HomeMy WebLinkAboutPermit Miscellaneous 1985-8-1
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Lane County for: iond, r
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roW"5"lP / ? I RANGE ~ c:< I ?7~d/~31 TAX 7~~c
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;r~Y~DN "7 :2Z',;;"woh spr /?A ~ /: ~..e3/ - l DECLARED S VALUE
. OF ;;/7;;.~ -I.-OFH/~ - 1'* OF #~ 1- WA~~#'~uJ ~~~~~~:
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PROPOSED USE OF PROPERTY
~C:Sidential D Industrial
o Commercial 0 Public.
9797~
I HAVE CAREFULLY EXAMINED THE CCMPLETEO APPLICATION FOR PERMIT, arod .]0 hcrcUy certify that all info1.lIlation hereon is true and correct, and that I
have the following legal interest in the property: ~er of record; 0 contr<'lct. purchaser; Dauthorizod agent ...ith ovidence of authority attached.
I f:;.rther certify that any and all work performe~ done in aCCI,)x-dilnc~ 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 ar.r structure without the permission of the Building Division. I fur.
ther certify that rogistration with the Builder's Board is in full force ,"lno effect as rec;uiccd by ORS 701.055, that if .exempt the basia for exemptior.
~~~j~~;;;;;;WhO a:O;:ith OM 70 055 Wi~~Jn ~is project. I AAW UM MO
NAME ~p~c4Be print) TURE OATE
READ THIS SECTION CAREFULLY. YOUR
BEEN BASED ON THE FOLLOWING CONDITIONS!
[] PLANNING/ZONING:
Zone
parti ticn *
Parcel "
Parcel Size
;;;s:etba/:';~~~~/?/--e ,b4L' Y- ~nOn~~;;/~ /~/;'Pr.)
/<C.?:Jd~...P~ pate: 7-2&~
o SANIT~ION: S. I. . Q P.. / jtanation Record Issu d? Yes 0 No ..
::::::::~~:ns: ~~~o\" "i" . d;:-\1.YJ--;~,^,{!.~A' ';- .:.
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yf::~:N:;:I~ION: ~ ~ ~ ~;f j~~1LtJ ~
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Date, g.." 1- as- --Gf~
'I _ S)~ 5 ~ . ~-/~Ys-
PERM~NE COUNTY DEPAR;~~~~i~~~I~o;O~~~~~~ ~~NA&EMENT DIVISION, 687~~7.-
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION C 14-25 R84-
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.
SETBi,CKS A~D OTllt:R.'CO::DITIO~:S OF APPRO'ltIL ~\liST BE STRICTLY OBSERVED. VIOLATIO~ CA~ RESULT IN REVO-
C,;710:: OF 'i'llIS PER:U7, CITATIO:I U:1D~R PROVISIO~S OF L;'~E COU::TY':; INFRACTION ORDI::;":,C!:;, MJD/OR OTHER
REMEDIES ALLOWED BY LAW.
"HEN READY FOR I:1SPEC7ION, CAL:' 687-';065. A ~:HHmm OF' AT LEAST 2'; /lOURS ADV,\:;~E :-:OTICE FOR INSPEC-
'no:-< K~QL"I::~,~ ;.j\.:ST 1,\1; GIV!:;N. Have the lollowihg info:-!lIation :-eady: permit number, job address, type
of inspection, when it will be ready, your name and ?ho~e n~~ber, and any s~ecial cirections to site.
BUILDI:1G DIVISION:
REOUIRED 1::SPECTIONS:
1. F'oundatlon Inspection: To be made after trenches are excavated and forms erected and when all
materlaJ.S ~or tne loundation arc delivered on the job. ",'here concrete from a central mixing
plant {co~~only termed ~transit mixed~l 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
serVl~e e~ment, cOnOult, plplng accessories, and other ancillary equipment items are in
place but belore any concrete is poured or floor sheathing installed, including the.subfloor.
3. Framin~ ~ Insulation Insoections: To.be made after the roof, all framing, fire blocking, and
Draclng are ln place a:la aJ.l plpes, 'flreplaces, chimneys, and vents arc complete and all rough
electrical and plumbing arc approved. All wall insulation and vapor barrier are in place.
4. Lath and/o~ Qypsum Board Inspection: To be made after all lathing and gypsum board, ~nterior
ano-c~rror, lS In-prace but belore any plastering is applied and before gypsum ~oard joi~ts
and fasteners arc taped and finished.
5. Final Inspection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. :10 work shall be done on any part of the building or structure beyond the point
indicated in each successive inspection without first obt3ining 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 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
rnspectlOn is required for each bond beam pour. There will be no approval until the plumbinq
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 after the mobile home is connected to an approved
sewor-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.
C. Swimmin9 Pool: Below grade when steel is in pIa is poured. Above grade
Io'nen pooJ.-r5"installed.
APPROVEO PLA:.S }IUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. '!'HIS PER"lIT WILL EXPIRE
IF WORK DOES NOT BEGIN WITHItl 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR }\ORE THAN 180 DAYS.
SUSPENSION OR REVOCATION .-1AY OCCUR IF THIS PER"'IT WAS ISSUED 0:1 THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORMATION.
ANYONE PROCEEDING PAST THE POIl:T or REQUIRED INSPECTImlS WILL DO SO AT THEIR OWN J.l.ISK.
SUBSURFACE ~ ALTERNATIVE SEWAGE DISPOSAL ~:
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 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 docs 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 within a reasonable time constitutes a vio-
lation of ORS ~54.60S to 454.745 and this rule.
Setbacks - Subsurface Scwaqd Disposal
Septic Tank
10'
10'
5'
la'
Drainfield
F:-om;
Interior property lines
Edqe ot road riqht-of-way
Building foundation.
Walls. dtncr water sources
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10'
.10'
10'
# 100"
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e L.ANE COUNTY DEf:-T ENV r1GT RECEIPT ~'2011 B~i DATE 07;,'68"
APPLICANT L.ONGWORTH, GLEN ADDR 1138 DONDEA ST., SPRINGFIEL.D, OREGON
eTU:' 1002061 :)'12100 SUBDIV riEADmJ GI'::E:l::N [STArTS un 016 Bl..I< 0.'
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES IBLDGS 001 PHONE 747 4920 '
OWNER NM~ LONGWORTH, GL.EN ADDR 113B DONDEA ST., SPRINGFIELD, OREGON" If
e CODE APPL NO ACTION DESCRIPTION SQ FT ,UNIT COST VAL.UATION FEE DA'f'.e" lin
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Pl.. 'I:' 'FIx'TUI,ES: SWI'(: FT. (Hf(: FT" RAIN:, FT. -
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MESH MECHANICAL FEE C
.SUI'( STATE SUf(CHAF,GE 4;:: e',:
PCK PLAN CHECK FEE 25% .
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MECH l..C 2011B5 WS 16.00 I'~
PCK 4.00 ~
eSUR 0.64 .
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EST. COMPL.ETION DATE
TOTAL. I' Eo 1': 1i';('
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ACTI~Y INFORMATION
~EET
.klne coorty
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTEDI
6/?/v L'r? ..v?A--e^,-r~
PERSON1MAKING REQUEST
// J r ..t?Q//'p~A
MAILING ADDRESS
C / ""....~ 4-:::2oh/O A.'" J....
PRO'r"!:'i{l Y OWNER
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MAILING, ADDRESS
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CITY
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CITY
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STATE
77';/Zk'
ZI P CODE
.::7,.! F
- STA fE
97Y~
lIP CODE
BUSINESS TELEPHONE #
-;?~7 -7'9~
HOME TELEPHONE T'
BUSINESS TELEPHONE #
7'77 -'7'9.J..cJ
HOME TELEPHONE #
2 PROPERTY ADDRESS
(IF DIFFERENT FROM MAILING ADDRESS)
3 MAP & PARCEL NUMBER
(REOUIRED INFORI4ATION)
(from tax maps in Department of Assessment and Taxation
or from tax statement)
TOWNSHIP RANGE SECTION
TAX LOTlS) OR PARCEL #
~ES'
tONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOWNSHIP ~ SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
ACRES
4 SUBDIVISION (if applicable) ?/JEA..1ooV 6Aj~ E5/A7'~5 LOT-Lh' BLOCK /
5 REQUEST (state exactly what you plan to do) J..b/7Je- s:fQ/)-P -I-hcJ' j}b~,
nn,VJ ;l~)f(d.t.r/ by r'(f'hrrf(l/175fq/fJ. /1)J-f'~17?f;;'o,,-
't-I)Y [,rf Tn\uJJt';,~oiJO{'(/lJ)1J )'P_\.
-6 DIRECTIONS TO SITE: =-/.P JAJ/OE/f, /-(.0
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** FOR STAFF USE ONLY **
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NUMBER
DATE
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lONE/LAND USE:
,BY: DATE:
TIME IN: OUT:
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LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061
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WOOD
STOV'
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bne county
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**
A COPY OF THE MANUFACTURER'S INSTALLATION INSTRUCTIONS
MUST ACCOMPANY YOUR APPLICATION
, .
NAM( OF MANUFACTURER .c./A E .r- ..;""./} IE
MODEl NAME and/or NUMBER
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ADDRESS FOR IN5TAllATlOtl
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DIKUSIONS:
Answer the (0110\111n9. fill in nullber of inChes 1n diagram
1. Side of unit to protected wall_1nches(unpl"Otected wall_inch esl
2. Rearofunittoprotectedwal1_fnches(unprotectedwal1_inchesl
];F1oorprotectlonatsideofunit_fnches
4. Floor protection in front of unit_Inches
5. Lengthof....olllprotection at rcarof unit_fnches
6. length of wo111protection at side of unft_fnches
1. He1ghtofwal1 protectlo"_inches
8. Edge of wall protectlontonea.restdoororw1ndow_inChes
9. Air spatt blltweenwall protectlon and wall_inches
10. 0lameterofch111l1'ley and vent connector_inches
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PLAN 1
t. _0
CONSTRUCTION:
A. The unit is listed by:DUl [jrtBO DOthllr(nalllel_____.____.._....
B.ThefloorprotcCtiOniS~inchesthickandWi1lbl!:DASb('st{lSlt.i1I !>Ool,-d
--~e or DOther covered 1.I:rl ne:~l
[:J~~~~Ck (describe) ~
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C. The wall protection will be:DAsbestos millboard ..........~C! or
covered with .rretal Lffb~i'~1:.
DOther(describe)
D. Type of ch1mey: DFactory chirmey
~nr[flUellner?l
~~1aSO y[Oyes Dna
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DOther(describe)
Eo Type of vent connector:DFactory chimney' ~qi(or heavier) galv.
F. Will be uSlng:DplAN 11 DpLAi{.2 ~,see attached
ShLllItl.
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!!!irE:
,10
IF YOUR INSTALLATION DIFFERS FROM THESE EXAMPLES.
PROVIDE A PLAN AND ELEVATION OF YOUR INSTALLATION
I ~ilI
ElEVATION
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Not all units are approved for corner installations or reduced
clearances with wall protection.
lhItsldl! Atr Inll'!t:Prov1dl! an outside air tnlet, a rnlnlll'llm of )-0 to supply 41r for
proper fuel combustion. Thts inlet shall be closable (da~er)
from the' bul1ding IntC!r10r. The a1r inlet supply duct shall be
incombustible! and continuous from the intC!rior inlet to the
e~terior of the building. The inlet shall be" located through
the wall (near the floor) or floor within 24- of the stove or
fireplace.
LANO MANAGEMENT DIV. / PUBLIC WORKS DEPT. / 125 E. 8th Ave., Eug. OR 97401 (503)687-4061
.CELLATION/REFUND AUTHORIZATIO~ PERMIT # 2. ('J / 1- 8~
NAME (PLEASEPRINTI 6LEA, LO/J(; 1;;10 Rt/-I WrRSfTL# 18-02 0("r~h-;:100
.... . "".
ADDRES~ //"g DDAJhEA <::"7, C:::Pf...'IAJ6FI/?LD
APPLICANT ( ) OWNER ( ))~ CONTRACTOR ( )
REASON FOR CANCELLING PERMIT(ORAPPLlCATlON) U/J L / S' 71.:: D .A PPL //j AJCE
SIGNATURE ..-L~"'(P, DATF 8- I-Be;-
FEES PAID FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR 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.
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 0/1-"/1/ / c;lhh00A!.T#
ADDRESS - // 3,F /~/7/7r,.,L;7. <:'7/A-'b7 <//'?O/.cP'.2r.9'/./ V.eY'
. ,,' -', '9 j?;/7/
LAND MANAGEMENT DIVISION / Public Works Department I 125 E. 8th Ave., Eugene, OR 97401 (503) 687-4061
FEES PAID
% REFUND
,1.;;#1-
%
%
%
%
I k"\)%
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/In-%
,
-,
%
%
%
%
%
%
%
%
%
SIGNATURE
Flood Plain Fee $
Building Permit Fee $
Mobile Home Fee $
Plumbing Permit Fee $
Mechanical Fee $ /1 (Jf av
Plan Check Fee $ '.3.~)
State Surcharge Fee $ r ',...Lj
Septic Disposal Fee $
Site Inspection Fee $
DEQ Surcharge $
Land Use Application $
Planning Director $
Recording Fees $
Partitions $
Copies & Ordinances $
Surveyors C'\/ h
" ----'-~/
Mlnus.$25. for P-rocessing Fee $
TOTAL AMoUNT TO BE REFUNDED $
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$
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DATF
5f -I-g~
/ t, 777
/~ 7'7&
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?4.17-881Acct. 42120/Prog. 060 Receipt#
24.17-88/Acct. 42124/Prog. 060 Recelpt#
?4.17-881Acct. 42133/Prog. 060 Recelpt#
?4.17-881Acct. 42134/Prog. 060 Receipt#
24.17.88JAcct. 42150/Prog. 060 Recelpt#
24-17-881Acct. 46202lProg. 060 Receipt#
?4-17-881Acct. 46210/Prog. 060 Recelpt#
24.17-881Acct. 48474/Prog. 060 Recelpt#
?4.17-881Acct. 44419/Prog. 060 Recelpt#
?<;.()6.74/Acct. 44451/Prog. 010 Recelpt#
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