HomeMy WebLinkAboutPermit Mechanical 1982-2-5 (2)
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I HAVE CAREFULLY EXAMINED THE, COMPLETED APPLICATION ~ PERMIT, and do hcrchy certify that all i.nfor.mation hereon is true und cor.rcct and I further
certi.fy that any and all work performed shall be 'd~ne in accordance with the Ordir'lances of Lane County an? the La\oJS of the SUite of Ore~nn pcr-Lailli IV!
to the work described h.~rein,.. and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further cpr-tiCl'
that, registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted
hereon, and that only subcontractors ,and employees who are in compliance with ORS 701.055 will be used on this project. I HAVE .READ AND CHECKED THIS
APPLICATION THOROUGHLY. .
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o PLANNING/ZONING: 'zon~~artition ii ;f'~parcel # ~ Parcel SizE' ~~~
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In flood hazard area? 0 No 0 Yes, see attached sheet. Date: / / D
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@NSTRUCTION/PLACEMENT
PERMIT 1f!t1 . t-J
COMPLETE THIS BLOCK.
PLEASE USE BLACK INK AND PRINT.
Ll T /$; xS/Jd
~
NAME (piease print)
SIGNA~URE
o
o
o
FLOODPLAIN:
GRJ;D COORDINATE
RURAL ADDRESSING:
N. .
" E
SANITATION:
FOR OFFICE USE ONLY
APPlicatikY,1') _ C7 _
Permlt #10 U 0 ~
[]TWO Copies' of Plans
D T"';~ Copies of Plot Plans
DMechanical Checklist
Dplumbing Che~klist
Dplan Check Info Sheet
PROPOSED USE OF,P'ROP,ERTY
~Residential ,[]Industrial
'0 COllU1\ercial DPublic
$ VALUE
~./ '0 -
, 0 Owner
~ ~n,tractor
o Agent
DATE
Installation
Specifications:
Gallon
Tank
Lineal Feet
of Drainfield
Installation Record Issued? [J Yes 0 No
Date:
S. 1. #
B. ,P. #
Conunents:
Maximum Depth
of Trenches,
D
)V(PLANS EXAMINATION: Type &)N Group (2.--=s use'WfJ/JO, S""'/L~,
J\ - . 'lILY' LI Ll182~
conunents:~~ .!~_ ~nwO ~~ 1. te"QPc:..-tt.:\L FtecRk.p, '131~
SttfML ~ U.~ B<k:rLLf t\) kr t:(lOPrNcE
~nP\CATirns~ Date: ~---~-f'2-. ~
Date:
CONSTRUCTION AUTHORIZED BY THIS PERMIT
C74-194
SEE REVERSE
By:
SETBACKS AND OTHER CONDITIONS Of APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF THIS PERMIT,
CITATION UNDER PROVISIONS OF LANE COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER REMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION CALL 687-4065. A MINIMUM OF AT LEAST 24 HOUR ADVANCE NOTICE FOR INSPECTION REQUEST 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.
BUILDING DIVISION:
REQUIRED INSPECTIONS
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 "transit mixed") 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 electrical and plumbing are approved. All
wall insulation 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 in 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 masonry (if applicable) and when installatio~ is comolete.
Installation shall be in accordance with an approved nationally recognized testlng agency and 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)
(~)
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 at 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
i sin s ta 11 ed .
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING 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
PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT HIS OWN RISK
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS
(1 )
(2)
Permits shall be effective for one year from the date of issuance,
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 ~he constructlon ~o
determine if it complies with the rules contained in this division. If the constructlon does comply ~Ilth
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 befor'e issuing the certificate. Failure to meet the requ,irements for satisfactory
completion within a reasonable time constitutes a violation of ORS 454.605 to 454.745 and this rule.
Setbacks - Subsurface SewaQe Disposal
From: Interior property lines
Edge of road right-of-way
Building foundation
Wells, other water sources
Septic Tank
10'
10'
5'
50'
Drainfield
10'
10'
10'
1 DO'
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PLANNJNG'~'&:: .COMMUNI TV DEVELOPME
ACTIVITY INFORMATION
SHEET
~ne county
.-
;~:;IS
\-/1 ()
SECTION. INCOMPLETE FORMS WILL BE REJE~TED!
~~
PERSON MAKING RE9ytST
PROPERTY OWNER
MAILING AIDDRESS
MAILING ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
BUSINESS TELEPHONE NUMBER
HOME TELEPHONE NUMBER
BUSINESS TELEPHONE NUMBER
HOME TELEPHONE NUMBER
Q) TAX MAP/PROPERTY DESCRIPTI07N ~BER (from tax map's in Department of Assessment,.)}1axation
Hap & Parcel Number: . f ~<-3, 53,!! Tax Lot(s): /VV
Townshl.p Range Section
or from tax statement) :
o Out of TL #
By Partition #
Tax Map & Parcel Number of Adjoining Property in Same Ownership:
Tax Lot(s):
Township Range
o None
Section
o Unknown
@ REQUEST (briofly dO"';;;;;;;200
~ ZZ~/- g;) :;?J~Vli4 /) )
C~~ ~)
Q) SUBDIVISION (if applicable):
COMPLETE' THIS SECTION FOR LAND USE,
cONSTRUCTION APPLICATIONS, OR PROPOSALS. SEE *NOTE BELOW.
~*FOR STAFF USE ONLY**
~
:?/ ~ rn
TIME INITIATED: !.QD
DATE:
<D TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: acres
NUMBER:
Q) PROPERTY ADDRESS:
Q) PRESENT USE OF PROPERTY:
'CHECKED BY: .~
J
Garage Shop
Barn
ATTACHED EXHIBITS: '
o Plot Plans (2)
o Constr. Plans (2)
o Si te Plan
o Copy of Tax Map
Dother
QD NUMBER OF STRUCTURES ON PROPERTY:. Standard home
Mobile home
Modular home
RV in use as residence
Storage
Other (specify)
@ ACCESS TO PROPERTY: Public Road Name
SCREENING VERIFICATION:
P2ivate Road Name
By:
Road Easement
Width
# of
Users
Date:
@ OTHER EASEHENTS OVER PROPERTY:
Time In:
Out:
(j) \~ATER DISTRICT:
@ FIRE DISTRICT:
o Accept OReject
9/81 REV
( OVER)
Routed to:
*NOTE: ATTACH A COPY OF
TAX MAP; SHOW EXISTING
STRUCTURES AND TAX LOTS
IN YOUR OI'iNERSHIP. OB-
TAIN TAX MAP IN SELF
HELP AREA OF A & '1'.
,
@ PENDING. PER!UTS ON PROPERTY:
i'\
:COMPLETE THIS SECTION FOR LAND UC"'~ OR CONSTRUCTJ;ON'';:t>PrLI<;ATl;QNS'"
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@ PROPOSED USE OF PROPERTY IN DETAiL:'
~ BUILDING REQUESTS:
Contractor's #
Directions to Site:
(for ~obile home setup also)
Check the type 'of permit requested:
D Dwelling: D New
D Addi tion
D Modular Home
DRV
D Plan Check Only
D Conunercial: Use
D Agr icul tural: Use
D Others: Use
D Change of Use ---How?
Q) NUMBER OF BEDROOMS
D Replacement
D Alteration;
D Mobile Home - Model
D Standard Construction;
D Addi tional;
Year
Floor j\rea
'''!''.'
Floor Area
NUMBER OF STORIES
Q) SANITATION REQUESTS:
D Site evaluation for SDS feasibility
o New system' installation
D Repair/replacement
o Al tera tion/re location
o Hook to existing
ADDITIONAL INFORMATION:
**FOR S,~AfF USE~0NLY**
ZONE/LAND USE:
By:
Dat'e:
Time In:
.Jut:
D Accept.
D Reject
o Planning Ap?lication
q Construction Permit App.
D Informatic:m Only
Zoning:
Compo Plan Designation:
SANITATION:
By:
Date:
Time In:
Out:
[J Accept
D Rejec~
P Constr. Permi"t Iss'ue
D Site Evaluation Issue
PERMIT ISSUED (SAME DAY ONLY):
. Permit fr
By:
Date:
Time In:
,Ou,t:
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