HomeMy WebLinkAboutAddressing Verification 1986-10-17
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roW:'>HIP /7 I RANGE ./7 7 / I SE>5~ s::: -"S J TAX Y'7/?Q?UT OF PROPOSED USE OF PROPERTY
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Z>ESCRIPTIOtiI OF/'PROPQSED W<fK' - BE SPECIFIC // . _ ~ /1. ;D~CLARE~ ~ VALUE
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. OF BEDROOMS l' OF /w.# .r' ~7~ l WATER SUPPLY ~' ~ ~ ~ ~~~~~~:.
0''''",\'5 NAME AND,AD'LRESS P /~. _ R6l I Tlll9HONE lroMBER
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RURAL ADDRESSING
CHECKED Li." 'j t::
FOR OFFICE USE ONLY'
Application/~~ /c:__~f'
Perm~ t i ;.-;:;;;;r/ d ~ /} h
I HAVE CAREFULLY EXAMINEf5""'THE COMPLETED APPLICATION !'OR PERMIT, .I.hd Jo. hcrcUy eettify t. at all information hereon is true and correct, and that I
have the following legal interest in the property; Downer of record; 0 contrdl't. purchaser uthorized agent.
I f::.rther certify that any and all work performed shall be done in accol'dancf, ....i tl) tb~ Ord )ance~ Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will m. made of ar-'i. structure without the permission of t:-he Building Division. I fur-
ther certify that registration with the Builder's Board is in full force .lnd effect as required by ORS 70t-QSS, that if exempt the basis for exemption
~~3~;;::':; Wh: a(Ar2:" :~:;'ed on th" proJect, I AAVE ~ MD
/ NIIME 'please print) ~ ~ r SIGNATURE DATE
READ THIS SECTION CAREFULLY. Y~~~~ THORIZATION gAS BEEN BASEO ON THE FOLLOWING CONDITIONS: //;1 ~
o PLANNING/ZONING: Zone ffi / ~ Part.lt.lon ., Parcel" Parcel Size K'/ ~
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, .' Date, ( /d/?"'/~~
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SANITATION: S. I. ., B. P. # Installation Record Issued? 0 Yes 0 No
Installation Gallon Lineal Feet M.aximum Depth
Specificatio"" Tank of '''.infield ,Of Trenches "~
:J-;d~~~- SOs. ~ z- ~f:::.~(J;o-f!:~~'
o PLANS EXAMINATION: Type
GroUD
Use
COMHENTS:
Date:
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~IT APPR~ED BY BUI~~ OFF!CIAL/DESIGNEE Coer ORS 456.805(1)) DATE
LANE COUNTY D~RTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SRR RRVRRSE FOR INSPECTION INFORMATION
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SETB;,CKS A;>JD OTHER CO='OITIO::S OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-
C';,ION OF- TillS PERmT, CITATIO:l UNDER PROVISI~:;:S OF LAl"E COLJ~:n"s INFRACTIO~ ORDI:,A~CE. AND/OR OTHER
REMEDIES ALLOWED Bl LAW.
\o:HEN READY FOR I~SPECTION, CAL:.. 687-.W65. A mNH1U:.l OF AT LEAST 24 HOURS ADVA::CE NOTICE POR INSPEC-
TIU;,\/ HEQI..:!:;ST::. ~lUST Ill:: GIVE:.l. Hllve tne following information ready: perr:lit number, job address, type
.of inspection, when it will be ready, your name and ?honc number, and any special directions to site.
BUILDING DIVISION:
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REOUIRED I~SPECTIONS:
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Foundatlon Inspect10n: To be made after trenches are excavated and forms erected and when all
materlalS .or tne toundatlon are dellvered on the job. Where concrete from a central mixing
plant (commonly termed "transit mixed8) is to be used, materials need not be on the job.
2,
Concrete Slab ~ Under-Floor Inspection: To be made after all in-slab or under-floor building
serVl=e equipment, condult, piping accessories, and other ancillary equipment items are in
place but beiore any concrete is poured or floor sheathing installed, including the subfloor.
3,
~raming &. Insulation Inspections: To be made after the roof, all framing, fire blocking', and
raclng are In. place and all plpes, fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approved. 'All wall insulation and vapor barrier _ar~ in place.
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Lath and/or Gvpsum Board Inspection: To be made after all lathing and gypsum board, '.nterior
ana-extcrTOr, 1S In-pIaCe but before any plastering is applied and before gypsum board joints
and fasteners are taped and finished: -
s. ~ 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 b& 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 germits 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
lnspeCtlOn is required for each bond beam pour. There will be no approval until the plumbing
and electrical inspections have been made and approved.
B. Wood Stove: To be made after co~pletion of masonry (if applicable) and when installation is
compl~ Installation shall be in accordance with-an approved, nationally recognized testing
agency and the manufacturer's installation instructions.
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, tiedowns,
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 elevation shall be certified when required by III 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. SWlmrnln9 Pool: . Below grade when steel is in place and before concrete is poured. Above grade
wnen pool-rs-lnstalled.
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 ~IORE THAN 180 DAYS.
SUSPENSION OR REVOCATION ~~y OCCUR IF THIS PE&~IT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POIl:T or REQUIRED INSPECTIOllS WILL 00 SO AT TllEIR OWN RISK.
SUBSURFACE ~ ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
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Permits shall be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Co~unity 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 construction does not comply with such rules, the Department shall nPtify the permit
holder and siia'rC require satisfaCtory completion before issuing the certific.i'te-: -Failure to
.~,~: .me~t\the 'req"uirements for satisfactory coinpletion.lwi.th.in a. rCq'sonable time con~titu_te..-~\a_v..io-
latior of ORS 454.605 to 454.745 amI this rule. \ I. \ ..
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'. .Setbacks - Subsurface S.o:lWage Disposal
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Septic Tank
10'
10'
5'
SO'
1.
2.
Drainfield
Froen:
Interior property lines
Edge of road riqht-of-way
Buildinq foundation
\o:e115, other ~ater sources
10'
10'
10'
100'
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AC1&'ITY INFORMATIOre SHEET
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d71l>LETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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PERSON MAKING REQUEST
J 6 IE: J ~ d ...:;:r.
MAILING ADDRESS
J)e-.4 E!IL1 //1&12//1/0
PROPERTY OWNER
IL/.Yd.. #efijJ.o toop
MAILING ADDRfSS
h.J6-61/E
CITY
t0~
STATE
tf'1~o/
ZI P CODE
~~/f?t'.1L~FlcL/}
CITY
.J ~4-#S/
BUSINESS TELEPHONE #
ARt,_ --od'77
HOME TELEPHONE #
BUSINESS TELEPHONE #
(,?"e t?7~17
STATE ZIP CODE
7.,.2 t.. -~-:,';(;:;J q I
HOME TELEPHONE"# '
"2 PROPERTY ADDRESS /-'I:f -l Ni;zAJL 0 LrV? L7
(IF DIFFERENT FROM MAILING ADDRESS) /
. 3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
(from tax maps in Department of Assessment and Taxation
or from tax statement)
/1-03 -,). '1- $3
TOWNSHIP RANGE SECTION
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TAX LOT(S) OR PARCEL #
fE'S
ZONING
TOWNSHIP RANGE' SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOWNSHIP RANGE SECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP;
,
TAX LOT(S) OR PARCEL #
ZONING
ACRES
4 SUBDIVISION (if applicable)
LOT
BLOCK .
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5 REQUEST (state exactly what you plan to do) ~II~ cFb7';L TJ'?/V,k' //l/SuEcTEn
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FOIe 1M FII/J J../UIAl-
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! 6 DI RECTIONS TO SITE:
tE/lJIF/.//lJIRI 70 /!.s:j?PAL-7-L1!.Q&(h. 70 /IIe/llLa
Lnob
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** FOR STAFF USE ONLY **
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ZONE/LAND USE:
14-33
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061
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