HomeMy WebLinkAboutPermit Application 1985-4-15
'NWNSHIP I? RANGE (j 3
SJBDIVISION/PKRTITION (if applicable)
~iff~~on
t'" '7\ (' / ..f\ -- '7) '--~
~ J J.hL6L-iI\ K. U~) j ~ JJ
SECTIO~y 111 3 TAx~odC,crrT OF'
LOT/PARCEL
(Y77:'"
LI!! b
for:
FOR OFFICE USE ONLY
.. ~
~
Appl~cationh/' G <)l~
Perm~t # ~~r)-()-~
BLOCK
.._ .... ,. .~ .", .. _,., I
PROPOSED USE OF PROPERTY
~Sidential 0 Industrial
o Commercial 0 Public,
W2jT5NjD~SS oS~S/~ ~P(Q 91)'T?7CITY ZIP ,
STRUr,RE~ ~ ~N PM~\Yl ' "d::~: ., , '.' :
T~~ TO +2> ~ 40 ~~. J,'~ ~~ 1r+oOJ!d.
J~S~~~O'\~!!:~J'~A~ O~I ~ ~. an la.1~ ;'CLAREO' VALUE ·
<~ rL (~L ~ RJv,^- 'LO Qvv.. ~j t eM )' '-1
= ~ OO(}Q .. qJ OF~" # Vl(~lY ~ \']J,CI~ /~ n 0 H i iJ ~~~~~~ '
.. O;;NEf I S NAME AND ADDRE:S~ ,\ \ (' /J {\ ES t~.., ;'E}Y7HON~ ~MOBER{ /?l_ .',
-Yllv\A..P.J ( -r' ()'u J Q.., ; y~ as ttibO' ve. 1 /7 - (;J T LL
CONTRACTOR'~~ CJ:t:f. ~ f ~.. TELEPHONE NUMBER 41':
'''"'' '" " ""'"0 m r'AM~a. . CB - ~ -e- . 1?~1;lo,-;?~=u? -.
reon is true and correct, and that I
gent ith evidence of authority attached.
C y and the Laws of the State of Oregon
permission of t;he ,Building Division. I fur- I
-V
Y ,--:/---
/'
b//?r :/.-'/J'
SIGNATURE
j./-/~-- ~S
DATE
. ,..""....J
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION qAS BEEN BASED ON THE FOLLOWING CONDITIONS~
[] PLANNING/ZONING:
Zone
Partition #
Parcel #
Parcel Size
,,..... CL, side _ interior
\ ptrLnV\L'n"j' &'+t~ .I?Y. '._.
Date: J(dY'(~13:5 ~
B. P. # Installation Record Issued? 0 Yes 0 NO; ( :
Installation
Specifications:
~rnum Depth
, ~~renches
5lLf1 . !h~ . ~~--?~ ~ / p: .
, ; / r, 1 a7~/7+-18'c- ~
_G~~' _ :{
~ --4' .A/~/ 1 /J / __ /f~ , R'2
('. //t/rl/~' I "/7(f/'1 'L.P: \./ ,r'br~ i
:y V. . ~f/~ I , cJ~~V dc:l/~~ftJ,,:
peRMIT APPROO," 'Y 'OILDI," OFF'C'AL/e"'G'" (oo, OR' "'..e' ") , . ~ "OA"pr! ({~
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.. 061, (J
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
,G?-llon
Lineal Feet
of Drainfield
COM/oIENTS:
'(in~
[] PLANS EXAMINATION:
Type
COM/oIENTS:
C 14-25 R84-
"
'.
..~'-
SETBl,CKS AND OTHER CmmITIONS OF APPROVAL ~1UST BE STRICTLY OBSERVED. VIOLATION CA)/ RESULT IN REVO-
CATION OF THIS PERHIT, CITATIO:l UNDER PROVISIONS OF LAt';E COU:HY' S INFRACTION ORDIt';ANCE, AND/OR OTHER
REMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION, CALL 687-4065. A MINU1U:t OF AT LEAST 24 HOURS ADVAr;CE NOTICE FOR INSPEC-
TION REQ~ESTS ~jUST BE GIVE~. Have the following information ready: permit number, job address, type
of inspection, when it will be ready, your name and phone number, and any special cirections to site~
BUILDING DIVISION:
REQUIRED INSPECTIONS:
1. Foundation Inspection: TO be made ~~ter trenches are excavated and forms erected and when all
materials for the foundation are delivered on the- job. h'here concrete from a central mixing
plant. {commonly termed "transit mixed"} is to be used, materials need not be on the job.
2. Concrete Slab or Under-Floor .Inspection: To be made after all in-slab or under-floor building
service equipment~ conduit, piping accessories, and other anc~llary equipment items are in
place but before any concrete is.poured or floor sheathing .installed, including the subfloor.
3. Framinq & Insulation Inspections: To be made after the roof, all framing, fire blocking, and
bracing are in place and all p1pes, fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approved. All wall insulation and vapor barrier. are in place.
4. Lath and/or Gv~sum Board Inspect~on: To be made af ter all 1a thing and gypsum board, '.nterior
ana-exterIOr, ~s 1n place but before any p'lastering is applied and before gypsum board joints
ana fasteners" are taped and finished.
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 first 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 buildin~ permits require inspections for the work authorized, 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 untii the plumbing
and electrical inspections have been made and approved.
B. Wood Stove: TO ~e made aLter completion of masonry (if applicable) and when installatj~'~ is
complete. Installation shall be in accordance with a~ approved, nationally recognized ~~sting
agency and the manuf~cturer's'installation instructions. l
C. Mobile Home: An inspection is required after~the mobile home is connected 'to an approved
sewer or septic system for setback requirements, blocking, footing connection, ti~~owns,
skirting, and plumbing connections.
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Mobile home minimum finish floor elevat~on shall be cert{fied when required by a flood-
plain management 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.
D. Swimminq Pool: Below grade when steel is in place and before concrete is poured. Above grade
when pool-rs-installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE
IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR HORE THAN 180 DAYS.
SUSPENSION QR REVOCATION 11AY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOHPLETE OR ERRONEOUS
iNFORMATJON.
I
ANY2!V.E P!pCEEDI_N9 PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEHS:
1. Permits shall be effective for one year from the date of issuance.
2. Upon completing the construction for which a permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Community Development by submitting the
installation record form. The Department shall inspect the construction to determine if it
complies with the rules contained in this division. If the construction does comply with such
rules, 'the Department shall issue a certificate of satisfactory completion to the permit, holder.
If the ~onstruction does not comply with such rules, the Department shall notify the permit
holder.and shall require satisfactory completion before issuing the certificate. Failure to
meet the requi~ements for satisfactory completion within a reasonable time constitutes a vio-
lation of ORS 45~.605 to 454.745 and this rule.
Setbacks - Subsurface Sewage Disposal
\
Septic: Tank
" 10 I
'10'
5 .,
50'
Drainfield
10'
10'
10 '.
100'
From: Interior property lines
Edge of road right-oE-way
Building foundation
wells~ other water ~ources
\
,
. \,
..
!df 1<: county
ACTIVITY INFORMATION SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
~.......... ..
s
i
',.. f
l)6L~.eS tW. Fbe:.-V-e./ /
PERSON MAKING ~EQUEST
12;:) ;;(~ r? m :EL
~lAILINGADDRESS
j"lh?.e,5 /."V &~e//
--. -, - - PROPERTY OWNER
~ ~%l,_? 'c) ,7T;, ~
MAILING ADDRESS
5"nr/~q.,Lj-eld
, 'HTY
Ore9t:J;-J
S TA'TE
9?t./77
ZIP CODE
5nr /'r?q f?/'.r; lei tfJre'7eJ"l..' '77L1)7
/' CIK ,Sf ATE ZIP CODE
I' '7::<6:- 7,~C:4- 7t.17-,t:OL/O l~&- 73 ~L/ 7~ 7-~Cf4CJ
BUS-INESS-rtLEPHONE # HOME TELEPHONE # BUSINESS TELEPHONE # HOME TELEPHONE #
2 PROPERTY ADDRESS:4~2,_3 d,. I1b ~ ,~_..,or)nc; ,L'/'.,:./c/, ///"e.q,,~n.. 97#:71'
I (IF DIFFERENT FROM MAILING ADDRESS) ., V ' ~
~ 3
MAP & PARCEL. NUMBER
(REQUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation~
or from tax statement) I:.'
tJ....S ~ t./ /7-oJ-;;zt/L./3 TL btX:CJ
RAN'GE SECTION TAX LOT(S) OR PARCEL # ZONING
, /7
TOWNSHIP
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOWNSH I PRANGE SECTIO'N
TAX LOT(S) OR PARCEL #
ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME O~NERSHIP: ~/ /;19
" J?1~ r/.J.<;
· 4 SUBDIVISION (if appl icable) SerA"" cI 4c1c1/f-/on- 70 Rol1c.4.. LOT J BLOCK 4
5 REQUEST (state exactly what you plan to do) I /J.eed 6L 5e;L>f/c...:t. -k $Y$tr..h'1-
L.s;apr f-)D~'L as I a..).7l 54? ///~ -rJ",-e.... k~~s-e. rdfl oz.- hKye.r, t..f..S/~
LI-I.I9,_EL~~_C.L,~_________ '
;(;4
DIRECTIONS TO SITE: -df (/~db--L-;-4.. a#L A"L!.'!- _1t!J Y~/~_y,cla. ^- C&~f/h~oJ;L
O~ f/.) (1/1 r.rd l" Dr. TtA- YA- R /9 h..-r q~t"6 1"4..e. En d C).p (1()Y'ra..- I
,l1r? \'1.'~. -- E2 !~i~':1.._ ' /:: 'e. F'-t- v v
** FOR STAFF USE ONLY **
. ACRES
~ 6
j
I
.J
--l
;;0
V)
NUMBER
ZONE/LAND USE:
BY: DATE:
~
--l
, ~
DATE
TIME I-N:
OUT:
'- '._-~-_.__._-._-- ..---.---...---- ~--
Ul.ND MANr'l,GEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 :'~I ~'687-4061 --,,'';'.
, ,
..' ......
CAN"'~LLATION/REFUND AUTHORIZATION PERMIT # 9' ~?, e.:)'
'-r--~ j I""" //
. NA~E(PLEASEPRINT( ,>rJ/1J,O_ :..// t T(')(,f)C// 1. ~,TL# /0 ~o3 .,;< ~-< '73
ADDRESS . b2- ~'2.;;{"3 (1)/10 .j'f. ' ~~>'flll :'1 ~~~ /et) (? 71 9' ) y:> t;>
i' ',/
APPLICANT ( ) OWNER(.,.() CONTRACTOR ( ) I -I /2 '
REASON FOR CANCELLING PERMIT (OR APPLICATION) -7)/1/;; (<1.1;( / ;"l:::'/i) Z.fl-i-1.(q)')
\ 1.1 ~;. r-, .. -I ," f'~. .1, ". ~.'" -. ....., .., /;' t. -~/!i}...oJ - ..1- /"- .~.
{}/;.?(i1. ',L' ,.1.1[},.( r.J..../L:v- (:/ 1/J,f.'7-},,1 j/ j;{)(2LL/ OJ;' L~1...I,L:' .':&Ul.f.bll2/!k~.l{,~1 (' ,'; ;-';.'-:,'
'1 {/ /'" l< jo "
t~/. (,7:' - 8-8",.)'- _ /) v , /
SIGNATURE ---;JrJh~;JJI /;;1 ~i );~~/i~ DATE // -/ ~ ' ?.::..
. . {' .
FEES PAID FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS ANDIOR APPLICATIONS TO INSTALL THE
SEPTIC TANK AND DRAINFIELD) ARE ORDINARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE
BUILDING, PLANNING, OR PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION
PROCESSED.
FEES PAID
_\ !
Minus'$25:--for Processing'Fe'Ef' .' $
TOTAL AMOUNT TO BE REFUNDED $
,1';;;'1/9
"
- , .
SIGNATURE
. ......-.--
.~,- :..,~. ~ /~. '<""-~';'.~:'/'.' .~(
DATF
"0 -.i..
TO DEPARTMENT OF FINANCE:
Building Permit Refund $
State Surcharge Refund $
Septic Disposal Refund $
Site Inspection Refund $
Land Use Applications $
Planning Director $
Recording Fees $
Partitions $
Copies & Ordinances $
Surveyors $
TOTAL AMOUNT REFUNDED $
PLEASE MAKE CHECK PAYABLE.TO: _ '.,
/---/ " ., /~
NAME ) /;~/'/r(-' 5 /4/ '1~' '>'/~/C (. <--
- ....;-:::.~ /-~J ~...? ,..-.,,---/~. ..-- 0'- ..) ',: v...,-~- , -../ :"'._ ," r- .~.~ _. .. ~. /';
ADDRESS ,"" .~--< o~ . ,) 'r' / / ,/ rj . ,c.., /~/........ ./' (,:- / . . //!' " /// .,?- t' C~. ( {./:
'/
'-=;-O"~";;'-'
24-17-88/Acct.42120/Prog. 060 Receipt#
24-17-88/Acct. 42124/Prog. 060 Receipt#
24-17.88/Acct. 42133/Prog. 060 Receipt# I ,,":. ~<f/.. ~:.-
?4-17.88/Acct. 42134/1?rog. 060 Receipt#
24-17-88/Acct. 42150/Prog. 060 Receipt#
24-17-88/Acct. 46202lProg. 060 Receipt#
?4-17-88/Acct. 46210/Prog. 060 Receipt#
24-17-88/Acct. 48474/Prog. 060 Receipt#
24-17-88/Acct. 44419/Prog. 060 Receipt#
25-06-74/Acct. 44451/Prog. 010 Receipt#
-/ 1/15'
,:) ()---
/" ':~": ~. '. ~t .
." .J'"
,.:~: -,:,( / '-;. -7
.of r g' . :
LAND MANAGEMENT DIVISION
Public Works Department / 125 E. 8th Ave., Eugene, OR 97401 (503) 687-4061