HomeMy WebLinkAboutPermit Building 1996-4-17
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PERMIT #
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, REQUEST
FOR:
Septic System Repair
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"17 "'""03 ~2 """':T.2 ''''f'700''''''''''''''''''"'''''
LOT/PARCEL Il.OO(
LOCATICN ADDRESS
3382 Game Farm Rd., Springfield
97477
STRUCTURES NOW CN PROPERTY
House; Carport, Shed
-PMOPOSED USE ~c NST.-u.a> WATER MTAllED 110 Of STORES NO OF EMPlOYEES CONSmUCTICN <XlSTNALUE
Res. Yes Rainbow
-OE:5OlPTl:JIIOfPRCPCliEDWCHI; NOOfIlEDAC:ll::NS
Repair of existing sewage disposal system.
DIRECTIONS TO SITE FROM NEARCST MAIN HTERSEClll::W
Belt Line East deadends into Game Farm Road; turn right; third house
on right.
APPUCANT~E I.\ODREsS Rd., Springfield 97477
Walter W. Haxby, 3382 Game Farm
OWNERS NAME' ADDRESS Springfield
Walter W. Haxby, 3382 Game Farm Rd. , 97477
CCM"AACTOR/INSTAt.LE~8UILDER NAUE "".
,"ONE
726-7809
726-7809
PHONE
PHONE
'MAIL PERMIT TO:
Walter W. Haxby,
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I have carefully read BOTH
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3382 Game Farm Rd., Springfield
STREET
97477
OTY
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PRNT NAME
sides of th:BS ppllcatlon and~re~Lfertify JI1}11 all Informat~o Is trua and correct
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CAREFULL VI Vour Authorization Is Based On The Following Conditions
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DATE
CALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTIONS) 687-4065
SEPTIC permits ere good lor one year. ALL other permits expire alter 180 days unless Inspections are current.
LMD 040 Rov. 6192
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VIOLATIONS
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smBACXS AND OTHBR ...................~ OF APfROV ALMOST BB snucn. Y OBSERVBD. VIOLATION CANRBSULTtN RBVOCATlON opnns PERMrr.
'. CrrATlONS MAY DB ISSUPD UNDER. mB PROVISIONS OP I..ANB COUNTY'S INPRACI10N ORDINANCE AND/OR. onmR. RBMFDIBS ALLOWED BY LAW.
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A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following infonnation ready when you call: 687-4065
Permit number - Job address - Type of inspection requirad Wheii it Will be ready
Your name and phone number - Any special directions to the site
PUBLIC omClAL RlGlrI'TOTRESPASS ON PRIVATE PROPERTY ORS D5.0SO .
POWER TO BNTER UPON LA!\'D. nm COMMISSION, AND ANY OP rrs MEMBERS. OPPJCBR.S AND EMPLOYES, [N'mB PERPORMANCE OPnmIR.FL.._..~.,~, MAY
BNTBR UPON ANY LAND AND MAKE BXAMINATlONS AND SUR.VBYS AND PLACE AND MAINTAIN nm NBCBSSARY MONUMENTS AND MARKERS TI-mRBO~,
REQUIRED INSPECrIONS
FOUNDATION INSPECrION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPECrION: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECrION: To be made after all in-slab or under-floor building service equipmen~ condui~ piping
accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing installed. including the subfloor.
ROUGH MECHANICAL INSPECrION: To be made after all ducting and gas piping has been installed and prior to being cov"ered.
ROUGH PLUMBING INSPECrION: To be made after all plumbing rough-in is in place, prior to being covered.,
FRAMING INSPECrION: To be made after the all framing, fire blocking, bracing and roof are in place and all pipes. chimneys and vents are complete
and the rough electrical. plumbing, and mechanical inspections have been 'made and approved.
INSULATION INSPECrION: To be made after all insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECrION: To be made after a1lla1lting 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.
ADDITIONAL INSPECTIONS MAY BE REQUIRED, such as but not limited to;
BLOCK WALL: To be made after reinforcing is in place, but before any grout is poured. The inspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have been made and approved.
FINAL MECHANICAL INSPECrION: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPECrION: To be made just prior to the building, structure or remodeled area being occupied.
FINAL BUIlDING INSPECrION: To be mad" after finish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILE/MANUFACfURED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system, prior to covering sewer or water lines. for setback requirements, blocking, tiedowns and plumbing connections,
Footings and piers to comply with State fOWldation requirements for-mobile homes or as reconunended by the manufacturer.
Minimum fmished floor elevation shall be certified when required by Floodplain Management
Tiedowns. if required. shall be installed and ready for inspectinn within 30 days after occupancy. Tiedowns shall be installed per enclosure,
APPROVAL REQUIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without fl!st 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.
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APPROVED PLANS MUST BE'ON TIlE JOB'SITE AT ALL TIMES DURING WORKING HOURS,
TIllS PERMIT WIll EXPIRE IF WORK DOES NOT BEGIN WI1HlN 180 OA YS. OR IF WORK IS "vU<'-U OR ABANDONED FOR MORE TIlAN 180 DAYS,
SUSPENSION OR REVOCA nON MAY OCCUR IF TII~ PEIW!T '!liAS ISSUED,ON '!'HE BASIS O],INCO!di'LETB,OR ERRONEOIiS,INFORMATION,
. '-V .', ~~XP~~,~~,-OC~ED~.G \'~S: .!!I~"PJl~' O,F R~9~~D ~SPEcr:rrN.S JYILL,DO ~04 T .~~~Hl OWI'\ RISK",
Y our ~ignature on t)le front of this form verifies the foUo;"'ulg: I HA VB' CAREFULLY EXAM1NED THIS COMPLETED APPLICATION.: and do
hereby certify that all information hereon is true and correct. and that I have a legal interest in the ................../ as owner of record or authorized agent. I
further certify that any and aU work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per-
taining to the work described herein. I further certify that if I am not the owner of the r."r".~)' my registration with the Buil~rs Board is in full force
and effect as required by ORS 701.055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEW AGE DISPOSAL SYSTEMS:
When subsurface construction is complete. the pennit holder shall notify the County Land Management Division by submitting the installation record
form. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the permit
holder. If construction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. Failure to meet satisfactory completion within the allotted time constitutes a violation of ORS 454,605 to 454.745 and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior Y'_Y_ ',' lines 10'
Edge of road right-of-way to'
Building foundation 5'
Wells or other water sources SO'
DRAINFIELD
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SEW AGE DISPOSAL
PLAN APPR9'1V::~'
pennit# //", IV.
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ENVI 125 EAST 8TH AVENUE
EUGENE. OR 97401
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REQUEST f:OlfASSISTANCE
LAND MANAGEMENT DIVISION 125 Eo 8TH AVE;, EUGENE. OR 87401
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Please complete all lines Inside white boxes, If possible
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You. ~~([.!l. Q flme ~ f} r /1/ I2d
Your AOdress I
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Owner 01 Parcel (if not lame as atlove)
Owner Mdrelll (II nOl nine as above)
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In5taller/ljUllder/l.:onlractor
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Zip
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Request for:
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MAP, PARCEL NUMSER
(Foutd on IIU ~ in.. II . Tuadon Dep()
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t..Lot
10"""" ~ MCUon -ll4l1KUon I all Lot
IOWlWoNp "IIiniii""" BecUon -114 8KUon IU ut
Site IkId~s
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Directions to site from
nearest main InfeIWect/on
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..c::.... Shed
SEPTIC INST ALlED1
_Yes
_No
/J Water Dislricl
,114/~~Y
91 {,/7 7
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Mail Permit 'Jb: I I For 1II0blle Home /
/ 1/ D. L +e \r uJ. N f.J K. bu ~menf Only
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'nrs v.ritJed ".,.'.. Y..E3NO Di(iPilitltloiil,SUbilNfjlOrii.. LOt a S/ode .
Allowed u..;?y.. NoDii'(":;(;'::: "",' (WalBr sew oue
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LMD staff can NOT be held
responsible for evaluatlons or
recommendations based on
faile, Inaccurate or Incom-
plete Information.
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. :~: :3 L.ANE COUNTY DEPT ENV MGT F(ECEIPT ~ 11 <,496 DATE 041 J.
"~~il.AL~P~~C0~~~.~A0'X1~Y00: WAL.TER ADDR 3382 GAME FARM, RD., SPRINGFIELD ,J.
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. NEW BI...DG TYPE UST F! rmm1S 0 U~nTS 001 STORIES '~BL.DGS 001 PHONE 726 78('.~
OWNER NME HAXBY, WAL.TER ADDR 3382 GAME FARM RD., SPRINGFIELD .
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VAL.UATION FEE DhYSa
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. F'CI< PLAN CHECK FEE 2~:>/~ .
SDS L.C 11649b SDSR j b5.00
SDEfJ FE:I:. SD;;'F( 30.0()
. ADM FEE 29 .. 2~5 .
TECH FE:E: 5.00
. CATG: PLN F!A SDS ELE PCI< ISS / SI DTR .
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TI\I<EN BY ML.C EST. COMPL.ETION DATE DEPOSIT ,** 229 .. 2~5 CI<
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. W: 3 LANE COUNTY DEPT ENV MGT RECEIPT ~ 116496 DATE 0413.~
9Htii APPLICANT HAXBY, WALTER ADDR 3382 GAME FARM RD., SPRINGFIELD I~g~
.TL~ 1703221201700 SUBDIV LOT BLK-
." NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES .:J;BLDGS 001 PHONE 726 780.:
OWNER NME HAXBY. WALTER ADDR 3382 GAME FARM RD., SPRINGFIELD ~
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAYS
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STATE SURCHARGE 5:Y.
PLAN CHECK FEE 25:>':
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30.00
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5.00
ELE PCK ISS I SI OTR
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COMPLETION DATE DEPOSIT ** 229.25
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FEE SDSR
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