HomeMy WebLinkAboutPermit Mechanical 1976-07-22LANE COUNTY PERMIT FOR:PERTVIIT NO.
CONSTRUCTION t ] IVIOBILE HOTVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
! owner NArvrE ADDRESS - - c,,y zrp cooE +to*E
tr Contractor
NAIVIE ADD R ESS CITY ZIP CODE PHONE
O.S. Reg. +
Tw Range- Section Tax Lot- Code- Census Tract
Subd ivision
-
Lot B lock Acreage Width
Access to Property (Road Name)Dept
Existing Structures on Property
Directions to Property - Address:
STRUCTURE (# BEDROON4S)SO. FT VALUATIONrt!
SEWAGE D ISPOSAL:
PUBLIC[] SEPTICTANKT]orHER [ ]
PLUIVIBING INSTALLED BY:
OWNER[] OTHER[] NAIVI F
BUILDING-
PLUIVIB ING
3% SURCHARGE=.----
IVIOBILE HOIVIE=---
WASTE DISPOSAL
PLAN BEVIEW
TOTAL
WATER SUPPLY: PROPOSED t ]
EXISTING t ]
] PUB LIC
COMIVIUNITY . NAME
dIvl
PRIVATE WELL
OTHER .SPECIFY
o
o
),i-
SPECTIONS AND WATER POLLUTION CONTROL SPECI F ICATIONSCONSTRUCTION PERMITS & 1N
tVIIN. SEPTIC TANK CAPACITY
GALS.MIN. DRAINFIELD---=--LIN. FT IVIAX. TRENCH DEPT I NCHES
ti STA , FROM AL E LLS
GROUP FIBE ZON USE CLASSIFtrTYPE OF CONSTRUCTION
SETBACKS - FT. FROt\4 CTR. OF rAtV
FRONT SIDE EXT
AUTHORIZED SIGNATURES
FT. FBOI\4 PROP. LINE:
SIDE INT. =- REAR ZON E
ISSUANCE DATE
lsl
c55.1 3
LA N E Co U N TY, D E Pr. o F E N v I B O N M E N T A L. M A!4-GFl'.'l ^EI
r
c'ciiiiiidUsr ilrGx, rgs EASr 6rh, EUGENE, oREGoN e7401
BLDG, PEBMIT - WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUMBING - CANABY
BUILDING - GBEEN
slutrrrtou - GOLDENROD
IMPORTANT:
call 687-4065 to schedule all required construction rnspections. call 687-4061 to schedule all required
JJpiiI iv.i,i,i, i;.;"ii"";. nrr ""J".vr"iiii" "i"ri "o.pii *ith the srat" Buidlins code, D.E.o. standards
for subsurface ""*"9" o,"poJJ lr-riJ'iii" StrG iiumUing CoOe err buildingi require a certificate ol
occupancy before being occuPied
(See Details on Reverse Side)
ST THIS PERM IT ON MAIN B AT SITE
I
SITE INSPECTION
Ap pnov r o
RrunRxs
DtsappRovEo Darr l nsprcton
FOUNDATION I NSPECTION
Ap pRov r o D r s appnovr E I ruseecton
Re urnx s t-?,
FRAMING INSPECTION
e-<,-ee
Drslppnove, D Dnrr -iz_g I rspecron
L4^L, * | a-797-<
LATH OR SHTETROCK INSPECTION
Appnoveo D Drsappnoveo f-a Darr I Nspecton
Rruanx s
FINAL INSPICTION
Appnovro
Reuaax s
ru Dr slppRoveo Darr '7-
I xspecroR
CERTIFICATE OF OCCUPANCY
Reaoy ro lssuE
ReuaRx s
D Nor Reaoy ro lssuE D Dare lruspEcron
(//ora-/,-^
79
r--
/t- 03 02, z +
/'-l',,t-'
LANE COUNTY INSPECTION RECORD
PHUNT ERO[^JNLR'5 NAIVIL
L-0-.1
1t
DIRECTIONS TO SITE
,-1
SITE ADDRESS PERMIT NUMBER
FOOTING / FOUNDATION INSPECTiON OR MOBILE HOME SET UP INSPECTION
Approved Correcti on D'isapproved Date Insp ector
CONCRETE SLAB / UNDER-FLOOR INSPECTIONApproved Correctjon_ Djsapproved_Date i ns pec tor
UNDER SLAB / PLUMBING GROUNDWORK INSPECTIONApproved Correction D'isapproved__Date inspector
i?OUGH PLUI'IBING INSPECTION
Approved Co rrec t i on Dj sapproved Date I nspector
I-RAM NG INS ECTIONTIP
Approved Correction----Disapproved_ IDa te I nspector
INSULATION / VAP OR tsARRIER I SPECTI ONNApproved Correcti on--Di sapproved_lDate I ns pec tor
App roved Correcti on _Disapproved Date Inspector
FINAL PLUMBiNG INSPECTIONApproved Correct'ion Di sapproved Da te I nspector
FINAL WASTE DISPOSAL SYSTEM INS PECTiON
Approved Correcti on_--Di sapproved Date I ns pector
N
Approved Correcti on_Disapprovea -iat€&3-g/ 1n5pector
BIL HOME
CERTIFICATE OF OCCUPANC TEMPORARY CERTIFICATE OF OCCUPANCYApproved--_Correcti on Di sapprroved
Form Cl4-L97
Date __Inspector
/5co ntL_/
/1
\ l.t)e (.p'l?
I RI
w J D c.l*
(2 ,\€,\Ll V
LATH / GYPSUM tsOARD I T.U I IUN
I Owner
LANE COUNTY PERMIT FOR:PERI\1IT NO
CONSTRUCTION [ ] I\,IOBILE HOTVIE [ ] PLAN REVIEW [ ] CHANGE OF OCCUPANCY [ ]
NAME ADD R ESS CITY ZIP CODE PHONE
I Contractor
NAIVIE ADD R ESS CITY ZIP CODE PHONE
O.S. Reg. +
Tw
Subd ivision
Range-- Section-Tu, Lot €€ode_=-- census Tract
Lot-- Block Acreage
--
Width
DepthAccess to Property (Road Name)
Directions to Property - Address:
STRUCTURE (# BEDROOIVIS)SO. FT VALUATION
SEWAGE DISPOSAL PLUIVIBING INSTALLED BY
PUBLIC t ] SEPTICTANK t] OTHER[]OWNER [ ] OTHER t I NAtvt tr
BUILDING
PLUIVIB ING
3% SURCHARGE---
IVIOBILE HOIVIE
WASTE DISPOSAL
PLAN REVIEW
TOTAL
WATER SUPPLY: PROPOSED t ]
EXISTING t]
PUB LIC
COIV}IVIUNITY - NAIME
PR IVATE WELL
OTHER.SPECIFY:
CONSTRUCTION PERMITS & INSPECTIONS AND WATER POLLUTION CONTROL SPECIFICATIONS
IVIIN. SEPTIC TANK CAPACITY
GA LS IVIIN. DRAINFIELD LIN. FT MAX. TRENCH DEPTH I NCH ES
STAY 1OO' FROM ALL WELLS
TYPE OF CONSTRUCTION- GROUP FIRE ZON USE CLASSIFE
SETBACKS- FT. FROIVI CTR. OF rAil
FRONT
FT. FROIVI PROP. LINE
SIDE INT REAR
-
ZONE-
AUTHORIZED SIGNATURES
lsl
ISSUANCE DATE
BLDG. PEBMIT _ WHITE
OFFICE COPY - WHITE
COUNTY TAX - PINK
PLUI\4BING _ CANARY
BUILDING _ GREEN
SANITATION _ GOLDENBOD
IMPORTANT
POST THIS PERMIT ON MAIN BLDG. AT SI
LANE COUNTY, DEPT. OF ENVIBONN4ENTAL MANAGEMENT
COUBTHOUSE ANNEX, 135 EAST 6th, EUGENE, OREGON 97401
Call 687-4065 to schedule all required construction inspections. Call 687-4061 to schedute atl requiredseptic system inspections. All construction shall comply with the Stale Euidling Code, D.E.Q. stanilardsfor subsurface sewage disposal and the State Plumbing Code. All buildingi require a certificate of
occupancy before being occupied.
(See Details on Beverse Side)
c55.r 3
TE
Existing Structures on Property:
SIDE EXT.
BUILOING SITE EVALUATION
N BUIIDING PERHTT APPL
( ) srrE rNsPEcrroN
PLANNIN6 DIVISION
\S4ctl-
rcArroN nil/blo-7a
T .{
SUBDIVISION:
s TAX LOT
Not
Jppl icable X!,
LOT:BLOCK:
Front
Setbacks from interior IrBs:Side
Rear
APPL I CANT
DAT
I
2
3
4
5
Zoning 0rdinance Cornpl iance: Zonu_KT-
Subdivision 0rdinance Compl iance
Requi red Access
Building Site (Area, Width, Frontage)
Other (see conments)
cxro gvr)6. Setbacks ftorn c/ I of road:F()
()
()
()
r)()
()
()
()
Yesw.6ktt
COHHENTS:
PIANNING Drvtstffi(--T N0(T-mmlmr Im#
BUILOING INSPECTION OIVISION Not
I icable No
CI()
()
()
Y
7
8
9
0
Plans Submitted
Soi I Stabi I ity (footings)
Flood Plain
Other (see comrnent
COHMTNTS:
COHHENTS I
T.'ATER POLUTION CONTROL
ll. l{eets Department of Environmental
Qual ity Standards.
12. 0ther (see cornments)
,
Not
Appf i cabl e No Yes ,/Ttw
CK!D BY:
CKID BY:
(
() ()()
)
DATE
TO APPLICANT
(/
:
Your Bui lding / Site lnsPection:
UY ca" be approved.
(tzf Cannot be approved at this t ta above
,1p
ime as indicated on item N0"
Ouestions and further informat ion on items I through
UNTY DlVlSl0N" Ouestion rther i nf
5 contact-IFe !ANE-
ormation on items 7
SAN TATION D ON
ve the prob
^'
t
)l{
he LANE COU
\t0 ill be held in this office unt
rough 2 contact t
) ls Ueing returned.
s and fu
BUILDING
you can reso(
(
c55-28
Your bui ldin
ems
s
nd i cated.
rmit I ica fee is
AL
135 Sixth Avenue East Eugene Oregon
PHoNE z 687-4055
LANE COUNTY PLANNTNG DIVISION PHONE:
97401
587-41 85
I
BUILDING SITE EVALUAT ION
( ) BUtLotNG pERHtr AppLtcAT!0N N06_
( ) srrE rNsPEcrroN
PLANI'I ING D lV lS lON Not
Aool i cablee *-17-
-t
I()
tage) ( )()
COITHENTS:
l. Zoning Ordinance Cornpliance: Zon
2o Subdivision Ordinance Compl iance
3. Requi red Access4. Building Site (Area, width, Fron
5" 0ther (see conrnents)
APPL I CANT
DATE
No Yes 6. Setbacks-Trom cZ- oF
Front
fl()
()
()
()
r)'()
)
)
)
(
(
(
road
Side Exterior
Setbacks fronr interior I ines:side #'Rear ..{a
'*.
PLAnN Nc D.VIS TTP-PrTeAr IoN#
7. Plans Submitted8. Soi I Stabi I ity (footings)
9, Flood Plain
0. 0ther (see corments)
Not
Appl icqbLe(I
()
()
()
No Yesr) TT() ()
() ()
() ()CKI D BY:
DATE
COMMENTS:|-:
I,ATER POLUTION CONTROL Not
Aool i cabl e r)rINo Yes
I l. l.leets Department of Environmental
Qual ity Standards.
12. Other (see comments)() ()()CKID BY:
DATE
COHHENTS:
TO APPLICANT:
Your Building / Site lnsPection:
()Qanbe
(i-YCannot
Quest i
COUNTY
r approved"
be approved at this time as indicated on item N0 " l.O , , .,.=.b
ons and further information on items I through 6 contact the LANE-
G DlVtSlON" Questions and further information on items 7
throug
Lri I I b
2 contact the LANE COUNTY BU D NG AND SANITATIO D
e held in this of ce unt i I you can reso
ls being returned.
VISION
ve the p()
()
c55-28
(Your bui ldin
PHoNE. 697_4065
LANE COUNTY PLANNING DlVlSl0N PHONE: 587-4185
ems indicate d.
ove.
rmi t a I i cation f s bein
NTAL ENT
135 Sixth Avenue East Eugene Oregon 974o1
T R S TAXLOT
SUBDIV!SION:LOT: BLOCK:
u
CKID BY:,'4ff"7 L
BUILDING INSPECTION DIVISION
I
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\-T
( er. G,(R/nER , pRopERrr owrvee)
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REE ED
BY
JUN2 91976
LAN E COUNTY
TMENTAL MGMT.
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?Aone, 726-A2?6 Jcrne- /? 76
To ACCom Plrvf 4 ppL /c4 r/o/vfoR EurzD/,yG pERtt tfFoR CA,?A 0f a4,x so.
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CONSTRUCTION
pERMrr +///O*76
NO PERMIT WILL BE ISSUED I]NTIL THIS APPLIC.ATION HAS BEEN APPROVED
APPLICATION FOR:
MOBILE }iOME PLAN REVIEW CHAJ{GE OF OCCUPA}ICY
X o*u* ?o
Name
CONTRACTOR
\ *0. /8 *,,g" .3 s."
Address
Q , 2 rax Lor /5OO {/?-o2 Census Tractlbol
Name
o.s. REG. il
tion
Block erty ,L6
)g' lccnss ro PRoPERTY (so^a xr eWT
\ A*i"ting Structures on Property:
\-.2'Property Location - Address/Dlrections:
Subdivision
Below for ice Use
Site Inspec tion /l
D
I^Iidth
Existlng Sewag
7
i,,0
#:ll-iLH"sprlng Other
PLUMBlNG
Install by owner
PLi]MB]NG
Comnunity Name of Conmunity or Public Sys
Name
FEES:
Blds.
Plumbing
3% Surcharge
waste Disp.
Plan Review
Mobile Hooe
Fixtures
.
Sewage
Connection
Water
Connection
TOTAL
CASH
CHECK
PLANS TURNISHED
7 vns
Signature of Appl
Fee Received By
FACILITY PERMIT
NO Wno
Date
Min. SeDLlc Tank Capacis'K lgu'a
ty.Requ lred - Lineal Feet
dL
Llaximum
Ztf-
tvp e of ConstrucEion Fire Zone Us e Classification
Bldg Setbacks - from Center of Road Right of Way:
Front !*"at Side rnt 5 gi'#ior -lRear S
c55- l2 I-A,NE COT]NTY OF ENVIRONMENTAL
Zone KA
DATE:DATE:
a
Y\,4J.
NOTE:
l-r
City Zip Phone
{
d or New system Required f-l
2v,-_--;TT
otter I
I
Da te
TO
_Land D j vi sion Section
_Reg iona I Pl ann i ng
_Pl ann i ng Research
_- _-Zon i ng Enforcerlent
___Envi ronnrental Heal th
t -l,Jater Pol I ution Control
--Soils Data
_Fl ood Management
--Transportat'ion Pl anni ng
-Assessment
& Taxat'ion
--Pa
rks Di vi s'ion
_Lane Real Estate Div.
__Lane Publ ic Safety
. Lane Public Lands
. . Lane Legal Counsel
- '._ llous i ng & Comm. Dev .
Extension Service
Transit District
Reg. Air Pol. Auth
_5ru te Fo re s try EAct -
___State Hi ghrvay. Dj vj sion
_ __State Envi ron. Qual i t_v
___State Dept. of Lancs
__#tate Fjsh & Gar;re =,\tT-
--State Geol. & l'fineral indus
__State Veteri nari an
_Dunes Nat' I Rec. Area
_S'iuslaw Nat'l Forest
_l^lillamette Nat'l Forest
__Bureau of Land l,lgmt.
Soi I Conservati on Serv'i ce
_Corps of Engi neers
_Fed. Av'iation Authority
--Fed. Conrnun jcations Cor,rn.
_f- Othe r PUZ*u AOCBESS rvr L-
0ther
__La ne
__Lane
_Lane
_-l,later District
School District
v--Fire DistrictsPFLQ ?
_Bounda ry Conrmi s s'i on
Po rt of S i us'l aw
-0.l
an Dept-
a ity of
--El.fEB
--_N . l^l. Natu ra I Gas
_r--Pacif.ic N.l,J. Bell
_Pacific N.W. Power
_Tri-Agency Dog Control
-LCDC.__ Neighborhood Group
Fronr:
LANE COUNTY LAND MANAGEIllENT DIVISiON.l25 East Bth Avenue, Eugene, 0regon 97401phone: 6€F4-oE] i:i] "_:;?i'd,,1. . r'r \ J
A request for land use action, as described on
DATA SUMI,IARY: Journal No. PA i 3 Z a -++
App licant -Rce=-r t.lx Cxr..rp
P rope rty Address lt9'5 S .
Data Summary and attached schemat'ic has reen
ant impact js evident, please send comments
impacts on
received by the Planning Division.If significto Land Management D j v"isi on by
Specific concerns of your agency should be addressed in addition to adverse
general livability of the area and its future development.
For additional information, contact Ce:*E (JE-E-ta
-'\r- .-t.
Zone Di stri ct
Lot si ze
Map
Tax Lot
l?+
+!_-
'ct-'
PR0P0SAL : lp-p.e_D-l_l]_ 1.E:;. jr -l 3=\A_\_PBN&rE.
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30 p'
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\YAfER S7PPLy FRo^t SUg
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