HomeMy WebLinkAboutPermit Plumbing 1984-8-16
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ne county
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CHECKLIST
PLUMBI NG / MECHAN ICAL
APPLICANT INFORMATION:
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(Name or jlll~~~~r~) (~1alllng AddreSS)
PLlJ1cD3TNG CONTRACTOR D Yes Firm
Address
OFFICIAL USE ONLY
Appli.; .
Permit #
(qt)' or Jown) lZIP Lode)
Cont. OSR#
D No DSelf
MEGlANlCAL CONTRACTOR D Yes Firm
Address
Cont. OSR#
o NoD Self
Type of Fixture
I-'LlJ1clBING
Number of Each
Fee On Each
$ 7.50
7.50
7.50
7.50
1.50
7.50
7.50
7.50
7.50
7.50
30.00
15.00
20.00
15.00
30.00
15.00
7.50
7.50
15.00
Sink
Lavatory (Wash. Basin)
Tub (with or without shower)
Shower} separate
Water Closet [toilet/urinal)
Dishwasher
Disposer (g.arbage gnnder)
\\'ashing ~lachine
Water Heater
Floor Drain
Sewer--1st 100 ft.
each additional 100 ft.
Water Service--lst 100 ft.
each additional 200 ft.
Storm and Rain Drain--lst 100 ft.
each additional 200 ft.
Special Waste Connection
Se\\'age and Sump Ptunp (e.iector)
~Iobi.ie Home Sewer and Water
Other (specify)
SUB-TO'l'.-\L (~linimum $15.00)
III
I
I
I
I TOTAL FEE
T)lle of Equipment
~ IEGlAN I CAL
i\umber of Each
Fee on Each
Total
~lechaJlical Permit Base Fee
Furnace lm to 100.000 BTU/H
Furnace over 100.000 BTU/H
Clothes Dryer Vent
Bathroom Ventilation Fan & Duct
Range Hood \\'i th ~lechani cal Exhaus t
\iood Stove (Wood StOVf' Vfmt $3.00)
Air Conditioner Only
He a t PtUllP
Floor Furnace
Gas Piping System 1 to 4 Outlets
I Per QjUet Over 4
Other (specify)
S 6.00
7.50
3.00
3.00
4.50
6.UU
6.00
6.UU
6.UO
2.00
.50
SUB-TOTAL
IruTAL FEE
C74.,200
~
Total
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ACTIVITY INFORMATION SH EET
kJne county
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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o.,"/w1" lJugth.k
. P~bN MAKING REQUEST
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PROPERT~ JWNER
JJ ~~ /')1~~ S:I:-
MAfLlNG ADDRESS
~F
C9v
STATE
q7lli1
ZI P CODE
S"'~I
MAILING ADDRESS
$~
CITY STATE
ZI P CODE
7~~-~ 1'1',) _
BUSINESS TELEPHONE #
7<1 to ' 77 7 '7
HOME TELEPHONE #
BUSINESS TELEPHONE #
HOME TELEPHONE #
2 PROPERTY ADDRESS AlI~
(IF DIFFERENT FROM MAILING ADDRESS)
3 MAP & PARCEL NUMBER (from tax maps in Department of Assessment and Taxation
(REQUIRED INFORMATION) or from tax statement)
17 03 {)3 3.1 ?i"'XJ7)
TOWNSHIP RANGE SECTION TAX Lm(sj OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL'fl ZONING
TOWNSH I P RANGE SECT ION
TAX LOT(S) OR PARCEL # ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable) ~p D".I"
5 REQUEST (state exactly what you plan to do) 7"" en/4..7'J)
I'Yt.4A 1-(,y J:rA./:.h n, I'J.dd tL .t:itm; L '\I ,"oc,.,., a"d
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ACRES
LOT BLOCK
P?a..sl-(!,y Jedl'tlt1n,. acid
/'s/aca~ of/L,'I-u
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~m. __n...___.__n___..._...._____
6 DIRECTIONS TO SITE :C,_.Or:Lnil.4...Jd~ .'EI!.,.'J(.......~..) .1,Urn. .Ie.l:fa.t. .CQ'("t-I':':.oi. ...5_~_.
dnd l-/~oll'A 'BY' kJ"""j'. GO North.on .C;#" ~u,.n _~e~~_Q..~ ~f~.~r.. "~$'fI.., fo.14nsf;~_1I:
~
** FOR STAFF USE ONLY ** NUMBER ~
V>
ZONE/LAND USE:
BY: DATE:
DATE
.
.....
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TIME IN: OUT: I r! j
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I~L______~____n ___..1 /J __
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LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 i 687-4061
A~('1~~h7i f. I .
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/.7 I RANGE ~3 I SECTd3:.$0T~~~OF
S;JBO~ON/PARTITION ~liCab~e)' ~. ' ~ I LOT/PfRrjL I BLOC5 .
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/:/J~~~~~ZFIC ~~ /' .'-:-;-~~', '1 DECLARED. VALUE
~"t~3r-OF ~rF'~ f W: ;JPPLY/~. h~~.~~~~
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. CONTRA OR'S NAME AM~ ~A"" r' - Y~7J7'7
~ l~~/~AM~~~ I ~~
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATIO FOR PERMIT, and do hereby certify that all information hereon is true and correct, and that I
have the following legal interest in the property: owner of record; 0 contrac:t purchaser; Dauthorized agent with evidence of authori ty attached.
I f:.::rthcr certify that any and all work performe sha be done in accordance with the Ordinances of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur-
ther certify that registration with the Builder's Board is in full forcll' and effect as required by ORS 701.055, that if exempt the bas'is for exemption
~:~~Z:25;;:~ho~r.~:~~D=:on t~is prOj.ct~;:6;;
NAME (please print) ~ATURE DATE
READ THIS SECTION CAREFULLY. Y~UR ~TH RIZATION HAS BEEN BASED ON THE FOLLOWING
,--,,;:> C I r' P-
O PLANNING/ZONING: zon~ ~n ..
Hinimum Setbacks: Ct~ront;;--- ~\ ~. CL, side '. ~ int .
COMMENTS()c\:-\.('\.",,", >-... -~\) . ~\)- ~'\")"""'_
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.OS sa~~nos ~a~EM ~a4~O.'s11aM
l~ . uOT~~punOJ 6U1PtTng
i Ot .4 ^eM-Jo-~46!~ peo.l JO 'a6p3' .
101 saUrt ,J.:~J:~doJ:d J:OT.Ia~UI r :WOJ:d
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~ lEso~~Ta abEMas a~EJ.Insqns - ~){ogq~as
. aln~ s'P.H pUe. St7L" t7SV o~ C;Og" VSt7. S'80 ;;0 uO:PEl
uo!~aldwo~. ^.Io~oeJSr~ES J:OJ s~uawa.Irnba.:r a4~ ~aaw
uOT~aTdwo~' J.:.Io:J.:Je::rs"t:1es a.J"tnba.I Treus nup JrinTnu
. 'NWKSHIP
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o~ a3ntT~d .a:J.E~!J1~3a~ a4~ 6u1nssT.a.:roJaq
FOR OFFICE USE ONLY
Application/ -,?"J ,ry / _ 0/ L
Perm~t It c:::::'fp<ab (J T
o Two Copies of Plans
o Three Copies of Plot Plans
DMech/Plumbing Checklist
o Legal Interest Document
o Plan Check I~nf~ She1
PROPOSED USE OF PROPE. '.
~esid~ntial, ' . ial
o Commercial - P ~ ic,
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CONDITIONS'!
E:fjX
Parcel Size \.--::v-')
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SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST ,BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-
CATION OF THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER
REMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION, CALL 687-4065. A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE FOR INSPEC-
TION REQUESTS MUST BE. GIVEN. Have thefoll:owing - in"fOrma t~on ready':- - petroi t number;- j'ob 'addre"ss, type
of inspection, when it will be ready, your name and phone number, and any special directions to site.
BUILDING DIVISION:
REQUIRED- INSPECTIONS:
1.
Foundation Inspection: To be made after trenches are. excavated and forms erected_and when all.
materials tor the foundation are delivered on the job. Where concrete from 'a central mixing
plant {commonly termed "transit 'm~xed"} is to be used, materials need not be on the job.
Concrete Slab or Under-Floor In5~ecti~n: To be. made after all in-slab or under-floor building
~er~ice equipme~tl. conduit, pIPIng accessories, and ,other ancillary equipment items are in
place but befor~ any concrete is poured or floor sheathing installed, including the subfloor.
Framinq ~ Insulation Inspections: To be made after the roof.,-all framing, fire blocking, and.
bracing are in place and all pipes, fireplaces, chimneys, and vents are complete and all rough
e~.ectt;'ica~ and plumbing are approved. All wall insula~ion .an~__v,:por. b~rr:ier a-.:.e i.n p.lCl;.ce.
4. Lath and/~ Gy~sum Board Ins~ection: To be made after all lathing and gypsum board, \nterior
~ext~r~or, ~s ~n place put before any plastering is applied. and before gypsum board.joints.
and fasteners are taped and finished.
2.
3.
5. Final Inspection: To be'made after the building is complete.and before occupancy.
,
APPROVAL REQUIRED. No work shall be done on any part of the building 'or structure beyond the point
indicated in each successive inspection without fiist obtaining the approval of the building official.
Such approval shall be given only after an inspection shall have been made of each successive step
in the construction as indicated by each of the inspections required.
NOTE: All building permits require inspections for the work ~uthorized, such as but not limited to:
A. Block Wall: To be, made after reinforcing is in place, but before any grout is poured. This
InSPection is required for each bond beam pour. There will be no approval until the plumbing
an~ electrical inspections have been made and approved.
B. Wood Stove: To be made after completion of masonry (if applicable) and when installation is
complete. Installation shall be in accordance with an approved, nationally recognized testing
agency and the manufactur~r's .~n~tallation instructions.
C. Mobile Home: An inspection is required after the mobile home rs connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tiedowns,
ski"r.ting ~ . and plumbIng- connec'tions. . - --. -.-
1. Footings and piers to comply with State foundation -requirements~for.mobile homes or as
recommended by the manufacturer.
2. Mobile home minImum flnish floor elevation shall be .certified when required by a flood-
plain manag~~n_t letter. . _ . ~.. _ ____ ___ __ _
3. Mobile home tiedowns, when required, and skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. Tiedowns and skirting'shall be installed
per enclosure. . , "
f . . '''-, . ,'. -.. -'-- ".
D.' Sw~mmin9 Pool:, ~elow grade whep steel is in place and before concrete is poured. Above grade
,when pOOl ~s insta,l,led. i\'
\. ',~"\"\ '--' ..\
APPROVED .PLANS MUST BE ON THE'JOB SITE'AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE
IF WORK DQES NOT -BEGI~ .~ITHIN' ~BO DAYS., 'PRiIF. WORK -,IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION':-_,,'1" " 1..;. '~\~V.....- .--,- ....-
"
ANYONE PROCEEDING PAST. THE' POINT or REQUIRED INSPECTIONS WILL.DO SO AT THEIR OWN RISK.
, " I ... , \' -'''\.', ..,. '-f
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAU'SYSTEMS: . ,
- " ,~ '". ", ,\
1. Permits shall be effective f~; one year Jfo~ the date ,of. is,suance.
. .. .'. ,._~
2. Upon completing the ~onstruction for which a permit has been1issued, the permit holder shall
notify the Lane County Department of Planriing~and Community Development by submitting the
ins'tallation record :form. The Department shali inspect theHcons'truction' to determine if it
,complies with the rules contained in this division.' i~ the cqnptruction does comply with such
,rules, the Department shall issue a certificate of sa~~s~actory.completion to the permitlholder.
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LANE COUNTY
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FILE NO. 22cf2J~
H.O. APPROVAL
GENERAL LAND USE APPLICATION.
DIRECTOR APPROVAL'
Zone Change
Partition: Preliminary
Final
Subdivision: Preliminary
Final
Cluster Subdivision:
Preliminary
Final
Condo Use Permit
Greenway Dev. Permit
Temporary Use Permit
Special Use Permit__..._.__
Request for Interpretation
Plan Amendment
Variance
Site Review
SpeciaL Exception
Hazard Check List
Site Investigation Re~rt L?
VSpecial Use Permit rLtl~P /Z.4J/C/
Planned Unit Development:
Preliminary
Final
PLANNING COMMISSION
FEE PAID
COMBINATION FEE
additional
DATE SUBMITTED
(Applicant's option-highest fee plus $25.00 for each
application) .
DATE RECEIVED
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I. APPLICANT AND OWNERSHIP IDENTIFICATION
L '0'0 of '~'HC"'~~~
Mailing Address_-7b~ ~~j ~~
Street "'/- '/ - /'
?4/?-;?/~~-/4/6' -
. 97Y/7777? '1)
Zip
Signa turcs.
Contract Purchaser ~
Other{ ~ JZf- ~
Lessee
2.
Legal Interest - Titleholder
3.
)
I (we) have completed all the attached application requirements and certify that
all statements aT'e true and accurate to the best of my (our) knowledge and belief.
I (we) am also authorized to submit this application as evidenced by the signature
of the owner below.
Owner's Signatured~hU~' J 0; //Ah / Date t,!1/r,!,fJ/
Agellt's Signa;ure
Date
Agent's Address
Phone
Zip
II. PROPERTY LOCATION
Assesso r I 5 Map
/ 7-c::f.5 -c:5? cK 3, ~
Tax Lot_<...~7c:Jc:J
Size Tax Code
Property Address ~~,~J/~~4:~~r~
Road Status - State._County R( ~~liC Rd. Easement ~
Abutting Property Owned
Map~ .4
Present Use /~~~d~
(acreage) ..
Tax Lot(s)
Present Zoning
Structures
Water Supply - Public
Onsite Wells
Community Water System
If Community Water System, please list name
Sewage - Public System____(list name)
Community System (list name)
HOr,/N F'?-ooO dd-Z...H?-LJ ,./t?"::-"""" ~ S//c4/1'? ":;/1/
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. PUBLIC WORKS OEPARTMENT, L~ GEMENT DIVISION
COURTHOUSE.PSB 125 E 8TH AVE. EUGENE, OREGON 97401
Individual Onsite
c - 9B-239