Garage_ ShoP-
@ otunn EASEMENTS ovER PRoPERTY'
-
@ eeuornc PERMrrs oN PRoPERTY:
acres
O pneseut usg oF PRoPERTY:
@ nrne DrsrRrcr:
widrh -.--
@ enoenRrv ADDRESS:
@ warrn DrsrRrcr:
Mobile home_
storaqe_
Barn
Private Road Nane
Road Easement
*of
U sers
@ accrss To PRoPERTY: Public Road Name
I erot Plans (2)
! constr. Plans (2)
flsite rran
Dcopy of Tax MaP
!oth."-
SCREENING VERTFICATIO'}I :
By:
Date
Time In: Out:_
I accept f] Reject
Routed tot--
*NOTE: ATTACH A COPY OF
iEl-uep ; SHorrr EXrsrrllG
STRUCTURXS AND TAX LOTS
IN YOT1R OWNERSHIP. OB-
TAIN TAX MAP IN SELF
HELP AREA OF A & T.9,/81- REV (OVER)
BUW ffi
@ SUeorvrSrOu (if applicabre):
qzo
COI{PLETE THIS SECTION TOR I,AND
@ rnoeosno usE oF PRoPERTY rN DETATL:
CONSTRUCTION APPLICATIONS .**FOR STAFF USE Oi!:iY**
ZONE D USE
By:
Date:
@ aurr-orltc REQUESTS
Contractor's #(for mobile home setuP also)
Time fn._ Otlt:.-=--
f] accept I neject
f] nlanning Application
l-lConstructj-on Permit APP.
fl rnformation only
Zoning:
Comp. Plan Designation:-
SANITATION:
By:
Date:
Time In:-- Out:_
! accept I neject
! constr. Permit Issue
f site Evaluation rssue
PERI'IIT ISSUED (SAME DAY ONLY):
Permit #
By
Date:
Directions to Si-te:
l-l agri-cultural: use
Check the type of Permit requested:
Iowe1ling: f]uew Inepracement [eaditional;
Iaaaition Ialteration;
fl uodular Home fl uoui-re Home - Mode1 Year-
nnv Istandard construction;
fl n:."n check only
n commercial: Use Floor Area i
n oth.r": Use Floor Area
@ uuuenn oF BEDRooMS NUMBER OF STORIES
@ sailrrarroN REeUESTS :
fl site evaluation for SDS feasibility
I llew system installation
I nepair/replacement
! alteration,/re location
l-l cn..rg. of use - How?
Time In:_ Out:---
f Hoox to exi-stJ-ng
ADDITIONAL INFOR]I4ATTON :
ZVZS Xhrc
LANE COUNTY INSPECTION K''ORD
NUMB
E PH NE7
SET_BNETTEOIIREMENTS #PLUMBING FIXTURES^ ' ct,*!tor IntERtoR RrRR"1, FRONT
I^JORK AUTHORIZED BY PERMIT
DIRECTIONS TO SITE
SITE ADDRESS PERMIT NUMBER
N UN T N NSP ON OR MOBILE HOMEApproved_ Correcti on Di sapproved_Da te I ns pector
I S ECT I ON
CONCRETE SLAB / UNDER-FLOOR INSPECTION
Approved Correctjon_ Disapproved-Date Inspector
UTDEtrTLA-B IP I-uI'Ig I NG GROU N DI^JO RK I NS P ECT I ON
,Approved Correcti on Di sapproved--Date I nsp ector
ROUGH PLUI'{BING INSPECTIONApproved Correcti on Di sapproved-]Date I nspector
FRAMiNG INSPECTIONApproved Correction Disapproved Date--Insp ector
I_NSTTION / VAPOR BARRIER INSPECTI N
Approved Correcti on -D'isapproved
IDate i ns pec tor
IATH- / GYPSUM BOARD INSPECTI
Approved - Correction Disapproved Date Inspector
FINAL PLUMBiNG INSPECTI ON
Approved_ correcti on_ Di sapproved Date _l nspector.--
F I NAL bJASTE D I SPOSAL SY ST EM I NSPECTI ON
Approved Correction Dj sapproved Date Inspector
FINAl INSPECTION BUILDING
proved u/ C orrecti
MOBILE HOME
n D'isapproved e Ins pec tor
CERTIFICATE OF OCCUPANCY
Approved__-._Correcti on Di sapprove
TEMPORARY CERTIFICA TE OF OCCUP AN CY
Inspector
Form C74-L97
d Date
LJ I]
1