HomeMy WebLinkAboutPlan Review Building 1981-9-24
FOR OFF:CE USE ONLY
TOWNSHIP
~~~;t~a;#<jR J?
[]TWO Cop~cs of Plans
D'rwo Copies of Plot Plans
DHcchanical Checklist
o Plumbin9 Checklist
~Plan Check Info Sheet
PROPOSED USL OF pkQPERTY
~sidential [JIndustrial
D Commercial DPublic
CO~WLETE THIS BLOCK.
PLEASE USE BLACK INK AND PRINT.
BLY
T ZIP
"9?'?7?
- '~~~./ I SVALUE
""? j '"DF!,SlJ1J: # OF ;~~ / I WA~Y ~'l~ J 0 pr~posed
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICtl.TION FOR PERMIT, and do h...r('by "(!rtify thAt all infQTf"ltion hf'rf'on iH tru.... <lnd "nrr('~t 1111 I fUrtt1l'T
certify that any And all work performed !lhall be done in accordance with the Ordina'l<;es of Lane County and th(' La'",:; of the St,lte of Ut"'<r,1l I"llairlinq
to the work described herein, and that NO OCCUPANCY will be made of any structur<! without tht> pf.'rmission of the auilding Division. I furth~r Cl rtify
that regi!ltration with the Builder's Board is in full force and effect as requir('d by ORS 701.055, that if exempt the basis for exemption i!l notf'd
IIOr:eon, and that only subcontr:actors and employees who are in compliance with ORS 701.055 will bC' used on this project. I HAVE READ AND CHECKED THI!:
APPLICATION THOROUGHLY.
g.:r?L ~hS/J/1)
NAME (please print)
~ .// 1'/
~""',.-"I
SIGNATURE
g- ~'>'-~I
DATE
jil-rrwl\er
o Con:;:ract.or
DAgen t
o PLANNING/ZONING: pRJ;or R ^
"hn~mum Setbacks: ~~~. 1.5 ' CL, sidC'
Comments, l2J{)tVdlf~'" . ~~e+~
Partition #
Parcel ;;
parcol Size 210 'x 132/
c'. /
~ rear 5 7'r>OE
V----. l/'-f ~
. Oat.. "i{ - Z. 7 - ~ I
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interior
o
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3
FLOODPLAIN: In flood hazard area?
RURAL ADDRESSING: GR!D CDORD!NATE
SANITATION: s. 1. #
)XlNO
[] Yes, see attached sheet.
Date:
0-
n
D
N
E
Date:
B. P.
.L:f~7-70
Installation Record IS~U0d? [] Yes [] No
lnstallation Gallon Lineal Feet Maximum Depth
Specifications: Tank of Drainfield of Trenche~
< ~rft) ,
Co~ent"' /J/n 1 WIl.,,""UJ>} fJ'1.~(J/IJr7, ~;!jn!!'l1A r/~ nddm~ C:I1tTU/Yr 1l1___
1JIA/ /)1011'/ ,NlAJflrJs.td ffMOV-U,,11rN.J _ .1 . /lj?P4/rf \Cf/tLbat1ke. - 'A 01.//0--1 J
~::J .,n.,yh,('} ,-<yv,~ Oat.. J{)'7 _(Pm 1'7 ~
C]lq PLANS EXAMIN~TION: TYP';\J-t-J GroupJ2r3/M~\ u5eSP!:>/fa~ '
Co~ent5,pt.A.lJ~ Ar ,--""Jet> ~IL{I)U5T!lk:i"\':::tt)1J ~ UJ.~. ee:suSMrr Z~S OF
~ ~rllJVFb rc.y ~r DJIJ"l'( 'M4el.1 ~'lIL.~ fi!ile.... co~_~\t':
~A J?UI ~~ 9h41~1 D
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CONSTRUCTION AUTHORIZED BY THIS PE~~IT
Sq. Ft.
-
') 1229~
.~ /StJ.fT
Fixed Feel
Unit Cost
FloOdplain Fee $
Subsurface Fees $
Building Fee $
~Storm Drain/Water $
Plumbing Fixtures $
Me hanical $ --i ~~ :-...
Plans Check Fee $ _~.;;:: fl-
S):H~4/-.~_/$ /t%. _
TOTAL FEE~ $ ~~---
/ 57. So
5.3. .PE-
,
'7 M~>()
17 TOTAL VALUATION
$
FEESB:~~ash
D;te:A.~Z 7 ~'l
~/tfJJI
DATE
"/,?:b
PERMIT APPROVED BY BUILDING OFFICIAL/DE-SIGNEE' 'c'per"-ORS ~ -
COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST 'kIGHTH
LANE
AVENUE, EUGENE, OREGON
97401
C74-194
SEE REVERSE
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SETBACKS AND OTHER CONOITIONS OF APP~L~US~<~.I.CT,.>.~~<~.~f;~~;~~u~;"~;"'~v:i~iTHIS PERMIT,
CITATION UNDER PROVISIONS OF LANE COUNTY'SI~lt 0 N ~E':"A~D~~ ALLO 0 A~.~':t .
WHEN READY FOR INSPECTION CALL 687-4D8S. A MINIMUM ~ L~ST 24 HOUR AOVANCE NOTICE FOR INSP CTIO~EQU ST MUST BE .
GIVEN. 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 directions to site.
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BUILOING DIVISION:
REOUIRED 1I1SPECTIONS
1) FOUNDATION INSPECTION: To be made after trenches are excavated and forms. erected and when all materials for the foundation
are delivered on the job. Where concrete from a central mixing plant (commonly termed lItransit mixedll) 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 ancillary equipment items are in place but before any concrete is poured
or floor sheathing installed, including the subfloor.
3) FRAMING & INSULATION INSPECTIONS: To be made after the roof, all framing, fire blocking and bracing are in place and
all pipes, fireplaces and chimneys and vents are complete and all rough electrica} and plumbing are approved. All
wall in5ulation and vapor barrier are in place. .. .
> \
4) LATH AND/OR GYPSUM BOARD INSPECTION: To be made after all lathing and gypsum board, interior and exterior, is in place
but before any plastering is applied or before gypsum board joints and 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 ip 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 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 inspection 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 completion of ma,onrv (if applicable) and when installation is comolete.
Installation shall be in accordance with an approved nationally recognized testlng agency dlld the manu-
facturer'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)
(2)
(3)
Footings and piers to comply with State foundation requirements for mobile homes or as recommended
by the manufacturer.
Mobile home minimum finish floor elevation shall be certified when required by a floodplain
management letter.
Mobile home tiedowns, when required, and skirting shall be installed and ready for inspection
within ~t least 30 days after occupancy. Tiedowns and skirting shall be installed per enclosure.
D. SWIMMING POOL: Below grade when steel is in place and before concrete is poured. Above grade when pool
is installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES OURING WORKING HOURS. THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN
WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 DAYS. SUSPENSION OR REVOCATION MAY OCCUR IF THIS
PERflIT WAS ISSUED ON THE BASIS OF INCGrlPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT HIS OWN RISK
SUBSURFACE ANO ALTERNATIVE SEWAGE 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
Department by submitting the installation record form. The Department shall inspect the construction to
detennine if it complies with the rules contained in .this divistog. If the construction does comply \tlith
such rules, the Department ~hall issue a c'ertificate .of satisfactory completion to the permit holder. If the
construction does not comply with such rules.. the Department~hall notify the permit hOlper and shall require
'satisfactory completion before is:suing the certificate: Failure- to meet the requirements for satisfactory
completion wit~in a reasonable time ~on~titutTs a Y~o)atio~ of ORS 4S~.ROS to 45~.74S'and this rule.
. '. .' . I.'. .' ,'. j
Setbacks.. - .subsurface'Sewaoe Di sposa] \ .,
. . t'. . i. '".
Seotic lank 'Orainfield
10' 10'
10' 10'
5' 10'
50' 100'
.,
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From:
Interior property lines
Edge of road right-of-way
Building foundation
Wells, other water sources
.... '.",.,,'.
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~ne COUr)ty
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CHECKLIST
PLUMBING / MECHANICAL
APPLICANf INFORMATION:
(Name or fIrm-Please PrInt)
(~mIlIng AddreSS)
PLUMBING CONTRAcrOR
o Yes Firm
Address
o No o Self
MEGlANICAL CONTRACTOR 0 Yes Firm
Address
o NoD Self
Type of Fixture
PLUMBING
Number of Each
Sink
Lavato!>, [Wash Basin]
Tub (with or without shower)
Shower, separate
Water Closet [toilet/urinal)
Dishwasher
Disposer (garbage grInder)
Washing Machine
Water Heater
Floor Drain
Sewer--lst 50ft.
each additional 100 ft.
Water Service--lst 100 ft.
each additional 100 ft.
Storm and Rain Drain--Ist 100 ft.
each additional ioo ft.
Special Waste Connection
Sewage and Sumo Pump (eiectorJ
Mobiie Home Sewer and Water
Other (specify)
SUB-TOTAL (Minimum $10.00)
I
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J
J TOTAL FEE
Type of Equipment
1v1EGIAN I CAL
Number of Each
Total
Mechanical Permit Base Fee
Furnace UP to 100,000 BTU/H
Furnace over 100.000 BTU/H
Clothes Dryer Vent
Bathroom Ventilation Fan & Duct
Range Hood with Mechanical Exhaust
Wood Stove
Air Conditioner Only
Heat Pump
Floor Furnace
Gas Piping System 1 to 4 Outlets
Per Outlet
'V
Other (specify)
SUB-TOTAL
IWT AL FEE
OFFICIAL USE ONLY
Appli. /
permi t #
(cny or Town) (LIp Code)
Cont. OSR#
Cont. OSR#
Fee On Each Total
$ 5.00
5.00 ~--
5.00 ~IO
5.00
S.OO ~pd
5.00
5.00
5.00
5.00
5.00
15.00
10.00
15.00
10.00
15.00
10.00
5.00
5.00
10.00
~
~
Fee on Each
$ 10.00
$ 6.00
7.50
3.00
3.00
4. SO
6.00
6.00
b.OO
6.06
_~(".CJcr
.50
Ifp, (X)
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""C
LANE COUNTY DEPT ENV MGT F~ECEIF'T * 18SElSl DATE 0El2_r
APPLICANT WILSON, BILL ADDR 242ElDUMAS DR., SPRING~IELD, OREGON
TLI 1703234400112 SUBDIV 3RD ADD TO NbRTHWOOD ESTATES "LOT 21 BLK 4.
NEW BLDG TYF'E USE R NO BDRrlS 0:5 NO UNITS 001 NO STORIES NO BLDGS 00'.
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DhiS
BP REMODLE AND 650 19.50 12675 :
BP r~DDITON TO ;1 ~)0 ~)3. ()0 7'?~)0 .:
BF' EXISTI~G SFD
BF'
ElF'
BP
F'CI(
F'L
MECH
SUI,
PCK
F'CK.
LC I 8~)ElEll RPRV
Np. FIXTURES:
2()62~>
.~
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3 . NO. CONNECTORS:
t1ECHAN I CAL FEE
STATE SLJRCHAI\GE
PLAN CHECK FEE
EXTI\A PLANS
IS. 00. EACH '"
4%
50%
62.0(l
10.()0
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SEQLJ:
T AI( EN
APP
o
BY RLH
F~A
FT'
SDS SI
I
COMPLTT I ON
PCI(
OTH
ISS
3
TOTAL FEElo,
72..00
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1:1(1 I
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EST.
DATE. 0904Ell
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COMP~TE THIS
C q 1/' ~ kine county
. . ~ironl1lental MiiPagement -, ~ ~
ACTIVI~ INFORMATION SeEET /-4: ~ ~
SECTION. INCOMPLETE FORMS WILL BE REJECTED!
0)
R;\\
w; ISoN
APPLICANT/REP~SENTATIVE
PROPERTY OWNER/CO~TRACT PURCHASER
o .Jf .2$\
SO-f Ld.
I CITY
J)(~)71.AS J)().
Hi.ILING ADDRESS
MAILING ADDRESS
f=)qf' '
STATE
qz~
CITY
STATE
ZIP CODE
2!:t tD- 0 Cl J/i
BUSINESS TELEPIIO~E NUMBER HOME TELEPHONE NUMBER
Q) '\AIL INFORJo\ATION TO, ~PP!.ICANT/REPRESENTI\TI'iE
BUSINESS TELEPHONE NUMBER HOME TELEPHONE lJUMBER
o PROPERTY Ol1NER/CONTRACT PURCHASER
Tax Map Number:
DESCRIPTION NUMBER (from tax maps
~ J.\
in Department of Assessment & Taxation or from tax statement):
CD TAX MAP/PROPERTY
1'1
0..'3
,13
Tax Lot{s):
o Out of TL #
By partition #
Tax map number of adjoining property. in same ownership:
g'None
o Unknown
Tax Map Numher:
@SUBDIVISION (if applicable), N 0 ~Th W()Od
Tax Lot (s):
EstAteS
BLOCK, -.p I
LOT: -4
@ REQUEST (briefly describe information needed):
COMPLETE THIS SECTION FOR LAND USE,
CONSTRUCTION APPLICATIONS. OR PROPOSALS. SEE "NOTE BELOW:
""FOR STAFF USE ONLY..
.i
(j) TOTAL. CONTIGUOUS PROPeRTY IN SAME OI1NERSHIP:
acres
NUMBER:
Q) PROPERTY ADDRESS:
DATE:
..,
tx
"-
..,
I:"'
TIME INITIATED:
CD PRESENT USE OF PROPERTY,;
CHECKED BY,
Garage_
Other (speci'fy)
Shop_
Barn
ATTACHED EXHIBITS:
o Plot Plans (2)
o Constr. plans (2)
o Site Plan
o Cooy of Tax Map
o Other
@ NUMBER OF STRUCTURES ON ,PROPERTY: Standard home Mobile home_
Modular home
RV in use as residence_____
Storage_
G> ACCESS TO PROPERTY: publ'ic Road Name
SCREENING VERIFICATION,
Private Road Name
Road Easement
Width
# of
Users.
By'
Date:
G:> \;I\TEH D I S'I'RICT,
@ FIRE DISTRICT,
Time In:_____Out:
o Accept 0 Reject
@ OTHER EASEMENTS OVER PROPERTY:
Routed to:
G l'~XlS'l'lNG PERHITS ON PROPERTY:
7/81
;?/?/~P/
(OVER)
*NOTE:
ATTACH A COPY OF TAX MAP;
SHOWN EXISTING STRUCTURES
AND TAX LOTS IN YOUR OWN-
ERSHIP. OBTAIN TAX HAP
IN SELF HELP AREA.
CO.MPLETE THIS SECTION FORWD USE OR CONSTRUCTION ~PLICA.S:
"Q9 PROPOSED USE OF PROPERTY IN DETAIL:
@ BUILDING REQUESTS:
Contractor's 11
Directions to Site:
(for mobile home setup also)
Check the type of permit requested:
o Dwelling: 0 New
lit Addi ticn
0' Modular Home
DRV
D Plan Check Only
o Commercial: Use
o Agricultural: .Use
0" Others: Use
o Change of Use - How?
D Additional:
o Replacement
t:t'}\l teration ~
D'Mobile Home - Model
D Standatd Construction;
Year
Floor Area
Floor Area
@ SANITATION REQUESTS:
[J.Site evaluation for 50S feasibility
o New system installation
o Repair/replacement
o Alter"ation/relocation
o Hook to existing
ADDITIONAL INFOR>~TION:
**FOR STAFF USE ONLY*~
ZONE/LAND USE:
By:
.
Date:
Time In:
Out:
D Accept
D Reject
[] Planning Application
o Construction Permit App.
o Information Only
Zoning:
Compo Plan Designation:
Comments:
SANITATION:
,
..
By:
Date:
Time In: Out:
o Accept 0 Reject
[] Constr. Permit Issue
[] Site Evaluation Issue
PERMIT ISSUED (SAME DAY ONLY) :
Permit #
By:
Date:
Time In:
Out:
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kl>. CJ Reo:;> d S:>:. ~ Tax lot No. c-
C!::Ja:.f~: ~:h Oq;rth Arc!a
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Bod"'L
VDlulItion
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Propo:::d W:ltCT Supplv; Public
Propoo;::d Scw;:c:3 Disposal: PubJlC
Plumbing to be Installed by Owner I
fEES:
BuikHng
W.1Ste Disposal
Pk.lmbmg
.... Choc>.
.
Spflnq
Sephc Tanl<.
Plumber l .
,Weli Oflllf"d
. Pil Privy
Name (If PIUlTlbel
Or....en
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s
M.ClD
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Signature 01 Applied"l
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COUNirV BUILDnNG lJ. SANIYAYnCIN SI>>IECI~9CAYIOMS
SANITATION:
$epuc Took Mm.mum LlIluld y,,""ly VIollh OlStllhullon Bo.
Sut>RllloKt' Oispoyl FINd ReQUlrf'<j 1~ llll Ft
S:::J
Sit
Gals
W"j'h ,f Trench, or
/;$9
SQ fr -
1=11 ol~ t~ c:l D"=l II> t._.
UaC] cc-:l c:l ~.o.a.
~9a. ==~~t:::lll==)
STRUCTURE: hilt' p Occupancy
ZOlle ~ Bldg, StHb;)cks Front Gi Feet trom Ct'nler rol Road
E~terlOr (1/ CQrner loll FM!llrO/n Center 01 Rodll. R.O w.
1(, J
R OW. SIde. 'nWlor 9' Feet.
= VC7'l S'
COI\JSTRuC1ION 10 Cm.Wl Y ~',l 1"H UNIFORM RUltOlNG COO[ AI\O SI A1F Ilf-GULJ\TIONS GOVE.VJING PLUMBING AND SE~';
M~f- DISPOSAL All BtJllnl"!GS f'lEOUlIlE A ClRTI!'ICATE OF OCCIIPAr.JC" Bl FORE m Ii~G O:CllPI[O.
~
A. portion of the work covered by thiS permit shall be startw wltttnl 60 days from date of issuance a:1d illt work. completed within one ye<l',
c..cept SlIW'1I9' disposal repair, which must bet)in immediattlly. If nOl, the 1,)8.I~it berorpe ~I.'d unleu renewe::l by the county buildillfil intpl:C_
tor. SrorO\lcrsetOflenewlll!et]Ulu,ments / '.. " J.
BY" .',1 BY . ~'. .'~ -D:I~
I ~. a. C:::::::::l BV'L~""~.qc....,~ O. B. C::) Q,7CO SANITARIAN O=c"...>P
L \"IHIN $IGNED 0'1' THE SANlTARIAfI\l AND 8UllDING INSPECTOR, THIS FOFlfi. 8t'::O'.~ES Y('IUR 8UIUJlNG PERMIT FOR THE STRUCTURlS
Llih.O tllmtON: POST THIS PERMIT IN A PROMIN~NT LOCATION ON OR .\DJACIlt.T TO Ht" r.:AIN aUILDING DriNG CO:::5TRUCTED.
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