HomeMy WebLinkAboutBuilding Field Test & Inspection Report 1982-4-9
I" , \
;< r:,.,
/() -{)<~'-()i. 7:
DOWNER'S NAME
WN'n~ArfTIRTs NA'ME
~~:~Y~SPECTlO:1 ':::.
(;f) i I I ILC1Il \ (yJ( r..;(, ))-~ .-( 5'-
- 0
r\ Ii \
- I., /; /
PHONE NU~BER /
."
" ';
" '
":.,... .
~ET BACK REQUIREMENTS
L, FRONT 4',>-CL, SIDE
WORK AUTHORIZED BY PERMIT
INTERIOR -:;
rv'\ H
PHONE NUMBER
#PLUMBING FIXTURES
REAR ,,-
DIRECTIONS TO SITE
Y./C': (, '----
1~7
SITE ADDRESS
:'T." b2 /'
~'k-:r-f\ -d ,
II V
OUNDATION INSPECTIO OR MOBILE HOME SET'UP INSPECTION
, Disapproved Date /-/C' Inspector
4 . , /11 00 dk, t:' f-A-.)., Z~
y .... ~.... ~
7'7s- - 23 /
PERMIT NUMBER
'FOOTI NG /
Approved
---=-
....,
~
CONCRETE SLAB / UNDER-FLOOR INSPECTION
Approved Correction Disapproved Date
Inspector
UNDER SLAB / PLUMBING GROUNDWORK INSPECTION
Approved Correcti on Di sapproved Date
Inspector
ROUGH PLUMBING INSPECTION
Approved Correction
Disapproved
Date
Inspector
FRAMI NG INSPECTION
Approved Correction
Disapproved
Date
Inspector
INSULATION / VAPOR BARRIER INSPECTION
Approved Correction Disapproved
Date
Inspector
LATH / GYPSUM BOARD INSPECTION
Approved Correction Disapproved
Date
Inspector
FINAL PLUMBING INSPECTION
Approved ~ Correction
Disapproved
Date 7-J~J<'J Inspector !/PI!-
FINAL WASTE DISPOSAL SYSTEM INSPECTION
Approved Correction Disapproved
Date
Inspector
--, '"'-
FINAL INSPECTION BUILDING (MOBiLE ~ ~I
Approved I/"" Correction_ ,Di'5oW1'~d Date ?/-9-?:>; Inspector ,IIf-.
~d- .y~/)')...7.Jj_n F..L.-,N7-~1 ~,..,.-" 11 . _' 7-c:-~(}..P/ A'1{._
CERTIFICATE OF OCCUPANCY TEMPORARY CERTIFICATE OF OCCUPANCY
Approved Correction Disapproved Date Inspector
Form C74-197
/
'1
<-
~.
,
VICINITY MAP
\
I
C(j
<
'1,
i
-I-
::S
~Jl
/
HMb..<l. DA".K')
)~, ~>\t-
/,,0'
_ MUST BE IN BLACK INK
Permit No, it:. 99~ - ffJ Twnshp, ,.y Range f)S Section a-z.:z.
Standard System IH'Alternative System 0 (Specify Typel hip. ' .-
JobLocationlStreetAddressl I;/,7 J)",.,..!'. Sf- Sl)r,,,!/~'~W 0,.,.
S ,~.~''- " / Partition # /L5'C, - lrl Parcel '::L. Lot
form c55-11
Tax Lot .:lr.OI oj- 4' OJ
Bloc~ -
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
____ Scale - "=-
-------------------
--
qp.Ofo.,....er
,,: \
(Y'ltl 't'\ort'-9
'lJ
-~
"
~ ~
'I:!.
N ~
~
\)::
'~
InstallerJ2e))DA+Mli.. (I 0 N"'>f C"
!Title as shown on DEQ licensel
Telephone 7 <-I to -- 'if 0 35"
.nse No, '00( '-II~ </ i?
Bonding Company U.v,hrP P/le,it.'t
~ f1~~, Dat" S-:J{'-~
(Signature ollicenseel
If Installed By Owner-
Dat"-
IStgnature01 Ownerl
Applicant's Name & Address
C, c:. F.4,- (S.4-.vC<S
/'-1"'-0 idLJrC,'____ D-
o
(p--!IJ O~G-~e>- CJ7'1??
~~:~~
s ~ 1/f4;- ,;, ('1 ~\
- , ,<?.o '--,
,:'. -.~U;t '. U In '# ! _ t
, {>, "'6', ' "
" ~:; ~~ ~~
" ,"/1(',
....;}~.~"
~
~..
A
c"
-
r-
o
ci
~
,
"
'0'
~
L- l..l;>I'p - - ~>_
lfol, ,b"
\:.
-tfl,J
~,
,0' 10' I
~
o
~ ~ ~
"
~'
So'
'"
,0,
"e.'
<.:. omtn~.v
r~,' H..4e
DA ~ve '-0"-'1
USE BLACK INK ONLY
FOR INSTALLER'S USE: Trench Depth "'Z.-'-I I ( ~ravel Depth Below Til" (;, t<
Tank Capacity 11)00 Manufacturpc (J) (II a"" e/rr> &-~4" ::,P"'",-----
Measured Distance from Well to Tan~ From Drainfielrl Total Length of lines,.,) 'Zt')
COMPLETE THE FOllOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I !installer's namp', certilv that a IMlg)
and Mercury Float Switch IMlg, and No,)
(Model No,) . Pump
have been installed with this sewage installation.
Signaturr
: Jatp
FOR SAI\IITARIAN'S USE ONLY:
COMMENTS: _P...:..., .~ ..\:,
i9 System Approved 0 System Disapproved
!">oJ"H..... cr.te...;... (It......~..rJ.'f'~.,J. .
o Needs Correction
System Capacity
.-----fI S'illem
oal,/day Signatur,,~>r--rz::::sJ
Dat"
Date~- . etL
Corrected
INSTALLATION RECORO & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, this certificate is
evidence as per OAS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
Return tn,s form to: tlulldlng and :;anltatlon UIV" Uept. ot tnvlronmental Management, located In tne casement 01 the
Public Service Building, 125 E. 8th Avenue, Eugene 97401.
.
I~
!~,~
'"
)
c:S
~
'tl
~
-1l
-.-
-
"\.
'-,
.
,.
,
.'
I
I
, ,
-5''''''''
~.
I
i
I.,
1 - - ,
,
i -'T'
i I
,
i i
i \
I i
!
, i
1 i
i
i "_I
.-1
\r;;
"t'1
-!
-
~-~-... .
'5'?d(C:"'.b.;>_",-? '
, ',", ""'--.,
-----"""
.
,
\,
~._-,.,,_.-.~-.-
;~-""''''-:::::,-
89.7/ '
, -
l
(~"~{~ .1
, I
G "'p
,)0
-_.~_....
J
"
'0
h
,
'--,
1" I I-IOIM(,
/vl.-' , . "
J-Jf x 1.0 "
S.f,()l,....':7~
C".po.A .
,
F -/""'~I-'.
(,~ I~
,
3<>'
/I/"
I,
8(,
CO*'.......Q1 ~l
(/-. \
'ooOf'~
- "Se _ 1,
i"v" __.....
""-'-
-,
',.',,,'^-
'r 0'-'
00 "v \-eV
/ I LJ'
i
!
I'
I"
,0
I'
j!),
"
"
!
\
I
1
;p'
S' eC~Mclo>~'1
F,-..n
Av~ ~
I
1 ,
10
'V
. I
Pr'v.l_,T"C-
Drf '\JP\.()~ Y
i~.'
.t -'(,03
/(-0.3-07, "'<>s
PG t<el ,rt 2. M /Sb- 8'0
LC, 7'1- C.S{,
I Sc"le / ", 1-0
I
f~"~~ .
'Y
'\ -Ii ~S\\" - ,"'~'\ ." 1I "\ >- "H
. 1 ~~')Oh1
~O "0\
\I~ . ,
,:I"'~Je ar men~ of ronmehta 1
t7e HUI //-/5,81
FLOODPLAIN ~1AtlAGEMEJ~ OOtyNS ;v;-,. R60U/~
Management/125 East~-Ave~tugene, uregon-
687-4357' ,
By NLb.
.' '.~
, 'j
-.
, .
.,'
'.
( ,
.5- IZ -81
~ Permit Processing
.0 Planning
~ bt\~h " Pub1 ic Works
~].iC [1'\1 Name :E?A, HA' "-'"
NO\] 12 Addr~s 'site +\A~:?,:130R. De..
\A~S;:):: '!2) . SFD AG W ADD, COMM.
, ;Approximate flood hazard study area, extra precautions may be appropriate to
~ ~~ssure that the building site will be reasonably safe from flooding.
~ Detail flood hazard study area,
~ Mobile home tie downs required'if -the '3I'CU,0 -+\..J ",'Obl'le .\10"'~ \-;'; plc\{@cI
o Substantial improvement. is belG01 --I I...., base .(1cOc.,{ e1., vcr~\<, n.
o Site in regulatory floodway channel, building prohibited unless it is demonstratl
that the cumulati,ve effect of proposEd de~e1opment will not increase the base
flood at any poirit: ' '
(3 . BASE FLOOD ELEVATION + l' = .444. d
,thise1j!vation required as check.ed below. .
, -- . ' , I' . '
. ~ OTHER. -p".... ......1o..U,-l~~t:> -'-M-IA...- rl t-:l, 1="(.C>O~ -r-:>~ ~t-.af\..-n=lJ~'. 44'l'
'", ,,' ~ ~~ "qtt::> 'P2eUMI/o..1oI>.,~"" ~D'J', - --, __
~*****************************.*****************************************************************,
Date
To:
Permit No.
Partiti on No.
Subdivision No. '
'1'1S--8 (
~
, U1SL).
Certification at'or above
w
o
[g!
[2J
o
o
CERTIFICATION OF ELEVATION
I ,Ge,..,a IrI k" 4..tiLy . , a Registered Professional
LOTic! ."') '-LI:Z.,ro',QI" in the State of Oregon, do hereby
certify to Lane counfy;- that the fo 11 owing e 1 eva ti on represent~} sur.vey /
made by me or under my supervlslon.
>-
The foundation elevation (including basement slab) =
I '
The ground elevation that structure will be placed on" -1-1-7.7/
The first floor elevation = ~L~CJ.1t/ '(MSL).
The elevation of the top of floodproofing =
Other
Refer~nce Bench Mark No. l:1a;,jr'ftMr/ Soi.k", "'<L?:,~/
. Location ~:<;f Pry€' Dr:' A. r n": l/a/"f6t'>'" Di""/Yp
/-iR7 #a,..,.~",.,. 0,."
Sig~ature $--df~/
Date /(/j/.f/ --'. "7-
<l
-c
I'
,)
, (r1SL) , C
(~lSL). '<
, (MSL).
I
\
r
l'
l/rYI,' ;L
Original to be certified and returned to
F1,00dp1ain Management,', '
, ';'. , I!~., I' ,". I .
1st copy with application/inspection
" """'I,j!
'~"',;;,j:.. :....,. 2nd cop-y to app 1 kant ~'il>(" ,. ,'.
: ~ '.;;" ,;,', ' ..;3rd copy, to Floodp1ll1n Management .
- ":'." ..,j'....lt: .' '. '. ',:I~ "," . .,;, ... . .-11 '...; ," tJ : ( " II ;'1) "I:' .,
iowil ""r,~'. 'I; \f11~~tl:r~rli.~'J"~ii':~"~r.lG;~"<i~t '\. ".j' Illil~'h'fl"Il'l;f ':l~t:'.. ',i .' \1'" ".', ~. !.,\,,,:,~,,:":."
~,' . <',,",I ~!,.~i, -,' ~~~..lt'P. ,; ',1:,'/.':~':',;!l.:i'W"I:J' .., '\'.! '
S~',
P.EGISTERED
PROFE5SI0i'-lAL
LAND 5U:1V~YCiR
Lane County ~
OREGON
SEPTEMBER 23, 1~~7
GERALD 1<, ATTI
1121
, r
r
,
(
(
f
D
~ C
v