HomeMy WebLinkAboutPermit Building 1991-6-6
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AutHORIZATION FORM'"
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Land Management Division 125 E. 8th Ave Eugene, OR 97401
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SECT10N 0 6 . t18~ON
TAX LOT 77 Q 0 SUBDIVISION I PAflllllQH
LOCATION ADDRESS
~Oll JASPER ROAD,
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SPRINGFIELD, OREGON
97478
STRUCTURES NOW ON PROPERTY
EXISTING SINGLE FAMILY DWELLING
PROPOSED USE
WATER "'STALL.EO
NO OF EMPLOYEEJl1
NO OF STORIES
SEPTlCINSTALLEO
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PERMIT #
1(1)6.('),-QI
lAD DRESSING
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C0H8T1lUCTlON COSTfYALUi:
PR IVATE USE
DESCRIPTION Of PROPOSED WORK
ADDITION TO EXISTING SINGLE FAMILY DWELLING (FAMILY ROOM)
DIRECTIONS TO SITE FROM COURTHOUSE
NO OF IEDROOII8
THROUGH SPRINGFIELD TO JASPER ROAD,,'ON CORNER OF JASPER ROAD AND FILBERT LN.
~TAL," Dl8l !/IVS pEIl
APPROVED 'lOT OAT~
TttE 'Y8T~ PEAR'" TO IE WOFlKlNl;I
.....x. TRN.7PTH' RJr;l.HT IF STeM !"AlLS.. YOU
MUST A Y FOR A REP"-I1'l PERUll'/ I
j' 0 H 0 EXIBTlN:J:'I'STOI
~ ALLED Pifl. / MIlT NU"I~/RI / I
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APPLICANT NAME il ",00RES9
R, V. LEBKOWSKY, SMIE AS' THE JOB ADDRESS ABOVE
OWNERS NAME' ADDRESS
'SAME AS THE AcOVE
CONTRACTOR NAME
OSR UCENSE ,
NA
NA
I MAIL PERMIT- TO
Y, f'iAIL PERrHT TO THE OI'NER AT THE JOB ADDRESS ABOVE
~ NAME
xJK::e~t:J~B7: sldes,of this
t PR~NAAlI; . I . .
ADDRESS
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MINIMUM
FP '7 I-EOAI,. ,,"on SETBACKS FRONTI,OTLINli.
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COMMliNTS
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BUILDING
TYPE
GROUP
COMMENTSI
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FEES DUE $
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CALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTIONS) 687-4065
SEPTIC permits are good for ona year. ALL other permits expire after 180 days unless inspections ara current
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VIOLA nONS
SSTIJACKS AND OTHER CONDmONS OF APPROV ALMUST BE SlRICIL Y c9SBRVED VIOLATION CAN RESULT D'J REVOCATION OF TInS PERMIT
CITATIONS MAY BE lSSUBD UNDER nm PROVISIONS OF LANE COUNTY S lNFRAcnON ORDINANCH AND/OR OTHER REMEDIES AlLOWED BYLAW
.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECITON REQUESTS
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Have the followmg mf?rrnatton ready when YOIl call 687-4065
Penmt number - Job address - Type of mspectlon requITed When It WIll be ready
Your name and phone number - Any specIal drrectlOns to the site
PUBLIC OFFICIAL RIGIITTO TRESPASS ON PRIVATE PROPERTY ORS ns 080
PDWERTOBmERUPONLM'D nmCOMMlSSION AND ANY OF ITS MBMBERS OfPICERS AND EMPLOYES INTItE.PBRFORMANCBOFTIlEIRPL........."..., MAY
ENTER UPON ANY LAND AND MAKE EXAMINATIONS AND SURVEYS AND PLACE AND MAINTAIN nIB NECESSARY MONUMI!NTS AND MARKERS TIiEREON
REQUIRED INSPECTIONS
FOUNDATION INSPECfION To be made after excavations for footIngs are complete and any requITed remfoICmg steel IS Ul place
UNDERGROUND PIPING INSPECTION To be made after all underground p'p1Og has been 1I1Stalled, pnor to any backfill
CONCRETE SLAB OR UNDER-FLOOR INSPECTION To be made after all 1O-slab or under-floer bUlld10g semce eqUlpmen~ conduit. plp10g
accessones and other ancillary eqUIpment Items are m place but before any concrete IS placed or floor sheatlung InStalled, mcludmg the subtIoor
ROUGH MECHANICAL INSPECTION To be made after all duct10g and gas plp10g has been mstalled and pnor to be10g covered
ROUGH PLUMBING INSPECTION To be made after all plumbmg rough-1O IS 10 place. pnor to be10g covered
FRAMING INSPECTION To be made after the all fram1Og, fITe bloclang. bracmg and roof are 10 place and all pipeS. clumneys and vents are complete
and the rough electncal, plumbmg, and mecharucal mspecuons have been made and approved
INSULATION INSPECTION To be made after all InSulauon and vapor barners are m place, pnor to covenng
LATH AND/OR GYPSUM BOARD INSPECTION To be made after alllath10g and gypsum board, 1Otenor and extenor, IS 10 place but before any
plastenng IS applIed or before gypsum board Jomts and fasteners are taped and fIDlShed
ADDITIONAL INSPECTIONS MAY BE REQUIRED, such as but not hrruted to,
BLOCK WALL To be made afterremfarcmg IS m place, but before any grout IS poured The mspectlOn IS requrred for each bond beam pour There
will be no approval untIl the plumbmg and electncal1I1SpectIons have been made and approved
FINAL MECHANICAL INSPECTION To be made Just pnor to the structure or remOdeled area be10g occupied and pnor to operatIng anyeqUlpment
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FINAL PLUMBING INSPECTION To be made Just pnor to the bUlld1O~. structure or remodeled area be10g occupied
FINAvJl1JTh.9INGlNSRl'<rUji)!:iI-..Tn'be.n\d~!(~~ad1hli"ii:hd tl1e"btiildnlg;-s'iiirelol'l!'l7r''''''''OOC'&RlreIl'lS completed and ready for occupancy
MOBILE/MANUFACTURED HOMES An UlSpectIon IS requITed after the mobile home IS connected to an approved sewer or septIc
system. pnar to covenng sewer or water Imes, for setback requrrements. bloclang, uedowns and plumblllg connectIOns
Footmgs and pters to comply With State fOW1dahon requrrements for mobile homes or as recorrunended by the manufacturer
M10unum fuushed floor elevatIOn shall be certIfIed when reqUITed by Floodplam Management
Tledowns, If requIred, shall be mstalled and ready for mspechon wlthm 30 days after occupancy Tledowns shall be InStalled per enclosure
APPROVAL REQUIRED
No work shall be done on any part of the bmldmg or structure beyond the pomt mdlcated m each successive mspectIon WIthOUt frrst obtammg the
approval of the bulldmg offiCial Such approval shall be given only after an mspecuon shall have been made of each successive step m the constructIOn
as mdlcated by each of the mspectIons reqUITed
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS
THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITIIIN 180 DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN 180 DAYS
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS ISSU~ THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION
ANYONE PROCEEDING PAST THE POINT OF REQUII}.E;SPBS;;TlQNS WILL DO SO AT THEIR OWN RISK
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Your SIgnature on the front of t/us form vermes the followmg I HA VE~ 'tl'.EX~P1THIS COMPLETED APPLICATION. and do
hereby certIfy that all mformatIon hereon IS true and correct, and that I ~ a leg81 mttie1 m the"P~y as owner of record or authOrIzed agent I
furrher cerl1fy that any and all work performed shall be done m accor{~c ",the c! ances of ~.91Pn,and the laws of the State of Oregon per-
tammg to the work descnbed herem I further certIfy that If I am not tfie er3';f:lihe pr rty1ttfegl~n ~ the BUilders Board IS m full force
and effect as requITed by ORS 701 055, and thallf exempt the basiS for th ~btI9P IS noted , and ~~ subcontractors and employees who
are 10 comphance With ORS 701 005 will be used on the Job ~.I' V
SUBSURFACE & ALTERNATIVE SEW AGE DISPOSAL SYSTEMS
When subsurface construchon IS complete, the penmt holder shall notify the County Land Management DIVISion by subnuttmg the mstallatIon record
form An mspectIon Will be made by a qualified sarutanan If constructIon complIes With all rules a certIfIcate of completIon Will be ISsued to the permIt
holder If construction does not comply WIth rules, the penmt holder will be notIfie&.3!lA..a!!.~.$.o~_~h;lJs;be made before a ceI1J.ficate of completIOn
Will be ISSUed Fllllure to meet satIsfactory completJon WIthm the allotted tune constItutes a VIOlatIon ~ 454 605 to 454 745 and thIS rule
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From Intenor property Imes 10'
Edge ofroad nght-of-way 10'
BUlldmg foundatIon 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
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. ~ C~CELLA TION
~~y REFUND AUTHORIZA TION
NAM~ ~d /EaKo?v{)~V
ADDRE:~''''~// //rcF/E7C~.
Jd. APPLICANT ~ OWNER 0 CONTRACTOR
REASON FOR CANCELLATION .r
PERMIT# ./6~ c;?' /
TRSfTL# //'-':;c-,::;6',/' ~ ""770~
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SIGNATUR<= / DATE , rk/ /7' /
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Fees paid for waste disposal systems (Site Inspections and/or applications to Install the septic tank and dralnfleld) are ordinarily
nonrefundable Refund may be on bUilding, planning. or plumbing portions according to the amount of the permit/application processed
FEES PAID
%REFUND
$---------------------
$---------------------
$---------------------
$---------------------
$-~------------------
$--~~~~----------
$---------------------
$ ---------------------
$ ---------------------
$ ---------------------
% Flood Plain Fee
% Building Permit Fee
% Mobile Home Fee
% Plumbing Permit Fee
% Mechanical Permit Fee
I tYFJ %'\~ Plan Check Fee
% State Surcharge
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% Septic Disposal Fee
% Site Inspection Fee
% DEQ Surcharge
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% Land Use Application
% PlannIng Director
% Recording Fees
% Partitions
% CopIes & Ordinances
$ ---------------------
$
$
$
$
% Surveyors
Less Processing Fee
$
$=====~"7s-:.00=~~~===~=
REFUNDED $~~~~_____________
nate C2:;-0:3 -q;
.~_AMOUNT TO BE
TO DEPARTMENT OF FINANCE
BUilding Permit Refund
State Surcharge Refund
Septic Disposal Refund
DEQ Surcharge
Site Inspection Refund
Land Use Applicallon
Planmng Director
Recording Fees
Partitions
Copies & Ordinances
TOTAL AMOUNT REFUNDED
$AO!2 ~
$
$
$
$
$
$
$
$
$
$ t?f V"t%' ~
PLEASE MAKE CHECK PAYABLE TO
NAMF k? t! /... F pf K/},u-/J' K Y
ADDRESS ~~/ ,-!_..zJ~~~ ~ f//:?~h/5:..~/4 ~~~
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M14-48
24-0674/Acct 42120/Prog 020
24-0674/Acct 42123/Prog 020
24-0427/Acct 42133/Prog 240
24-0427/Acct 42123/Prog 240
24-0427/Acct 42134/Prog 240
24-0674/Acct 46202/Prog 010
24-0674/Acct 42150/Prog 010
24-1870/Acct 46211/Prog 110
24-0674/Acct 46202/Prog 010
24-1870/ Acct 44419/Prog 110
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