HomeMy WebLinkAboutPermit Building 1985-10-3
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S~BDIVISION/PARTITI:'(if /~tJ 3'-' / rr ~7~~LOCK
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~ .P"",I~~EO TO ~~ ~~ v'JiELEP~ NUMBER '
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/" I HAVE CAREFULLY EX~NE~ ~HE COMP~TEO APPLIC~TIO t'QR PERMIT, lJd IIQ~r('uY . (;-~tiJ~ is tr:e and correct, and that I
have the followl.ng legal l.nterest l.n the property. owner of reeo ,OCt t-(a~,JJ. au ~K~~--,------ .
I f_rther cert1fy that any and all work performed ha be done 1n accotda r;€: rt'll.lth~ rd' a c 0 Lant;! countYl"- t~e of Stat~ of Oregon
pertaining to the work described herein, and that NO OCCUpANCY wi bIo'made . a." str ctu e thout the permission of th . Division. I fur-
ther certify that registration with the Bu.ilder's Board is in ful force' ffect as required by ORS 701.055, thh~'e e t the basis for exemption
~~:~~);;~y?7;;- ~d .mpl~m who a in ~~w: OR;~:Will b. foon t/ ro ct, I ~VE ~~ MD
- - ' . NAME lpl.a,. print) ~, SIGNATU~ II DATE
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READ THIS SECTION CAREFULLY. YOUR.~ 9AS BEEN BASED ON THE FOLLOWING CONDITIONS! ~ ,,~
o PLANNING/ZONING: Zone .#'//# Partition # Parcel It Parcel Size ~/......".
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::::::S~~,~~~~ ~~-".~-/#,~~ar _
r/ __ P' Oate, 4?-c;. -fi..r-~
B, t#'V "-
Installation Record Issued? Dyes D No
\ Lineal Feet Maximum Depth
" .J of Drainfield of Trenches
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Ty(P....- ~ ~ '-/ -t:d::fl tMHAtiAAn -tA--Ll.J.LL/AJ. #;9$!L
l\ /) gee:; /,,-j~g-
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\ Date:
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.
for:
FOR OFFICE USE ONLY
Application1"7r-/ '/ C,.,.-
Perm1t # ~~ ~~~(T~
PROPOSED USE OF PROPERTY
~RCSidential 0 Industrial
o c~ercial D Public.
-'
v
o SANITATION:
S. 1. '"
Installation
Specifications:
Gallon
Tank
COMHENTS:
j( PLANS EXAMINATION:
CQMl'lENTS :
,
Date:
.
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PERMIT __ BUlLOING OFFICIAL/OESIGNEE 'Der ORS 456.805 (1) )r-pJ kE 9- 25'"-~A~
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
C 14-25 R84-
.
.
SETBl,CKS ASO Q'r'!Ir:R CO::OITrO::S OF Jif'PRO'/'\L ~:UST BE STRICTLY OlOSER-VED. VIOLATIO~ Ci\.~ RESULT IN REVQ-
C;",10:1 Of T!ILS rEmll., CIT;,TIO:l U~OER PROVtStO:>lS Of LA='E ':0;';::,,';> I:>lFRACTIO:>l ORDI:;';~C&. A:-:O/OR OTHER
RE~Il::DIE5 ALLOWED BY LAW.
.
..HE~ RE.:"OY FOR r::SPCCTIO:,J, CAL: 697-';065.' ,,\ mNI}IO}\ OF' AT' LEAST 2~ HOURS AOVA::cr NOTIC~ FOR INSPEC-
nv" Kt:QL"t:::;.:i ;.;:.;::;1' U!:: G1VE::. W.lVC tnc tollowing info~:nation ready: ;:,errnit number, job address, type
of inspection. when it wlll be ready, your name and phone nu~oer. and any special directions to.site.
BUILDING DIVISION:
REcur RE:J I::SPECTlONS:
t.,
FoundatIon Insp~Ction: TO be made after trenches are excavated and forms erected and when all
~atcrlalS tor t c tounaation are delivered on+the job: ~hefe-concrete'from a central mixing
plant (commonly termed -transit mLxed-j is to be used, materials need not be on the job.
.2.
Concrete ~ ~ Under-rloor Inspection: To be_~ade.a~t6r al~ in-slab ~r unde~-floor building
SerVl~e e~ulpment, conault, pLpLng accessorIeS, and other anClllary equlpment ltems are in
place but bel ore any concrete is poured or floor sheathing installed, including the subfloor.
~tamirtq-., TnsDlatiort Inspectio!ls: To be made after the rODI, a'lr framing, 'fire blocking, ana
raclng are ln ?ldCe ~ all ?lpes, 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 Gvpsum Board Inspection: To be made after all lathlng a~d g;psum-boa;d, ;nterior
ana-exterTOr, 1S In place but betore any plasterlng is applied and before gypsum board joints
and fasteners are taped and fini~hed.
3,
5. Final Ins~ection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. ~o~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 permits require inspections for the work authorized, such as but not limited to:
A. BlOCK Wall: To be made dfter reinforcing is in place, but before any grout is poured. This
TnSP.ectrOn is required for each bond beam pour. There will be no app'rov~l until.tne plumbing
and electrical inspections have been made and approved.
B. Wood Stove: To be made after completion 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 aft~r 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 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.
SWimmin'J Pool: Below grade when steel is in place a. .te is poured. Above grade
wnen pooi-rs-installed. I.
o.
APPROVED PLA~S MUST BE ON THE JOB SITE AT ALL TIMES DURI~G WORKING HOURS. THIS PERMIT WILL EXPIRE
IF WORK DOES NOT BEGIN WITHIN lBO DAYS, OR IF WORK IS SUSPENDED OR ABANDONeD FOR-MORE THAN~lBO DAYS.
SUSPENSION OR REVOCATION HAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
AlIYONE PROCEEDING PAST THE POIllT or REQUIRED INSPECTIO::S WILL DO SO AT THEIR OWN RISK.
SUBSURFACE ~ ALTERN~TIVE SEWA~~ DISPOSAL SYSTEMS:
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 construction does not comply with such rules, the Department shall notify the permit
holder and shall require satisfactory completion before issuing the certificate. Failuro to
meet the requirements for satisfactory completion wLthin a reasonable time constitutes a vio-
lation of QRS 454.605 to 454.745 and this rule.
Setback~ - ~ubDurface
Fro::l:
S"!:waqe Di sposa 1
Septic ~
10'
10'
5'
50'
Drainfield
10'
10'
10'
100'
Interior property lines
Edge of road rlqht-of~way
BUlldinq (oundation
~ells, other wuter sources
--
~
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ACTI_TY INFORMATION.HEET
klne cOJnty
~
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
1
,iM.../< f'< u.P-f
PERSON MAKING REQUEST
.JAr/~ 6i j,-R-/I
.. 'PRO RTY OWNER
1 f'i. n .I...4./? ??1 ~p F_If>.,..? --I fi' /I
. -- MAILING ADDRESS '
Ire, O.P_AJJ??1'n77n 1"/17'"/7 /(/,
. MAILING ADDRESS
V~Jr0:,k, e(;.p
- yrtv
c0~ e5!/1~ q '7 ~ U
STATe - . ZIP CODE
l'-l(,- ;;-r/7
HOME TELEPHONE #
C~-o n(l .e:..J -<>_ GD
C IT,y
{!)_dP''1H 9' 7L/.lJ ,
STATE ZIP CODE
BUSINESS TELEPHONE #
BUSINESS TELEPHONE #
7 ft. -?-iFf?
HOME TELEPHONE #
2 PROPERTY ADDRESS (' A"" ~
(IF DIFFERENT FROM MAILiNG ADDRESS)
3 MAP & PARCEL NUMBER
(REQUIRED INFORHATION)
(from tax maps in Department of Assessment and Taxation
or from tax statement)
/5 ~ 32.34 ItJ ()
TOWNSHIP RANGE SECTION TAX LOTlS) OR PARCEL #
1/
ZONING
TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL #
ZONING
TOWNSHIP RANGE SECTION TAX LOTlS) OR PARCEL #
ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
LOT
ACRES
BLOCK
5 REQUEST (state exactly what you plan to do) J ~..t-"" .z / ('~ /'L r-7'~ 'r/t'-y
lire ----...? A n A- /' ~o ....IJ 5-r.. v 0 b v / -~ J a. ,q 1..4-,.< :J", ~ ('I
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** FOR STAFF USE ONLY ** NUMBER
, ,
ZONE/LAND USE:
BY: DATE:
DATE
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In
-::!
TIME IN:
OUT:
LAND MANAGEMENT DIVISION / 125 E. 8th ^VE., EUGENE, OR 97401 / 687-4061
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EST,
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_NCELLATlON/REFUND AUTHORIZATJil, PERMIT #-'-~''= I;"~ -as-
NAME (PLEASEPRINTI .,//'0(-: A.\.t. L FE I,.TRSlTL#I7<:..' s III / J'7u<,j
..,..' ,
ADDRESS JR(n DE/1/)^IO,u1) FE!,',:'/ 'FrD" 5 f'!<:uJGFll:lL'
APPLICANT ( ) OWNER ( ) CONTRACTOR ( )
REASON FOR CANCELLING PERMIT (OR APPLICATION) I hJ L r: II: b A PP/ Jll !. JC '- '
AF'I-hOHJT Cid l(E/ED Tsv --Tl.=Lr.=Pl'loA.JE:..
-
SIGNATURE -' r: '--'-7/ jJrk, DATF 9- -L c: - 8':':-
FEES PAID FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE
SEPTIC TANK AND DRAIN FIELD) ARE ORDINARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE
BUILDING, PLANNING, OR PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION
PROCESSED.
TO DEPARTMENT OF FINANCE: / c?~-
Building Permit Refund $ /
State Surcharge Refund $
Septic Disposal Refund $
Site Inspection Refund $
Land Use Applications $
Planning Director $
Recording Fees $
Partitions $
Copies & Ordinances $
Su~eyoffi $
TOTAL AMOUNT REFUNDED $
PLEASE MAK=-CHEC~ PAYABLE;TO: / .___
NAME )//(,p( (.. A t- c 7"'---
ADDRESS /',--(~ /}//7,?/.4?if....7h7 r;;:-:z:"/',v ..!.~'-...>>>/' ,~/:;.,Z:;;?D/:?-c20,
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LAND MANAGEMENT DIVISION / Public Works Department / 125 E. 8th Ave., Eugene, OR 97401 (503) 687-4061
FEES PAID
. -
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.
1-I.'7C,
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SIGNATURE
% REFUND
% Flood Plain Fee $
% Building Permit Fee $
% Mobile Home Fee $
1M) % Plumbing Permit Fee $ / 'I, crv
% Mechanical Fee $
/) % Plan Check Fee $ ()
,") % State Surcharge Fee $ ()
% Septic Disposal Fee $
% Site Inspection Fee $
% DEQ Surcharge $
,
% Land Use Application $
% Planning Director $
% Recording Fees $
% Partitions $
% Copies & Ordinances $
% Su~eyors $
Minus $25. for Processing Fee $ 1./ II '1 I," c::
TOTAL AMOUNT TO BE REFUNDED $ - ' ~ - ,
gift t( C.c"J) Jq..~
DATF /0 -f~ ;s.c:-
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24-17-881Acct. 42120/Prog. 060 Receipt# / 7c.? /1
24-17-881Acct. 42124/Prog. 060 Receipt#
24-17-881Acct. 421331Prog. 060 Recelpt#
24-17-881Acct. 42134/Prog. 060 Recelpt#
24-17-881Acct. 42150/Prog. 060 Recelpt#
24-17-881Acct. 46202IProg. 060 Recelpt#
24.17-88/Acct. 46210/Prog. 060 Recelpt#
?4-17-881Acct. 48474/Prog. 060 Recelpt#
24-17-881Acct. 44419/Prog. 060 Receipt#
?5-06-741Acct. 44451/Prog. 010 Receipt#
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