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L Co Authoriza'tion for,E'OR OFFICE USE ONLY
Applicatio
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S'JBDIVISION/PARTITION (if applicable)I,OTIPAF.CEL BI,OCK
FROPOSED USE OF PROPERTY
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JT.ELEPHONE NUMBER7/'7-zrzr
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SIGNATURE DATE
COI4PLETED APPLICATION !'OR PERMIT, ar'd (lo herely
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TIAVE ,YCAREFULL INEDEXAM THE c ti thaL ai1'henf omat.i.on onre trueI5 correctand and Ithat
thehave reinte t1ega1following orlauthprrrchaser zedf,agentIcef:rcher that and aI]rtify any thc ofOrdi.trances Lane theandCowty ofLaws Statethe of Oregontothedescri.bedwork here n thatand NO OCCUPANCY wil nadebe of s rcturearrl thoutWI the s sronmf,ofPe the Di vis i on fur-BuiLalingtherthattrationththecertj. fy regi Bui l" de r Board fulI anfo rce effectd as red 70oRs o5 1thatrequiby e the for ribasxemptexemp1Snotedhereonandthatedsubcontractorsonlyarewhoananceth70IORSwil055employeecomplbeedusthisonectIHAVEprolREADAND
CHECKED THIS THOROUGHLYAPPLICATION
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of Trenches
CO}I.}IENTS:
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ZATION IIAS BEEN BASED ON THE FOLLOWING CON
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READ THIS SECTION CAREEULLY. YOUR
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DITIONS:
ParceI SizeParcel #
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DATF
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 6874061,
125 EASTSTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INI'ORMATION
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PERMIT APPROVED BY BUILDING OTTTCTEI/P
SETBNCXS AND OTIJER CC:iDITIO\S OF APPROTIAL IIUST BE STRICTL)'OESEF,\'ED. VIOLATION CAN RESULT IN REVO-
C,:,TrON OF rltIS PCllIlI?, CIT,iTIO! UTnDER PROVISlONS Oi LA\-E COU\T!'.1 INFRACTION ORDINANCE, AND,/OR OTHER
RE}IEDIES AI,T,OHEq BY LAW.
ViHEN RE.\DY FC]R I:ISPIICTION, CAL:, a81-1065. I\ 11JNl:.1U:1 OF AT LiAST 21 IIOURS ADVAiiCE !-OTICE FOR INSPEC-
iLji-TEIIESTS-ll,:sT-i:::-crV'-ri. -:t"':Z rne r"IIowi:rj rn:c:a3tion ready: pernit number, job address, type
of inspecEion, when it wlII be ready, your nane and phoic nunber, and any special Cirections to site.
BUILDING DIVISION:
REQUIRED II]SPECTIONS :
I. Foundation _II:!:SjIl: To be made after trenches are exca!'ated and forms erected and when aII
ffiTE;T;fr'o;Jh-e ionndaLion are rlclivorcrl on Lhe' job. lJherc concrete flom a central nixing '
plant (comonly Lermed "transit mlxed") is to be used, natelials need not be on the job.
2. Concrete Slab or Under-aloor Inspection: To be made after aLl in-slab or under-fl.oor building
EE?v]-e cqulpm*t, cmJulf, prpugrrcssorres, and other ancillar)' equipment items are in
place but-beiore any concrete is poured or floor sheathing i-nstalled, including the subfloor.
l, |IglltnS & Insulation Inspeqlions: To.be made after the rcof, all framing, Yire blocking, and
f-i-acil6 i'reTEre ma-IIl p+es, fileplaces, cnimneys, and vents are complete and alL rough
electrical ani plumbing ale approved. All" wall rnsulati.on and vapor barrier are i.n place.
4. Lath and,/or cvosum Board Inspection: To be nade after aI1 Iathinq and qypsum board, interior
aila exreri6r,-s in-pTrce Eua-EEIxe any plastering rs applj-ed and beiore gypsw board joints
and fasteners are taped and fini-shed.
5. EinaI Inspection: To be made after the building is complete and before occupancy.
APPROVAL REeUIRED. No work shall be done on any part,of the buj-lding or Structure beyond lhe point
j,ndicaLed.in each successj-ve inspection without first obts3ining the approval of the building official.
Such approval shall be given cnly after an inspection shaII have been made of each successive gleP
in the construction as indicated by each of Lile inspectlcns lequired.
NOTE: A11 building -oermits require inspections for the work authorized, such as but not limited to:
A. Bl.ock t;all-: Tc be na.le aiter reinforcing is in p1ace, but before any grout is poured. This
I-repecE16n is required ior each bond beam pour. There will be no approval until the Plwbi4g
and electrical j.nspections have been made and approved.
B. i'lood stovei To be made after completion of masonr)' (if applicable) and when installation is
(mlefa Installation shall be in accordance ilith an approved, nationally recognized testing
agency and the manuiacturer's install'ation rnstructions.
C. Uobj.le Home: Ao inspection is required after the mobile home is connected to an approved
ilr oi-*ptic systen for setback requirements, blocking, footinq cgnnectj.on, tiedouns'
ski!trnq, and plwbing connections.
1. Footings and piers to comply with State foundatj-on xequirements for mobile homes or as
recomended by the manuiacturer.
2. i'lobile home minimum finish floor elevatlon shalI be certified when requj.red by a flood-
plarn management lelLer. ' i
3. llobile home tiedowns, uhen requj.red. ani skirting shall be installed and ieady for inspec-
tion within aL Ieast 30 days aftser occupancy. Tiedowns and skirting sha]l be instalLed
per enclosure.
D. Swiming pool: Below grade when sieel is in place and before concrete is poured. Above grade
nlen prc]-lFinstallcd.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS.PERMI? WILL EXPTRE
IF h,ORK DOES NOT BEGIN WITHIN l-BO DAyS, OR IF !,IORK IS SUSPENDED OR ABANDONED FOR }IORE THAN 180 DAYS.
SUSPENSION OR REVOCATION I,1AY OCCUR IF THIS PERI4IT WAS ISSUND ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFOR}IATION.
ANYONE.PROCEEDING PASr TiiE POIIiT Of REQUIRED IN-SPECTIONS HILL DO SO AT THEIR OwN RISI(.
ALIEfitrIFiIVE SEWAGE DISPOSAL SYSTEMS:
Permits shall be effec.live for one year from the date of issuance.
Upon iompleting the construction for which,a pl.irit niu been Gsued, the permit holder shalI
notify the Lane County Department of Ptanning and Comunity Development by subnitting thej.nstallation record form, The Department shall inspect the construction to determine if it
complres with the ruLes contained in this Civision. If the construction does conply wi.th such
ru1es, the Departrent sha.l-.1. issue a certifj.cate of satisfactory completion to the permiti holder
If the construction does not compl,y uith such rufes, the Departrent shalI notify the permit
hoLder and shaLl- require satisfactory conpLeLion before issuing the certificate. Failure to
neet Lhe requirenenLs for satisfactory compLetlon within a reasonable time constiLutes a vio-
Iation of oRS 454.605 to 454.745 and this rule.
Setbacks - Subsurface Sewage Disposal
scptic Tank Drainfj.el,d
Fron:In!erj.or propert,/ li.es
Edqe o.i road. riqirt-of -uay
Buil,dinq foundation
liells, other Hater sources
I
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SUBSURFACE AND
10 't0'
50'
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l-0,I0'
100 |
bne countyACTI .TY INFORMATION -,HEET
COMPLETE THIS SECTION.INCOMPLETE FORMS I^JILL BE REJEC @TED !
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2 PROPERTY ADDRESS *Q( IF DIFFERENT
3 rvlae e pAFtcEL NTTMBEFT
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(from tax maps in Department of Assessment and Taxat.ionor from tax statement)
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TAX LOT(S) OR PAREELT ZON I NG
ACRES
4 SUBDIVISI0N (if applicable)LOT BLOCK
5 REQUEST (s;tate exactly what you plan to do)Aoorl:l ft NA a^6E
6 DIRECTI0NS T0 SITE: [r4$ F]curto6 R-d L^ S
** FOR STAFF USE oNLY **
ZONE/LAND USE:
BY t _ DATE:_ TIME IN:-. OUT:_
NUMBER
DATE
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LAND MANAGTMENT DIVISION / 125 E. Bth AVE., L-UGENE, OR 9740I / 687-406I
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MW_NSH]P RA-NGE SEETI_ON
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: