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is noted hereon, ed that only subcontractors ed enployees who are in conpJ-iance with ORS 701.055 wi-I1 be used on this project. I HAVE READ AND
THOROUGHLY.
NAI'IE
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cor,lPLETED APPLICATTO)' r'OR
in the propettr,[Q,.. ,
. work perf ored 6ha-t I be
PERMIT AI ,lrl heo thHAVEIEXAMlNEDCAR.EFULLY THE 5u rtice f nfomatiaII hereonoIl truel5 correand ct and that
offotheinterest record a5errrch rcent authori zed ntIegaIIlowingpa9enIcertif:rther that and al andone accoLdaltc.,th.:th sOrdir)ance Laneof andfyany Lawsthe theof ofStateCouty OregontoworktheheredescribedlnthatandOCCUPANCYNOl1madebt'of ures trlrct thwl theout m ofon but ldi vtsDi lonrtaining I fur-pe ng!herthethattrationthwatherregBuideBoardINforceful1edndctffeasred701oRs.0certj.fy re.iu1 ifthat t bas isthe for xeebye xemp
Date :
Installation Record. Issued? ! v." ! u"
Date
Date:
COMI'IENTS
I
tlrour;
cL, fro.t
B. P. +
u'e FIEAPIACE l0aEg+f,
ZATION IIAS BEEN BASED ON TIIE FOLLOWING CONDITIONS !
Partition #fl pr,eNn:nc,uzoNrNG
COMI'IENTS:
Minimun Setbacks:
COIO1ENTS:
inter rear
Parce1 *Parcel
Linea1 Eeet
of Ilrainfjeld
rraximum Depth
of Trenches
READ THIS SECTION CAREFULLY. YOUR
I senrtetron: s. r. #
Installation callon
Specifications: _ Tank
PLANS EXAMINATION
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PERMIT APPROVED BY BUILDING OFF IGNEE (Der oRs 456.805(1))
LANE COUNTY DEPAB-'IENT OF PUBLIC WORKS LAND MANAGE' '-NT DIVISION, 687-4061,
1i -AST 8TH AVENUE, EUGENE, OREGON 9. -.r1
SEE REVERSE FOR I.NSPECTION INI'ORMATION c14-2s R*
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SETBnCKS AND OTIICR CC:iDITIo:]S OF APPROiTAL IIUST BE STRICTL':- OBSERVED. VIOLATION CAN RESULT IN REVO-
C;?ION OF TIIIS ?iN}tIT, CITNTIO! UNDSR PROVISIONS OT LANE:OU);TY'; INFRACTION ORDI:iANCE, AND,/OR OTIIER
RE}IEDIES ALTOVIED BY LAW.
WHEN RE.{DY FOR INSPCC?ION, CALL 687-{055. A MINI}'UiI OF }T LiiST 21 IIOURS ADVAIiCE NOTICE FOR INSPEC-
ilbSnTffEET:f,aST-.tr-crvsr.'- ,t-i;rA-Eh6--?ollowing infoanafi()n ready: larmit number, job address, type
of inspeccton, when it wiII be ready, your name and ph#.P-\aber, and any spccial Circcti.ons to site.
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BUILDING DIVISION: ii'
REQUIRSD I\SPICTIONS:
L. Foundation IlglllS.lgron: To be nade after trenches are excavated and forms erected and when all
fiTEl;Ts ioT--EIA-Eundation are delivered on the job. Hhere concrete fron a cenlral mixing
plant (comonly termed "transit mixed") is to be used, naterial,s need noc be on the job.
2. Conclete Slab or Under-iLoor Inspection! To be made after aIl in-slab or under-floor building
;E;i_-.q".prst.;-conduir, pIifit-E;;assorj.es, and other ancillary equipment items are in
pl'ace but-beiore any conclete is poured or floor sheathing instarled' incruding the subfloor'
3. Framj.ng & Insulalion Inspections: To be nade after the roof, all framing, fire blocking, and
b=rcf;6 are-Tnlfre aiE-al]-pT-pes. fj.replaces, chimneys, and vents are comPlete and aII rough
electrical an<i plumbing are approved. All walI insulation and vapor barrier are in Place.
4. LaLh and,/or cvpsun Board Inspection: To be made after all Iathing and qypsun board, i.nterior
aailexE-errcri-is fn-plrce-Eut-E-efre any plasteling i.s applied and betore gypsu board joints
and fasteners are laped and finj.shed.
5. pinal Inspection: To be nade afLer the building is conplete and before occupancy.
APPROVAL REeUIRED. No uork shall be done on any par! of the building or Structure beyond the point
indicated in each successive inspection uilhout first obtainj,ng the approval of lhe build.i.ng offrcial.
Such approval shall be given cnly after an inspection shall have been naCe of each successive step
in the construcLion as j,ndicated by each of the inspections required.
NoTE: AII building permits require inspecLions for the work authorized, such as but no! Iinited to3
A. Block tJaII: To be made after reinforcing is in pLace, but before any grout is poured. This
Inspectlo is lequired fo! each bond bean pour. There uill be no approval until the plmbing
and electrical j,nspectigns have been nade and approved.
B. itood Siove: To be made after conplelion of masonry (if applicable) and when installati,on is
coti,olete:- fnstallation shall be in accordance wi.th an approved, nationally recognized lesLing
agency and the nanufacturerrs inslal,Lation instructions.
C. t'tobile Homei An inspection is reguired after the mobile home is connected to an approved
EEi6Foi-EEptic system for setback requirements, bl.ocking, footing connection, ciedovns,
skirt j,ng, and pJ,mbing connections.
1. Footings and piers to comply wj,th State foundation requirements for nobile hones or as
recomended by the manufacturer.
2. Mobile home minimun finish floor elevation shall be certified uhen required by a flood-
plain management Ietter.
3. .\obile home tiedouns, when required, and skirting shalL be instal,Ied and ready for inspec-
tion within at least 30 days after occupancy, Tiedowns and skirting shall be installed
per enclosure.
D. swiming PooI: Below grade when steel is in place and before concrete is poured. Above grade
,fen prcI-fs instaLled.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORXINC HOURS. THIS PERMIT WILL EXPIRE
IF WORK DOES NOT BEGIN I{ITHIN I8O DAYS, OR IF IiORX IS SUSPENDED OR ABANDONED FOR I'IORE THAN I8O DAYS.
SUSPENSION OR REVOCA?ION I,IAY OCCUR IT THIS PERMIT IIAS ISSUED ON THE BASIS OF INCOMPLETE OR ENRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POIIIT OT REQUIRED INSPECTIONS I.'ILL DO SO AT THEIR OWN NISK.
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEUS3
l. Permits shall be effective for one year fron the dale of issuance.
2. Upon completing the construction for which a permit has been issued, the pernit holder shall
notify lhe Lane County Departnent of Planni,ng and Comunity Development by submitting the
installation record form. The Departnent shal,L inspect the construction to detcrmine if it
conplies uith the rules contained in this division. If the construction does comply with such
rules, the oeparthent shalL issue a certificate of satisfactory completion !o the pernita holder.
If the constructj.on does not comply with such rules, the Departnent shall noti,fy the permit
holder and shall require satisfactory completion before issuing the certifi,cate. Failure to
meet the requirenents for saLisfactory completj.on within a reasonable time constitutes a vio-
Iation of oRs 454.605 to 45,1.745 and this rule.
Setbacks - Subsurfacc sewage Disposal
septic Tank Drainfield
Fron: Iiterior property lincs 10 ' I0 '' Edge of road rrqht-of-way 10' l'01
Buildinq foundation 51 10'
. liel,Ls, other water sources , 50' l00l
TRS# 77-03-24-4-1 2000 DATE ISSUED:PERt[rr]i2tu+6e/25/85
OWNER'S NAME
JAMES A. OSBORNE
PHONE NUMBER
oao-ztz_L
CONTRACTOR'S NAME
SAME
PHONE NUMBER
S
C
ET BACK REQUI REM
C
ENTS # PLUMBING FIXTURES
L FRONT SIDE I NTER I ORL REAR
SDS APPRO\IAL REQUIRED
D
MOHAWK EXIT TURN LEFT ON NOR?H 19TH WHICH WILL TAKE YOU TO NORTH 23RD.
S 3go 3c
N FOUNDA
App rove d Date
EMENT iNSPECTION
Correcti on Date Insp ector
PLUMBING GROUNDWORK INS CTI ON
Approved Date Correcti on Da te I nspe ctor
UNDERSLAB PLBG-. ETApproved Date
/u PLBG.I NSPECTI ON
Correcti on Date I nsp ector
OTHER INSPECTIONApproved Date Correcti on Date Insp ector
ROUGH PLUMBTNG (ToP OUT)I NSPECTION
Approved Date Correct'ion Date I nspector
roved t/ Date
proved
Correction 'Date
Da te l(t+^-8{tcomection Date
I nspector
Inspector
INSULATION /VAPOR BARRIER INSPECTIApproved Date Correcti on Date I nspector
LATH 7 GYPSUM RD INSPECTIONApproved Date
,OV
i
Correcti on Date
Correcti on Da te
Correcti on Date
I nspector
/H00
NSP
App rove d Da te
L
I nsp ector
I nspector
FINAL I
Approve Date
IONzuWtr /AG PLACEMENT n
d Correcti on Date Inspector
CERTIFI F OCCUPANCY TEMPORARY CERT IFICATE OF OCCUPANCY trApproved
t47 4 - L9l
Date Insp.proved_Date Insp.
LANE COUNTY INSPECTION RECORD
wooD srovE
** A COPY OF THE MANUFACTURER'S I
MUST ACCOMPANY YOUR APPLICATIO
'1. I )to o
b7212+-95 FttE @(
NSTALLATION INSTRUCTIONS
N
lane county
.PLAN I
PIAN 2
t-o_:
!rEvATrory
, Eug. 0R 97401 (503)687-406.|
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-
NAIlE
OIIIf NSIONS:--IiiiEiJtre fo'llowing, fill in nunber of lnches in diagram
'1. Slde of unit to protected wall_lnches(unprotected walt_lnches)
2. Rear of unit to protected wall inches(unprotected wall inches)
3r Floor protection at side of unit inches
4. Floor protection in front of unit inches
5. Length of wall protection at rear of unit 'lnches
6, length of wall protection at slde of unit inches
7. tl€lght of wa'll protection inches
8. Edge of wal'l protection to nearest door or window inches
9. Air spacc between wall protectlon and rall l[ches
10. 0lamter of chimey and vent connector-__-_____inchcs
Arr^urrro*,(-
\r-rte unit rs Irsted oy: nul [rcoo lotnerlnawy 4/_TL-_
B. The floor protection is x inches thick ana 'i, be:ffi|:i::::rrTil',l:l;i
r-'lstone or r---l 0therL-l u.ick L-l (describe
c. The wail protect.ion *irr u.,ffif!:::.,Til,Htli f Stone or
bri ck
G-
[-l otner( aescri be )
of ch'imey: TFactory chimey B,.t"rrrlfri:r"frii]
I
I
v-
+-
0ther(describe)_
E. Type of vent connector: f Factorl chinrnel J_l aOga(or heavier) galv. sht. mtl
F. uil t be usins: nerAN rt [-lpr-at rz f-lotn.", see artached
NOTE
Not all units are approved for corner installations or reduced
clearances with wall protection.
0ttslde Air Inlet:Provldc an outslde alr jnlet, a minimum of 3,,0 to supply nir forproper fuel cornbustion. This in]et shall be closab)e (damper)
from the building inter.ior. The alr inlet supply duct sha'll be
incombustible and continuous from the interior intet to theexterior of the building. The inlet shall be located through
the rall (near the floor) or floor within Z4,,of the stove orfi repl ace.
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IF YOUR INSTALLATION DIFFERS FROM THESE EXAMPLES,
PROVIDE A PLAN AND ELEVATION OF YOUR INSTALLATION
LAND MANAGEMENT DIV. / PUBu-C I{0RKS DEPT. / 125 E. 8th Ave
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ACTIVITY INFORMATION SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS l^,lILL BE REJECTED!
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HOME TELEPHONE #
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BUSINESS TELEPHONE #BUSINESS TELEPHONE #HOME TELEPHONE #
2 PROPERTY ADDRESS
( TF DTFFERENT TnO
3 rvlae 6i PAFIeEL NUMBEn (from tax maps in Department of Assessment and Taxation
( REQUiREp rNF0RI4ATr0N)or
3
RANGE
from tax sta nt)
_11
TOWNSH IP
2!
SECT I ON W TONINE
MTNSETP MN6E SMTMN
MENSETP RANGE SEETTON
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
W ZONING
W ZON I NG
ACRES
+ SUBOIVISI0N ( if appl icable)LOT BLOCK
5 REQUEST (state exactly what you plan to do)
** FoR STAFF USE 0NLY **
ZONE/LAND USE:
BY : _ DATE :---* TIME I N:-- OUT :.-
NUMBER
DATE
{nv1
-{
LAND MANAGEMENT DIVISION / 125 E. Bth AVE., L-UGENE, OR 9740I / 687-406I
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MAILIN6 ADDRESS
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6 DIRECTI0NS T0 SITE T &jeu-,_&_ 1i t J-p_-,__ ]_<-f
Q,.,".L 'atz f gr""- tT zy'-e%x .3eL,