HomeMy WebLinkAboutPermit Building 1978-6-29
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JOB LOCATION
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LANE COUNTY PERMIT
Acreage or Lot Si70
Contractor's O.S. #
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Partition i ng #
) Co mp leted
Subdivision
Lot
Bloc"
APPLICANT'S NAME AND ADDRESS_
OWNER'S NAME AND ADDRESC:
CONTRACTOR'S NAME AND ADDRESC:
Mail permit to ('; ) Applicant ( ) Owner
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) Contractor.
) Prefer to pick up. Call
Phono
Phono
Phon'o
(owner, etc,) when ready.
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. STRUCTURES NOW ON THE PROPERTY
.HIS PERMIT IS FOR I~):.:l.',-' f':r':J :'::c', - ('-Hi~2c:"l,h, !'--n~[>ll n<:OR1'" r1\7RI:",C
WATER SUPPLY ;',,1rC~.:c, 1'.-:>11 SEWAGE DISPOSAl
# BEDROOM" (,
.
# PLUMBING CONNECTION&......-
Pr;1.:n~r-{l r::l-:r:ic C'.!'\7i!':
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THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
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,PLUMBING BY ::0-:::;;] :i:-:-':-c:.
"I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: _owner of record;
contract purchaser; _ potential buyer; _ realtor or agent, I further certify that (if not the owner) I am authorized to act for the owner of
record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit.
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Fee Paid :l: ~ Signature ' ' Dato ,- - '. .
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) NEW ADDRESS ) FACILITY PERMIT TO TRANSPORTATION DEPT. ( - ) SPECIAL PMT, AREA. MIN, ELEVATION:
.
.mments:
Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
BUILDING ~II.I." (,1''1,:,:''1.,,<,'
- #' f\i~ 'U'~jJ.J J. Q
, Type of onstructlon '
. 'Ise Classification
S':;;Z{IAl
"'roup
PERMiT ~.~=l~
Fire Zone
SANITATION
Comments: ./~;':~.I
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By: _< Date:
PLANNING REQUIREMENTS SATISFIED. By:
ZONE: '-"<;, SETBACKS: FRONT
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By:
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Date: 6/ !:J/itJ
(F ROM CIL)
Date: t'
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Date Issued: "h;--~ )'/,:: ?-
INT, SIDE YARD .:>' REAR ';:)' (FROM PIL)
':'; SIDE FACING STREET
,
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE" EUGENE, OREGON 97401
POST THIS PERMIT ON MAIN BUILDING AT SITE
PHONE: 687-4394
C55-13
BLDG. PERMIT - WHITE: BUILDING"": GREEN; PLUMBING - CANARY: SANITATION - GOLDENROD; OFFICE COpy - WHITE
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SLAB FLOOR
PLUMBING GROUNDWORK
ApP'ROVED C1 DISAPPROVED C1 DATE
REMARKS
GAS PIPING GROUNDWORK
ApPROVED C1 DISAPPROVED C1 DATE
REMARK S
ROUGH PLUMBING
ApPROVED C1 DISAPPROVED C1 DATE
REMARKS
ROUGH GAS PIP I NG
ApPROVED C1 DISAPPROVED C1 DATE
REMARK 5
.
.
INSPECTOR
INSPECTOR
INSPECTOR
INSPECTOR
FINAL PLUMBING
ApPROVED /j..// O'SAPPROVED C1 DATE 3 -';;/-1;; INSPECTOR
,REMARKS J1L il e N' / A/ <: dK'
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c;:'# J aT I 1Vt' f1h' I -:ls-- :, 11 "'-
FINAL GAS PIPING
A~PROVED C1 DISAPPROVED / / DATE
REMARKS
C~RTIFICATE OF OCCUPANCY
READY TO ISSUE C1 NOT READY TO ISSUE / / DATE
REMARKS
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INSPECTOR
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INSPECTOR
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JOB LOCATION
L.ANE COUNTY PERMIT
Acreage or Lot Si70
Contractor's O.S. #
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Partitioning #
) Completed
Subdivision
Lot
Bloc'"
APPLICANT'S NAME AND ADORE'''' .b~,:v ~':~'v -.~ ~ ?,:~.;;~ I "--C-'J ,,"'", ' """~ ::"1
OWNER'S NAME AND ADDRES~ c,' "
CONTRACTOR'S NAME AND ADDRESS
Mail permit to (:..: ) Applicant ( ) Owner ) Contractor. ) Prefer to pick up. Call
0'it'.,,: Phone
Phono
Phon.
(owner, etc,) when ready.
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# BEDROOMS--,,-# PLUMBING CONNECTI;~5-........
WATER SUPPLY
THIS PROPERTY IS WITHIN ONE MILE OF THE CITY OF
. '. _..~. '-"~'.-' <^-1
SEWAGE DISPOSAl .~"~~,' ~..~,,~~ ~....-,
S,I. #
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PLUMBING BY ::',"2'07 ::'...
t I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: _owner of record;
contract purchaser; _ potential buyer; _ realtor or agent I further certify that (if not the owner) I am authorized to act for the owner of
, record, and that said owner is aware and approves of this action. I hereby agree to comply with all applicable Codes relating to this permit,
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(' ) SPECIAL PMT, AREA, MIN, ELEVATION:
Fee Paid ~
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...Signaturo
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) NEW ADDRESS (
) FACILITY PERMIT TO TRANSPORTATION DEPT,
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B~~~DING UiNF, WU~mi ~!"':;{J~L prD~UIi' ~ i1"<""
,:It'" ,Type of Construction 'J - '. r,1"0\;~'" "1"e'Zone --,~
n ",".r 'Ise Classification
Comments: /'1/// /'-~I...t.,VI, r)...- 1".:11/1:1" /./';- .
SANITATION
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Minimum Septic Tank Capacity (Gallons)
Drainfield Required - Lineal Feet
Maximum Depth
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'.omments:
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By' ---- 0 Date''/ JV ~-:7 By', "'./ '::7......" ,,-! Date'. / /' _, .,.r
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PLANNING REQUIREMENTS SATISFIED. By: '. " "") Date: ::0/~::,n:1 Date Issued: ,~/~;;/-;J ,:
ZONE: ;'d:. SETBACKS: FRONT C'" SIDE FACING STREET (FROM C/L) INT, SIDE YARD ~.'3' REAR";:",:: -(FROM P/L)
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT, 125 EAST 8TH AVE" EUGENE, OREGON 97401 PHONE: 687-4394
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C55-13
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POST THIS PERMIT ON MAIN BUILDING AT SITE
BLDG. PERMIT - WHITE, BUILDING - GREEN, PLUMBING --.: CANARY; SANITATION - GOLDENROD, OFFICE COpy - WHITE
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SITE 'I NSPECTI ON
ApPROVED Cl
DISAPPROVED
REMARKS
FOUNDATION INSPECTION
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REMARKS
FRAMING INSPECTION
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ApPROVEO / I DISAPPROVEO Cl OAT,E
REMARK 5
LATH OR SHEETROCK INSPECTION
ApPROVED ~
DISAPPROVED
REMARK 5
FINAL INSPECTION
ApPROVEO d DISAPPRovEo
REMARKS
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CERTIFICATE OF OCCUPANCY
READY TO ISSUE Cl NOT REAOr TO ISSUE I / DATE
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Plat Plan
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Job Location (Street, mile post)
Subdivision,
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Lot
Block
FOR SANITARIAN'S USE ON L Y: I&l ~~e;: Approved, 0 Sys~jm Disapproved
COMMENTS: [,,"YO ~S ;n/h,'het'
Signature: ffi Date.7h ~
FOR INSTALLER'S USE: Trench Depth =?,,' N Filler Depth Below Tile _I'::. N
Tank Capacity / f')C) n Manufacturp' "EwG eN<!? S'c, A/d
Measured distance to well from tank _5,"\0 " from 'd~~infieli'l-.,ij/ t? "
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INST~LLATION REC~RD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat-
isfactory completion of a subsurface sewage disposal system at the above location.
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Return this form to: Permit Processing Section, Department of Environmental Management,
Public Service Building, 125 East 8th Avenue, Eugene 97401
C55-11
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SA"'ITAT~_G(M"""'l""l~
Cc;:::r";;::-;=:1 r: ~ with uniform building code and county rogu!oticma
~rt::J [:~n::~!7t\:'J and wwogo dispo,al. All bui:ding, requiro a certificat:l
'c1 =~ ~ro ho1r.a c<cupiad,
(:00 Slatomon' on Royers<> S;de)
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3174 '"" c- .,UEST FOR SITE FEAS IB ILlTY STUDY .
~~~ ~~i~ce ~ \~.:;s 36--/502A- \~\Qc::.... Yes
Received b Code C.T. Number Soecia ermit Area Urbanizina Area
THIS IS A PRELIMINARY EPDRT WHICH DOES NOT INSURE THE IS ANCE OF A FUTURE BUILOING PERMIT.
PLANS OR EXPENDITURES M E IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK.
PLEASE PRINT
S.I.# ~~1~
1/ No
If Subdivision - Name:
-<
Lot # I
Block # ~I
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'It
Seller
Realtor
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-~::";fP";:':~:f''" Co, ~.
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Mail ing Addr~s
;:-Jf\-ot~" >r\l;./d '17</-77_
21/7 -'N::,-'f c; ~,tp~ f ~~,61--/.;,~:r /'
Telephone #~~gnatur~ican~ )fD~tf;- Owner v'
Proposed Use "--"- Appl icant's In erest Buyer
of Property: '-- ~ ''''-~ in Property: ther (Specify):
IS- a..cn::> G~..rlH A,,~. ~ .;!oo.taoo AR~:KA <fs-kb\~:>
Property Size Legal Access - Road Name Existing Structure~ on Property
I
Proposed Water Supply
Publ ic .,' Ois'trict:
Spring ------ W~)l t:::-- Other (Specify):
il
Owner of Property
YesV"' No
Owner 1 5 Consent
No. of Sites
oQ--l:'~
$ c-Y...""""
No. of Acres
I~
$
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$~
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Property Location (Directions): "'\n">pl'.... 1?J -4-37-~ 1-
1-.6. U l- '<:. J to 1/ coJ +0 c.1"\ d
Is Property Within One Mile of
Ves What City?
No ~
City?
fu I'll 5oo..-th
Dn
When Will Test Holes Be Ready? Mal./.:2.1 '- /~.\. \.~~>-.~ ~
MARK TEST HOLES WITH OUR FLAGS -rro;lteJ /-
Location of Test Holes on Property: ~
Draw diagram of property showing location of any I~Ga 'K~OOa?:~/lJd reluatior~. p of test holes to
these landmarks: ~ ~
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MAKE CHECK PAYABLE TO: ENVIRONMENTAL
MAIL TO: LANE COUNTY DEPARTMENT OF ENV
CSS-S5
135
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REFUND
o F
FEE
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THE LANE :COUNTY DEPARTMENT OF ENV IRONMENT AL MGT. r HAV I NG REQUESTED RErUND_
OF FEE TO:- '.
Bcvcrl y Partri,d'!c
NAME
OF
Rf'l11rA 1 u,,~ Lt'n_'D ". H,__r'_~ .
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ADDRESS
ApPLICATION FOR BUILDING PERMIT DENIED, AND NO APPEAL or SUCH DENIAL
HAVING BEEN MADE.
ApPLICATION FOR BUILDING PERMIT CANCELED.
APPLICATION FOR BUILDING PERMIT, OVERPAYMENT.
ZONING PETITION.
ApPLICATlnN FOR RESTAURANT LICENSE.
ApPLICATION'FOR CERTIFICATE nF SANITATION.
APPLICATION FOR PRELIMINARY SITE INS~ECTION.
FOR THE ,OLLOWING REASON:
CC.nce:'lcd ap')licc.ni...' 3 :ccque'.it ~lr:'v:;:, to ~.roc~.
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ful: re:und C( tec~
\
AND TH~ APPLICANT DESIRING THAT THE FEE BE REFUNDED, THE DIREC'~R ~F FINANCE
AND AUDITING IS REQUESTED TO REFUND THE AMOUNT 0, $ 25.0C , (UNDER APPLICATION
NUMBER 75-:;5 IN THE CASE OF APPLICATION FnR' BUILDING PERMIT), WHICH IS THE
YEE CHARGED.
DATE "
june 5. ',975
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\':at~r POllution Concrol :Jiv" s ',en
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55-029-12
CK I D By~;T az.z.J-z<.,.-
6. Setback~~' ell of road:
Front
Side Exteri or
Setbacks from interior lines:
Side
Rear
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BUILDING SITE EVALUATION . ~S/{ ++
() ~ILbiNG PERMIT APPLICATION NO. 15-375'
(~ITE INSPECTION
1.
2.
3.
4.
5.
Not
Applicable
Zoning Ordinance Compliance: Zone ~~ ( )
Subdivision Ordinance Compliance ( )
Required Access ( )
Building 5ite (Area, Width, Frontage) ()
Other (see comments) ( )
PLANNING DIVISION
COMMENTS:
Af?t?i""Odftt- (,)F- A ~C'fJO.
~()R 7D I, (', I/tn. k-E ~,r:=
T 1J?A 0"" S 6 . ~'4AX LOT 5t)U
S~:
LOT: BLOCK:
Fhr+M~~
APPL I CANT
DATE
No Yes
() TI
( ) ( )
( ) ( )
( ~ ( )
YJ ( )
PLANNING DIVISION ACTION -P~NDING:-YE5(}- NOr} AppDCATlON#
BUILDING INSPECTION DIVISION
Not
Aoolicable
( )
( )
( )
( )
7. Plans Submitted
8. Soil Stability (footings)
9. Flood Plain
10. Other (see comments)
COMMENTS:
WATER POLUTION CONTROL
Not
Aool icable
( )
( )
11. Meets Oepartment of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
No Yes
() TI
( ) ( )
( ) ( )
( ) ( )
CK'D BY:
DATE
No Yes
()TI
( ) ( )
fJrf~-~e,,"-
CK'D BY:
DATE
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TO APPLICANT:
Your Building I Site Inspection:
( ) Can be approved.
( ) Cannot be approved at this time as indicated on item NO. above.
Questions and further information on items 1 through 6 contact the LANE-
COUNTY PLANNING DIVISION. Questions and further information on items 7
through 12 contact the LANE COUNTY BUILOING AND SANITATION DIVISION.
( ) Will be held in this office until you can resolve the problems indicated.
( ) Is being returned.
( ) Your building permit appl ication fee Is being,g,turn!l.d under seoarate cover.
DEPARTMENT OF t:NVIRONMENTAL MArll\liEMt:NI
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55-28
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, MIi~On ::;uoJ rO~,THE PUR?O"r.
IT IS {\:O" DI\:I",(:I'I" p",""~' ."" OF
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Surname Twp. Range Section Tax Lot Cbde Census Tract
Receipt No. Date I Owner Owners Consent
Yes No
REQUEST FOR SITE FEASIBILITY STUDY
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK:
; ',' r
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','
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$ ~
No. Sites
$
No. Acres
TOTAL $
Name ,'Ii ,.,', .r
and
Addres~ . I " ,. ~r
Telephone No.
'Applicants Interest
_~r_=,.
in Property I ProPo,':d Use of Property
Name Ispecial Permit Area I Urbanizing
.' Yes No Yes No
Is Property Within One Mile of a City?
What C i tv? Yes No
Other
Soecifv
Area
....1..3.:
Property Size
Legal Access - Road
Existing Structures
, ,
Proposed Water Supply
Pub! ic District
50rinq
Well
Propertv Location:
(Directions)
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APPROVED
NOT APPROVED
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BEFORE CONSTRUCTION IS STARTED bring this form to the Department of Environmental
Management and make application for a building permit. If the property is a por-
tion only of a tax lot, a metes and bounds description of the parcel must be fur-
nished. Exact specifications for the sewage disposal system will appear on the
building permit. Two sets of building plans and a plot plan will be-required.
I .
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Authorized Signature
LANE COUNTY DEPT. OF ENVIRONMENTAL MANAGEMENT
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
'-,
C55-32
Date
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