HomeMy WebLinkAboutPermit Building 1983-02-15coNsTF.;CTION /ptec
PERMIT
EMEN-,6l\'--
CO}lPLETE THIS BLOCK. PLEASE USE BLACK INK
n PLANNING ZONING Partition #_Parc.r I i
-.,----\/rntcrior r--/,"*T'|JJE
Farcef S1
Ili.:rrmum Sctbackg:L, frlnlc c-+,, siae ^
FCR OFiICX USE ONLY
Applica+-i
Pernit *i
Ir*o Copies of Plans
firwo Copies of Piot Plans
!ltechanical- Checlili st
! llumb.inc Cl''ecklist
Plan Chec]" Info Sheet
-To'rvllsnrrl
I 1
to the work described herein, and that No occupANcy will. be nade of any structur. wiLh()ut thc pormi:ision of t-ire B'rildirtg Di'vision' r turth'rr c' r'-iti'
that registration with the Builder,s Board is in fu11 force and effect as requjrcd by oP.s 701.055, that if exenlpt t:rc basj's for exeml:tl<'rr is'rrot''d
hereon, and that only subcontractors and enproyees who are in compriance with oRs 701.055 wilt be usod on this Froiect' r HA\'IE READ AllD cllE('l"ED Tlirs
APPLICATION THOROUG}ILY.
ZTP
; OT STORIES
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n D.\TiSICNATUiTE
T"'
ALUE
NUMBER
*
A
NAME (please Print)
FubIic
Re s iden ti a1 f, lndustrral
Proposed
Exi, s +-ing
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ffi...'-r..'
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Ll Comnerclal J
n
Cornnents:
Date @
I rr,ooopr,aru ! rn f lood hazard area?
I nunar, ADDRESSTNG' (;R]D cooRDrNArE
,.,.*)WQb lnstalLation Record lssucd? ! v.. I n"
Maxj-munr Depth
of Trelches
No I ves Date:
Date:
see attactred sheet
E
s. r
InsEallation
Specifications
cal lon
Tank
Lineal Feet
of Drainfield
.71,Corunents:
El'ryauq EXAMINATION: rype
Comments:
t;
Use
44
,3
{-tv GrouP
Date:
Date
CONSTRUCT ION AUTHORIZED BY THIS PERMIT
iptio Sq. Ft
d Fee,/
Cost
l-xe
L
F Floodplain Fee
Subsurface Fees
Building Fee
Sevrer/Storm Drai n,/Water
\3 nr*fns Fixfures
Mechanical
Plans Check Fee
State Surcharge
TOTAL FEE
$
I
s
$
>
$
$
$
$
TOTAL VALUATION $
PER}IIT APPROVED BY BUILDITIG OFFICI.\L/DESIGIIT;E
FEES PATD
By:
ate:
f] cnect< [ casrr
a
IANE COUNTY DEPART!4ENT OP PLAIINING & COI.IIIUNITY DEVEI.OPI',1UNT // I25 EAST EIGHTH AVENUE, EUGENE, OFEGON 9
SEE REVERSE FOR ]NSPECTION INFORMATION
5
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SANITATION:
tr
tr
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lone ccurty
PLANNING & COMMUNITY DEVELOPI'itrI,IT
ACI"IVITY INFORMATIG^.I SH EET
COMPLETE THiS SECTION. INCOMPLETE FORMS tllILL BE REJECTED!
6tt'I7
I
*S:te fi€ou)4a
RTY
o
??tt 4?q77
ffi HOME TELEPHONE #
(from tax maps in Department of Assessment and Taxatiot
or from tax statement)
Ies
ZON I NG
milNsHIF RENGE mmN ffi-t-oTrsTTRmneEm ZON I NG
mrNSHiT mGE SECTI-oN TEX*I0-TTs-)-0'R-EAffiEIT ZOt\ I NG
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:ACRES
O ,rrr*-ON (if aPPl icable)U BLocK
5 REQUEST (state exactly what you plan to do)
/1 K '/a ,(il,1,^
lq 6t 6f,Jt4
7t4-53J-/
BUSINE-SS TELEPHONE #
2. PROPERTY ADDRESS(IF DIFFERENT F
3 rvree B PAFIeEL luuMBEFl
( REQUIREp INF0RI4ATIoN)
6 DIRECTIONS TO SITE:tril
l/or*f /tts
** FOR STAFF USE ONLY **
ZONE/LAND USE:
NUMBER
DATE
-tna
-t
BY:
--
DATE:- TIME IN:._-
,?/
t
OhlNER
str'
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)
/7 oj 1,{ -..a=1.J=,4_==.===T6TN.SF-IF RTN6T SMTMN MLOT(S) OR PARCEL #
3
fnra e t
rsN[.-:
Z!* ?-7#^-psstSSUED:
BfjioBD
rns* /
ET
L FRONT
PIRMI T
PHONE NUMBER
"/- --PHONE NUMBER
Sn SI DE
i<'INTERIOR E./REAR 7',L
I
*n /?
A IN
Approved rr( Date 51 7-3F-/,|orrectjon._.__*Date_*,_lnspector
pmBlmd-trmflo-tl0flf -r ru-$[l c r i-o [-
fl
Approved Date_ _*i.orrecti on Da te
,/
I nspec tor
'JWurfiiEpr1-tr-fi-u i. Ef-l-r{SPE-c-tTot(
App r o v e d oE
-Oite
5 -23 =-83-l
i.o rre c t i on
-_*Da
te---....-- -- -l
n s p ector
SL-AB INSPECTIONApproved__Date*_ - _ _ -_l Correcti on--___Da te __lnsp ector
R0UGH PLUMBTNG (TOP 0UlI TNSPECTT0N
A p p ro v e d- ot t<-_ *D a te - bt:|.*__/ c o r re c t i o n_ __'-_-*D a te I nspe ctor
FRAMING INSPECTION
Approve(4,+- _Qate -b=t4 -*1 -/correction Date I nspe ctor
ROUGH MECHANI'CAT
Approved Aa Date_b=t4.% /correction_-___,Date I nspe ctor
INSULAIIUN / VAPO RB ARRI r-R INSPI CTI ON
ITTHTTFSu rf BOIm-i NSFE c]ION-*-
Approved-g2&_Date 4 - /:{- 8 ?-./Correction- Date--*_-___--Inspe ctor
Approved_.--.* _Date i.orrecti on Date i nspec tor
1-ffifIsemTcAl-fl- 7w-0O0
-siOvft t- -
Approved -_*__-Date. _--_{.orrec tion Da te Inspector
F INAL PLIMBING INSPE cTIni..l
/\oprove 1,0 rrec ti on .__^.-..0a te*_*"-I nsp ector
I-INAL I irlr -HbNr E 7nc PLACEMENT []
Approve orrecti on Da te Insp ector
illeilPnlrcTf_l---- - --*-TE[iF0RRRY CERTIFICATE OF OCCUPANCY trApproved_ .-_!ate. __.._ - -.- Insrr - _ _ __ Approved. -
I nsp ._t-.Uate
s$v\qn
COIINI Y I IJSPFCT I ON
Da te
EFN-TTFIC{TE*Or
lane county6llr-
-
CHECKLIST
PTUMBING/MECHANICAT
APPLICANT INFORMATI ON:
h
OT rm-eas
PLTIMBING CONTRACTOR tr Yes Firm
Address
E No n s"rt
ruEGL{NICAT CONTRACTOR tr Yes Firm
Address
fl No I serr
,IESS or
Cont. OSR#
1p
Cont. OSR#
PLIIMBING
OFFICIAL USE ONLY
Permi
11App
#t
Type of Fixture Number of Each Fee On Each Total
Sink $ s.oo
l,avatory I 1n /s. 00
Tub (with or without shower)5. 00
Shower, separate I s. 00
Water oset to 1 t 5. 00
Dishwasher 5. 00r5. 00
Washing Machine 5. 00
Water F eater 5.00
Floor Drain 5. 00
Sewer--lst 50ft.15 .00
10. 00
Water Service--1st 100 ft.15.00
each additional 100 ft.10. 00
st 100 ft 15.00
additional 100 ft.10. 00
te 10n 5.00
e'iector 5.00
It{obile Home Sewer and Water 10.00
Other (
SLE-TOTAI (Minimum $10. 00)
TOTAL FEE
MEGI,ANICAL
Type of Equipment I,iuunber of Each Fee on Each Total
Mechanical Permit Base Fee $ ro. oo
Furnace up to 100,000 BTU/H $ 6.00
Furnace over 100.000 BTU/H 7. 50
Clothes Dryer Vent 5. 00
Bathroom Ventilation Fan ti D.rct /5. 00 3,@
Ranse Hood with lvbchanical Exhaust 4.50
Wood Stove o.0u
Air Conditioner Only 6. 00
Fleat Purur o. ut)
Floor Furnace 6.00
Gas Piping System 1 to 4 Outlets
Per Outlet 50
Other (specify)
SIIB-TOTAI
TOTAL FEE t ?d/d
t
torm anc
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;ewaqe and Sur