HomeMy WebLinkAboutPermit Building 1991-2-28
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REQUEST
FOR:
-.
f TOWNSHIP
TEMPORARY MOBILE HOME RENEWAL
RANGE
SECTION
1/4 SECTION,
TAll LOT
SUBDIVISION I PARTITION
LOT I PARCEL BLOCK
1 7 (l~
LOCATION ADDRESll
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41
lnnn
i.s, !).fltl rrl.1lt"r
STRUCTURES NOW ON PROPERTY
SFD: Shedi TMH
PROPOSED USE SEPTIC INSTALLED
C:nrinrr-Fi~'r1 np
Q7/J77_ 1 -:<n?
WATER INSTALLED
NO. CW STORIES .
NO. CW EMPLOYEES
CON8TRUC~ COSTNALUE
R
DESCRlPTlON OF PROPOSED WORK
NO. CW IEDROOUS
qfTMHR 91-89
DIRECTIONS TO SlTE FROII COURTHC?USE
havden Bridae Wav to Wavside Looe to Ann Court
APPLICANT NAME .. ADDRESS
'Samuel BQQher
OWNERS NAME " ADDR~SS
PHONE
( s i t.e rlc'J(Jr)
74n-nQQ.i
PHONE
Same
CONTRACTOR NAME
OSR LICENSE ,
PHONE
~ MAIL PERMIT TO:
Samuel Booher
~ NAME
I have carefully read
Sam~Juel Booher
~ PRINT NAME
ADDRESS
J
(site addr)
BOTH sides of this application and hereby certify that all Information Is true and correct
By Mail 1/16/91
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Slgflllf1Jre
DATE
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.APPROVED BY: ~, ..d!'1. -./ . DA TE
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CALL FOR 'INSPECTi~NS:' (SEE"BAC~"'OF~M ;OR"~S~RUCT;O~S)~~~;';065 _.: ,~".;"'::.. -~~:.-
SEPTIC permits are good for one year. ALL other permits expire after 180 days unless Inspections are
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FEES, DUE:
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VIOLA nONS
SETBACKS AND 01lIIlR ~~...m .ONS OF APPROVAL MUST BB S1RIcn. Y OBSBRVBD. VIOLATION CAN RBSUL T IN REVOCATION OF TInS PBRMIT.
CITATIONS MAY BBISSUBD UNDBR nIB PROVISIONS OF LANB COUNTY'S INFRAcnON ORDINANCB AND/OR 01lIIlR RBMBDIBS AlLOWED BY LAW.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following information ready when you call: 687-4065
Permit number - Job address - Type of inspection required When it will be ready
Your name and phone number - Any special directions to the site
PUBLIC OFFICIAL RIGIIT TO TRESPASS ON PRIVATE PROPERTY ORS 215.080
POWBR TO BNTBR UPON LAND. nIB COMMISSION, AND ANY OF ITS MBMBERS, OFFlCBRS AND BMPLOYES, IN nIB PBRFORMANCB OF 1HEIR FUNcnONS, MAY
BNTBR UPON ANY LAND AND MAKE BXAMlNATlONS AND SURVBYS AND PLACB AND MAINTAIN nIB NBCBSSARY MONUMBNTS AND MARKERS THBRllON.
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND 1'il'lNG INSPECTION: To be made after all underground piping has been installed, prior to any backfill.
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 placed or floor sheathing installed, including the subfloor.
ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECTION: To be made after all plumbing rough-in is in place, prior to being covered.
FRAMING INSPECTION: 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 "1'1'''' ..ed.
INSULATION INSPECTION: To be made after all insulation and vapor barriers are in place, prior to covering.
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.
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 INSPECTION: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPECTION: To be made just prior to the building, structure or remodeled area being occupied.
FINAL BUILDING INSPECTION: To be made 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 "1'1'.vved 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 fOlmdation requirements for mobile homes or as recommended by the manufacturer.
Minimum fInished floor elevation shall be certified when required by Floodplain Management
Tiedowns, if required, shall be installed and ready for inspection 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 fIrst obtaining the
approval of the building official. Such "l"l".vval 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.
APPROVED PLANS MUST BE ON TIlE JOB SITE ^ T ALL TIMES DT,JRING WORKING HOURS.
THIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR'IF WORK IS'STOPPED OR ABANDONED FOR MORE TIlAN 180 DAYS.
SUSPENSION OR RE'(OCA 110N MAY OCCUR IF. TIlI~ PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMA TIO~.
'4NYONE PROCEE~ING PAST THE POINT OF REQUIRED ~SPECTIONS WILL DO SO AT THEIR OWN RISK.
Your signature on the front of this form verifies the following: I HA VE CAREFULLY EXAMINED TIllS COMPLETED APPLICATION, and do
hereby certify that all information hereon is true and correct, and that I have a legal interest in the property as owner of record or authorized agent. I
further certify that any and all 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 property, my registration with the Builders 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 permit holder shall notify th~ 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 pennit
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 property lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAIN FIELD
10'
10'
10'
100'
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MOBILE h,-"ME TEMPORARY PERMIT kc'NEWAL '
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APPLICANT
MAILING ADDRESS
1103224101000
TMH 009189
SAMUEL BOOHER
35 ANN CT.
SPRiNGfIElO, OR 91471
CITY, ZIP
l1wroililltt&Ubilliilli&i:mf:i:iirrili:itiiir::ii IN FORMA TION PRO VI D ED BY APPLICANT U::m'iru&r=/11rlli:'BiliiiUMbiiiid'Bill
1. WHO HAS A MEDICAL HARDSHIP? (NAME)' SA.L22.1/EL
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6. LIST THE FOllOWING MOBILE HOME INFORMATION IF KNOWN:
MAKE: jJ./LL(1.e~f7. YEAR:...L'1,f').. SIZE /4- X 6 q:
7. SIGNATURES -L..~ ; ~ 0 L
PERSON WITH HARDSHIP
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4. WHO LIVES IN THE MAIN DWELLING? (NAME) .sTct/e/y'~CJtJ#E/e ~':~~;" ~ ,:! Jj2
\\; ~.>" ~ 'd/ f.:
5. WHO LIVES IN THE TEMPORARY MOBilE HOME? (NAME) SJ;Jm~,t(~ AtJtP#t::?/8.. .~,.:: ~ - ^~
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L1CENSE# I< )( 17.3 ~d3
3. WHAT RELATION IS THE CARE-PROVIDER
TO THE PERSON WHO HAS THE HARDSHIP?
$1//0/
2, WHO IS PROVIDING CARE? (NAME)
..<)/ E//E/l/
ACJt!JHE.-e
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DATE
y'f~ Z ~AA--
., --P-ERSON PROVIDING CARE
1- r?'- 1'/
DATE
m:::::::::::::::::::::::;:;::iWl;;~:::;:::I:::::::::;:;:;:;:;:;o;::::!TIINFORMA TION PROVIDED BY PHYSICIAN OR THERAPIST ~:*:::::::::::::::::::::::::::::::::::::::?~;:~::::;:~:;:;:;:W:::ill:l
1. NAME OF PATIENT: ~f1 \IV! rA.-t I Pv-t"1 ~-p-r
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2. NATURE OF MEDICAL HARDSHiP:- t4 J;:l'/"AY'1~_~
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3. DOES THIS HARDSHIP NECESSITATE THAT A FAMilY _ _. "" .L
MEMBER PROVIDE CARE? PLEASE COMMENT: ~ Cvv\--r- 9 , f.A^
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4, PHYSICIAN'SSIGNATURE: , ~ (\olL(/)~_ VVtD
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MAILING ADDRESS: ,-f!)o!!p'as P. Jeffrev. M.D.
Jo~ I l.emellOlal Blvd
CITY, ZIP Sprlngfield, OR 97477
(;,Jf~ rlu\1v~
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DATE -1-,1 fj'
Lane ~ounty Land Management Division 125 E. 8th Ave. Eugene, OR 97401
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Lane County Authorization for:
TEMPORARY lImllE Ha.m RENEWAL
FOR OFFICE USE ONLY
Appl~cation/~ J_ ~~
Perrn~t # l-7/. If /
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RANGE
SECTION
17 03
SJBDIVISION/PARTITION (if applicable)
22
TAX LOT DOUT OF
41 1000
LOT/PARCEL BLOCK
PROPOSED USE OF PROPERTY
j}(] Residential 0 Indu'strial
o Commercial 0 Public.
LOCATION ADDRESS
STREET
CITY
ZIP
35
Ann Court
Springfield, OR
97477-1302
STRUCTURES CURRENTLY ON PROPERTY
SID: Shed; '!HI
DIRECTIONS TO SITE
Hayden Bridge Way to Wayside loop to Ann Court. (Ihvwuish-stained house)
~~SCRIPTION OF PROPOSED WORK - BE SPECIFIC
RcHwal of TMH # 211-87
= OF BEDROOMS # OF STORIES
DECLARED $ VALUE
# OF EMPLOYEES
3
O;vNER' S NAHE AND ADDRESS
1
o
public '.
~ Proposed
i71 Existing
TELEPHONE NUMBER
\-.JATER SUPPLY
Samuel & Vinrinia Booher
CONTRACTOR'S NAME AND OSR #
35 ~ Ann Court. Sorind'ield. OR
746-6993
TELEPHONE NUMBER
P~R}lIT TO BE MAILED TO (NAME AND ADDRESS)
Sarnual & Virginia Booher 35! Ann Court. Springfield, OR 97478-1302
-TELEPHONE NUMBER
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT, ar.d Jo hcre~y cettify that all infol"ffiation hereon is true and correct, and that I '
have the following legal interest in the property: [X)owner of record; 0 contrac:t- p1lrchaseri o authorized agent.
I f::rther certify that any and all work perfonned shall be done in accoldancf, with the Ordinances of Lane County and the Laws of the State of Oregon
Dining to the work described herein, and that NO OCCUPANCY will be made of a~y str'lcture without the permission of the Building Division. I fur-
, \~ertify that registration with the Builder's Board is in full force and effect as re~uired by ORS 701.055, that if 'exempt the basis for exemption
, '.6t"d 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.
Samuel & Virginia Booher
NAME (please print)
By mail
1/12/89
SIGNATURE
DATE
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION qAS BEEN BASED ON THE FOLLOWING CONDITIONS~
o PLANNING/ZONING: Zone
Partition #
Parcel #
Parcel Size
Minimum Setbacks: CL, front
CL, side
interior
rear
WHI CllliVlili <X>MES FIFSl'.
THIS l-'lilil'AIT IS VALID UNTIL JAN 1. 1991. OR UNTIL HA.tux>.tUP CEASES
Ilii 1/12189
Date:
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COMHENTS:
Installation
Specifications:
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COMHENTS: ,15/' /' /.\/ ,;,
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Gallon
Tank
Lineal Feet
of Drainfield
Installation Record Issued? DYes D No
Maximum Depth
of Trenches
o SANITATION: S. 1. #
B. P. #
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~ERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE/per ORS 456.805(1)) DATE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
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125 EAST 8TH AVENUE, EUGENE, OREGON 97401
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'NEW BLVG TYPE USE R BDRMS (> UNITS 001 STORIES ~BL~GS 001 PHONE 746 6993
OWNER' NM~ BOOHER, SAMUELADDR 35 ANN CT., SPRINGFIELD, OREGON
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE
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