HomeMy WebLinkAboutPermit Building 1978-08-31#?/m
TRS" T I 9,4,4 JOB LOCATIO
LANE COUNTY PERMIT
Acreage or Lot Size
Contractor's O.S. #
Partition ing
APPLICANT'S NAME AND ADDRE ss
CONTRACTOR'S NAME AND ADDRES s
lail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call
\I/ATER SUPPLY SEWAGE DISPOSAL
) Completed Subdivision :
Lot Block-
OWNER'S NAME AND ADDRESS
(owner, etc.) when ready
Phone-
Phone--
Phone-
s.t. #
STRUCTUBES NOW ON THE PROPERTY . ' '
THtSpERMtT tS FOR # B EDROOIIS-# PLUMB ING CON NECTIONL-
THlSPRoPERTYlSWlTHlNoNElVllLEoFTHEClTYoF.PLUtVlBlNGBY
I hereby certi{y that the above statements are true and accurate, and that I have the following legal interest in the property:
-owner
o{ record;
-contract
purchaser;
-
potentiat buyer; ----:, realtor or agent. I further certify that (if not the ownerl I am authorized to act lor the owner of
record, and that 9id owner is aware and approves of this action. I hereby agree to complY with all applicable Codes relating to this permit.
Fee Paid $Signature
( INEWADDRESS () FACILITY PERI\4IT TO T RANSPO RTATION DEPT.- ! SPECIA L PMT. AR EA. ININ. ELEVATION
Date
-
SANITATION
)
BUII-DING
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date:
Type of Construction
-Group -Fire
Zone
Use Classification
Comments:
Comments
By
L.
By:Date:
PLANNING REOUI REMENTS SATISFIED. By:Date Date lssued
ZONE SETBACKS: FRONT SIDE FACING STREET (FROM C/L) INT. SIDE YARD REAR (FROVI P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55.1 3 BLoG.PERMIT_WHITE; BUILDING-GREEN; PLUMBING-CANARY; SANITATIoN-GOLoENRoD; oFFICECOPY-WHITE
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST 81 \VENUE, EUGENE, OBEGON 97401
\
rtltlonlng l-- f]eendins f]comptetedParccl No._
Par tltloninq Reouired
Other t
rtTEn POLLUTION CON"ROL I o( Sltee--
llca Slt. fnspactlon (r)
6DS Conltructlon [-J Hew ! nepalr
Nunb€r ol Bedroonst
Comncrcla l,/Indus 1-lo!Employee I
AVERAGE PROCESSINGDMSION Current Zon
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CONSTRUCTION PERIIITS AND INSPECTTON(See abovc lor I of bedroorns./l of employeea)
t] .'.tobt lc Horoe '
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Renewa I Sq. Ft. valuatlon
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Planc Check Fec
Change o( Occupancy
TOTI\L BUILDING PERHIT FEE
Hlnlrnun ttructural, oetbacks I
FroE centerlinq of etreet: Front
Ext sl
SroI[ lntarlor loe lincs: Side
I Conto'l plans toa PPI cut ------=-to apPltcant
PUBLIC I.ANDS tion
PUBLIC I.'ORKS acility Pernit
E}IV L HEALTH
Subtotal S_:r
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bre coLrnty
Carh_
AfFIDAVIT: Il thlswlll be used for agrfor no otherthts appl
Roc'd by AI,
to
tural building, I hereby thls bu ing
Iotred by zoning and,/or the State Building , andt the statencnts and other information su ted onthat I have the following legal intercst the
rchaser;lessee i holder of an exclu ve optlonperson r.,E5-hag the f6lflouing legal lnte st!
, or that the of record is knowledgea of this
am own I fur ag y with ll ppI icoble re t in9a
Applicant's Signat
THIS IS YOUR RECEIPT, AND DOES NOT GIVE YOU PERMISSION TO BUILD.
ION AAOUT THE PROGRESS oF YOUR APPLICATION. CALL PERI'IIT CONTROL, 687-1357 (687-HELP)
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OIOIER (IF DIFFTiRENT)
ADDRESS
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AlrJrolntnk[t Dat.'
Offlce Uee Only
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CONTRACTOR
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}iAIL COMTI.ETED PIlRHIT TO A.Pt,I-IC^NT Ir croR (clRcLE oNE)[ _l
PREFER TO prCK
PRESENT USE OF PROPERTY (ree 1al; t yPe/of amlngi col@rclal or indutrlal; v6c8nt; etc.)
DESCRIBE STRUCTURES NOW ON I}IE PROPIIRTY. NOIE A}I S]'RTICTURES TO B!: DEH()LISIED.
3. IH}IEDI,ATE PI,TNS FOR THIS PROPERIY (THIS APPLICATION)
^RE:
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4. FUTURE PLANS:
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5, PLOT PLAN. Sketch (a) all roads (b) borndarles of property (c)
proposed s*ate d1s posal areas (e) exlstlng/proposed
dralnageways, streare, creeks, any
f rees!andlng elgrs, parklng areas,
exlstlng/proposed bu1ldlngs (d) exletlng/we1ls (f) exlstlng/proposed drlveuayeother pertlnent features. If coamrclal
INDICATE DIMENSIONS,
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3. I.IETIIOD OF SEI{AGE DlSPOSAL
--- l. stTE INSIECTTON T!:ST I|OLES READY (DATE)
IIROPOSEI) HA [:R STIIPI,Y
EI,ECTRICITY FIJRNISIIED BY
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EEFORE YOUR APPI.ICAI lON CllN BE PROCESSED YOU MUST TURNISHT __-8!xll PLOT PLA.\S LEGAL DESCRIrTION
(DIMENS IONED)
bre carrty
D,lTE
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST BTH AVENUE, EUGENE, OREGON 97401
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FROI,I:
rLOOD PLAI:i ;#.:IAGiHL;iI
DtPARTl.lEllT CF PIJDL I C ;J0::,S
PH9;it - 60r- -4195
SUBJECT:
BUILDII{G PTPJIIT IIUHEER
SUBDIVISIOI'I
Pt RiII T PROCI55 IIIG
OIHI R
27 ?o -28 PARTITIOII I.IUi43ER
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OTHE R
SITE IiI FLCC] HAZARD AR[A. YES it,l x
DITAILTD STUDY APPROX I IIATE STUDY
riOI A SUBSTA:{TIAL II4PROVEHEIIT
HiNIITUM FL00R ELEVATI0t{ REQUIRED
SITT III OESIG:iATEO FLOOD HAZARD AREA
IXTRA PRECAUTIONS HAY BE APPROPRIATE.
RICOFT'ITNOAT I O}{S:
DAIE BY I
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST 8 AVENUE,EUGENE, OREGON 97401
AVERAGE PROCESSING
,q
he county
t\tNc DIVISION Curront Zon
tlt lonlng l_ f]pendtng f]cornpletcd
P.rc.l No.
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llIIEI ?OLLLTfION CON?ROL I o( sltcr
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Qornarclal/I - I ol Enployecr
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coNstRtctloN ptRrllts AND INSPEC"IOT{(Ser abovc lor I of bcdroorar,/f of cnployror|
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at Stat. Surchorga
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Changc of Occupancy
TCTTAL EUILDITIG PERHIT TEE
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PUBLIC h,ORXS
for no oLhcr tural purpoaes as alloyedfurther bertify that thc
re3a
clllty
EMvI HEALTII
Carh Crrt
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{-nGcrd by \'d\ t s
AFFIDAVITT If thl It lr for an agrlcultural bu 1ldlng, I h€reby declI prrmgrlculvlll be used for a
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thltby zoning and/or the StatG Building.t!tctncnta .nd other lnformatlon Bu
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and
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Pro!€rty:to Pu
purPorc.
tjon e{arot
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tru6 and acc\rrata, and trecord, _ bontract purauthor i zei[-iir act f or .
hat I have the followlng I cAaI int.r.st thechaeer I Learee;holder of rn axc vc optlon
t
pcrson wE-o-het the f6Tl,owing Icaal ln stt
r or that the of record 1e knowledgca of thiaam no owne r furt a9 rc y with ll I icabk tre t ingCApplicant.r Signat
Tllrs rs YouR RECEIPT, AND DoEs Nor crvE you pERMrssroN ?o EUTLD.
oN lBouT THE PROGRESS Or YOUR APPLICATTON, CALL pER!.rrT CONTROL, 587_a357 (687_HELP)
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4. FUTURE TLANS:
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\PPLIGATI c] N Offlcc U:c Only
('!ry
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RHIT T0 Al'l't.r ER/coN'nl cloR ((.lkclf, oNE)[--] r,RtFER T0 plcx
I'ERTY (rorldenr lrl i t ypo .of fa rrtrlt coEre lrl or lndut rlat; vacant i atc.
2, DESCRTBE STRUCTURES NOIJ ON T11E ptot'ti'r1y, N()lI A,N\ S',l HucruREs ro 8]: DE!,|{)LlllltEt).
[| xrtt coln'r.rrriD PE
I. PTESENT USE OI' PRO
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l. IHHI:Dti\TE f LINS noR 'lHlS PROPERI-I ( f illS Apt'l.t(:A,f toN) ARE:
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5. PLOT PLAN. Sketch (a) all roads (h) b<rrndarlca of property (c) exlstlng/pproposed sryrte dlspossl arers (c) axls tlnt/propored sells (f)(g) oast:mnts (h) dratnagevaysi straaas , creeka, sny othar partior lndurtrlal. ghou frcestand!ng rlgns, parkl nt ir.r!, INDICATE DIImISIONS.
roposed bulldlngr (d) extrt taglexfutlng/propoccd drl veuayanent fertures. If cocrcltl
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fl .[(]TltJCtT] FlllcirsItD BY
SITI: INSI,ECTION TI:ST II(,LES READY (DATE)
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lEFoRl: YouR ll'Pl'lcAl lox c]\N BE PRocEssED You Hl-rsT !'UlL',llsH: ,-_--,8!xr I PLoT pLANs LEcAL DEscRIpTIoN
(DrMElrsloNr:D)
ldne aourty
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L ANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
BY
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STATE
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Plot Plan Subdivision Lot_ Block
FOR SANITARIAN'S USE ONLY: dsystem Approved fl system Disapproved fl Needs Correction
COMMENTS: 44,
Signature:Date
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FOR INSTALLER'S USE: Trench DePth Filler D ept h Below Tile
Tank capacity lJ-rO Gftl Manufacture Nt',fl
Measured distance to well from tank--:l-\o\ -(2
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from drainfield
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!NSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat-
isfactory completion of a subsurface sewage disposal system at the above location.
Return this form to: Permit Processing Section, Department of Environmental [\4anagement,
Public Service Building, 125 East 8th Avenue, Eugene 974O1
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Acreage or Lot Size
Contractor's O.S. #
JOB LOCATIO
Partitioning #
LANE COUNTY PEBMIT
) Completed Subdivision
Lot Block-
CONTRACTOR'S NAI\4E AND ADDRESS
APPLICANT'S NAME AND ADDRE cc Phone-
OWNER'S NAME AND ADDRE ss Phone
Phone
Vlail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready
Fee Paid $-Signature
()NEWADDRESS ( } FACILITY PERI\4IT TO TRANSPORTATION DEPT.- | SPECIAL PI\4T. AREA. I\4IN. E LEVATION:
-
STRUCTURES NOW ON THE PROPERTY
THlSPERlv]lTlSFoR#BEDRool\4s-#PLUMBlNGcoNNEcTloNL
\AJATER SUPPLY SEWAGE DISPOSAL s.l. #
THlSPRoPERTYlSWlTHlNoNEMlLEoFTHEClTYoF.PLUtVlBlNGBY
I hereby certify that the above statements are true and accurate. and that I have the following legal interest in the property:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit.
Date
-
SANITATION
[Vlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Date
BUILDING
Type of Construction
c"r.."t,
Use classification
By
roup Fire Zone
Comments
By:Date:
PLANNING REOUIREMENTS SATISFIED. By Date Date lssued
ZONE:SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGEMENT, 125 EAST BTH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
C55-13 BLDG.pERMTT-wHrrE; BUTLDtNG-GREEN; PLUMBTNG-GANARy; sANtrATroN-GoLDENRoD; oFFrcEcopy-wHrrE
PHONE: 687 4394
.-.r I
, TR$, TL JOB LOCATIO
LANE COUNTY PERMIT
//
$ptoc- Qr.- Ztt*ae 5Acreage or Lot Size
Contractor's O.S. #
Comments
Partition ing ) Completed Subdivision
Lot Bloc
APPLICANT'S NAME AND ADDRE SS-
Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call
lVlinimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
Phon e
OWNER'S NAIVIE AND ADDRESS Phone
CONTRACTOR'S NAME AND ADDBESS
-
Phone
(owner, etc.) when ready
STRUCTURES NOW ON THE PROPERTY
THlsPERMlTlsFoR#BEDRoolv]S#PLUl!lBlNGcoNNECTloNS-
WATER SUPPLY SEWAGE DISPOSAL s.l. #
THlSPRoPERTYlSWlTHlNoNEtVllLEoFTHEClTYoF.PLUtVlBlNGBY
I hereby certify that the above statements are true and accurate, and that I have the lollowing legal interest in the property:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves of this action. I hereby agree to comply wilh all applicable Codes relating to this permit.
Fee Paid $-Signatu re A Date
( } NEW ADDRESS () FACILITY PERIVIIT TO TRANSPORTATION DEPT.- () SPECIAL PI\4T. AREA. IV]IN. ELEVATION
SANITATION BUILDING
Type of Construction roup ire Zone
c",.nn..,.".-
Use classification
Date B Date
PLANN ING REOUI REMENTS SATISFI ED By:Date Date lssued
LANE COUNTY DEPABTTIENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE., EUGENE. OREGON 97401 PHONEi 687-4394
POST THIS PERNIIT ON MAIN BUILDTNG AT SITE
BLDG.PERMIT-WHtTE; BUtLDING-GREEN; PLUMBTNG-CANARy; SANTTATTON-cOLDENROD; OFFtCECOp\/-wHtTEc55-1 3
r
By:
ZONE:SETBACKS: FRONT SIDE FACING STREET (FROIVI C/L) INT. SIDE YARD REAR (FROIVI P/L)
SITE INSPECTION
Ap pnov r o
Rruenx s
D r sappnoveo Darr I rs re cton
FOUNDATION I NSPECTION
APPRovEo
REurnx s
Drsnppnovro
FRAMING INSPECTION
APPRovEo D DrsappRovEo D
RruaRx s
D oar r .fiJrl-JS- rNsecro*-$aal
7-7 I
F,t<
Dare l nseecron
LATH OR SHEETROCK
Ae pnov e o
RruaRx s
I NSPECT I ON
Dr sappnovro Dar E I Hspecron
FINAL INSPECTION
Ae pnov r o
REunnx s
M DrsappRoveo Darc -{-/a -7? lHsprcroR
CERTI F I CATE OF OCCUPANCY
Rerov ro lssue D Nor Rrrov ro lssue D
ReuaRxs
Drre I NSPEcToR
D
SLAB FLOOR
PLUMB ING GROUNO^/ORK
Appnov eo
Reilenx s
Drr e I xsprcron
GAS PIPING GROUND^/ORK
Ap pnov r o
Rsi{anx s
D r slppnovro Dar e I Nseecron
ROUGH PLUMBING
Appnov r o
Rexrnx s
Dr srppRoveD Dat e I Nspecron
ROUGH GAS PIPING
APPRovEo D DrsappRoveo D
Reranxs
Darr I Nsercton
FINAL PLUMBING
AppRove o
Re uanx s
Drsrppnoveo Dare I Nspecton
FINAL GAS
Ap pnov r o
Rexlnx s
PIPING
D r sAPPRovEo Drre I Hs pe ctoR
CERTIFICATE OF OCCUPANCY
Rrlov ro lssue
RruaRx s
D Nor Rrnoy ro lssur n DnrE_I HspEcroR
D Drsapppovro D
D
, TRS,,T
Acreage or Lot Size
Contractor's O.S. +
JOB LOCATIO
LANE COUNTY PERMIT
Partitioning #-( ) Completed Subdivisi
Lot B
APPLICANT'S NAME AND ADDR trcc
OWNER'S NAIVIE AND ADDR
CONTRACTOR'S NAME AND ADDRE
( Mail permitto ( )Applicant ( )Owner ( )Contractor. ( )Prefertopickup. Call-(owner, etc.) when ready
Phone
Phone-
Phone-
s.l. #
STRUCTUBES NOW ON THE PROPERTY=_--.-''-
THlsPERMlTlsFoR#BEDRoolv1L#PLul\4BlNGcoNNEcTloNL
\I/ATER SUPPLY SEWAGE DISPOSA
THIS PROPERTY ISWITHIN ONE MILE OF THE CITY OF PLUIV]B ING BY
I hereby certity that the above statements are true and accurate, and that I have the following legal interest in the property:
-owner
of record;
-contract
purchaser;
-
potential buyer;
-
realtor or agent. I lurther certify that (if not the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves oI this action. I hereby agree to comply with all applicable Codes relating to this permit.
Fee Poid $-Sigrature
()NEWADDRESS () FACILITY PESMIT TO TRANSPORTATION DEPT.- ( }SPECIALPIV]T.AREA. I\4IN. ELEVATION:
-
Date
-
SANITATION
Minimum Septic Tank Cepecity (Galloris)
Drainfield Required - Lineal Feet
Maximum Depth
BUILDING
Type of Construction
c",n,n.".*
Use classification
Group ire Zone
Comments
B Date:B Date
PLANNING REOUI REMENTS SATISFIED. B v Date:Date lssued:
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL IVIANAGEMENT, 125 EAST 8TH AVE., EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
BLOG. PERMIT - WHITE; BUILDING - GREEN; PLUMBTNG - CANARy; SANTTATTON - GOLOENROD; OFFTCE COpv - wHtTEc55-1 3
PHONE:687-4394
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ZON E:SETBACKS: FRONT SIDE FACING STREET (F ROrvr C/L)INT. SIDE YARD REAR (FROM P/L)