HomeMy WebLinkAboutPermit Mechanical 1984-1-20
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Lane County Authorization for: Appl~cationu'''''7 ~ c/../L
Perml.t # /CX" /- 6 T
A ~orh(1rn tC'n L ) 1~'JLrYVt- ) DTWO Copies of Plans
~~ D Three Copies of Plot Plans
- TOWNSHIP RANGE6 SECTION TAX LOT DOUT OF - DMech/Plumbing Checklist
'STaAl' 3 20 zoo D Legal Interest Document
SJBDIVl~T~n I(~f apPh~l(LhJ 0, , I L~RCEL I ~K D Plan Che~k Info Sheet
~:...r A~SS ~~I- .-r"' ~ q~f;';~ZI PROPOSED USE OF PROPERTY
J-tI'J ~\j \0 ~ to) Ln'J c7/~ ::::J ~Side_ntial D Industrial
5~RUC URES~N Y OPERT ~ ~l a l D Commercial D Public
. i~"rttJ;nO') daM, 1r'@6IYn'R.~mo1lL-ing~J
(121 ,An (:(1rr.o/i%:inn ~), ~".:\ q
U~ItIPo~r~ W~~llPEC)IC '~Q}o~ '~ 9-ta m'c& ~ ~h1il ( $ VALUE ,
=- OF '"'B~OO~ # OF ST~S - " ' # OF, EMPLOYEES W R SUPOC,' .......... J Q I LJ Proposed
C) v(Q . u ru. -/ .n ('jyU2 J JXLo 1ny; _ Y\I e-~1J Existing
I (i1tl ~D~a fuAQ025 i2rlLYl'1~2i, / -h ~to ~ ,~~6C)
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMIT, and do hereby certify that ~ information hereon lS true and correct, and that I :
have the following legal interest ~n the property: []owner of ecord; []contract purChaser;~uthorized agent with eVldence of authorlty attached.
I f:....rther certlfy that any and all work performed shall be don \,n accordance i the Ordinances of Lane County and the Laws of the State of Oregon I
;pertaining to the work described herein, and that NO OCCUPANCY ill be made of n structure without the permission of the Building Division. I fur- ;
ther certify that registration with the Builder's Board is in fu -'force and ~,c as required by ORS 701.055, that if exempt the basls for exemptlon
is noted hereon. and that only subcontractors and employees who a ~ complla e~ ORS 701'~ 5 wlll be used on thlS proJect. I HAVE READ AND
'CH:CKB;~;;TIONTHrr/~ VEe, ~~ ~ " ' ~\-\lt?-~4-
, ........ NAME (please print) , ~~\ J~NAT '\ DATE
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS .~~ BASED ON '~E ~O~~WING CONDITIONS!
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FOR OFFICE USE ONLY
[] PLANNING/ZONING:
Zone
Partition #
Parcel #
Parcel Size
:::::,~p"~;;'i7n gg-~w rrd-r;ti0rr1 ~ I
Dat:,:Min /0/5\ C1J)
[] FLOODPLAIN: In flood hazard area? D No DYes, SEE ATTACHED SHEET. DateD -~ ~, '-rl'
o SANITATION: S. 1. #
Installation
Specifications:
Gallon
Tank
Lineal Feet
of Drainfield
Installation Record Issued? DYes D No
Maximum Depth
of Trenches
B. P. #
cmlHENTS :
Date:
n
~PLANS EXAMINATION: Type ,...,
COHNENTS: ~ltJ AL/.....abO
Group e~
(A! AP/Ju.~ U~i./1
use~J'\ '
~fAU/tiZ-~ I~W,
Date: \ -~P/8!f D
TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PERMIT
~~Dn}~)
Sq. Ft.
Fixed Fee/ Floodplain Fee $
Unit Cost Subsurface Fees $
Building E'ee $
r,12Ch/P 1mbg Fee $ 3/~
plans Check Fee $ ~ 10:>
.;..---
S ta te Surcharge $ (,.lC . 2-Y
i
DEQ Surcharge $ /-
TOTAL FEE $$ 6~ ,=3 7'
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (per ORS 45f\1~~
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- JjA TE
LANE COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
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SETBACKS AND, OTHER CONDITIONS OF APPROVAL MUST BE' S1'RICTLY'OBSERVED-; VIOLATION CAN RESULT' IN REYO-
CATION OF THIS PERMIT, CITATION UNDER PROVISIONS OpTLANE COUNTY I S INFRACTIoN, ORDINANCE;" AND/OR OTHER., ..
REMEDIES 'ALLOWED BY LAW. ," !" " :~ ' ' , _ _', ,~' ' " - , ' -'-:.:.J,' . _ ;;:' .:
WHEN READY FOR ,~~~P~S:TION, CALL 6 87'-~4'O'6 5..-- h(MINI!:-W!1 'OP" AT +.-E'AST 24 HOURS ADVANCE 'NOTICE FOR INSPEC.,. ~< '
TION REQUESTS MUS'!' tit: GIVEN. Have', the .followihg ,info.r:mat,ion 't,eady,:- pel'mit number',- jqbaddres~, type,'..
of inspection, when it will be ready, your name"and'phone,n}lmber" ana,any spec::ial<di~ectioris tc! sit~",'
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BUILDING, DIVISION: "
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REQ U I RE Di NS PECTI:ONS-:";,
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1. Founda'tion Inspection: To ~e-~ade ~~a~i,' ~tr'ench~s, a're;'le),;~~Va tea. ana; fcirms er~c;ted and when ,all',
" materia,~~, for th~ f?u.n?a~icin ,:re ~eli\"e~~d-'qn the .\JOb.' . wh~r~- c,on'cre'te "from' acentr'a~' m1'xi~'g- ,
plant :(commonly termed "trans,l. t 'ml.xedl') 'lS to beused',;,materl.als need not be on ,the Job. ' I
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.2. Concrete Slab or Under-Floor, Insp'e}tion ll'''' To, be', made Cj,fteJ; all'in-slab or. unde'r-floor bui'lding"
serviceeHuipment, condqit, pip;i.ng i:'l~c.es~o:bes" ansl'6the'r :ancillaryequ~plne?t items are ,in ,;,' ,
L" ):lac:e b_ljt~,befcir'e ,any con'cre.te i-s.'potired', Dr,'floor shea'ff1:i:n'g ili~'talIe-d, includingtlje subf-roor'. ., J _~,',~
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3'~'~' Fra~irlg, ,~>,insula~tion In~;~c:tions.:;~. !I'obe"ma:~e' aft'~/:the 100(, all jrarp.il}g ;hf,ire' bJ,.oqJ~ih9', _ in~',_'
',-'bl'a8in,?:,at,e i in"-?l~ce,,, an? al.l pipes.' f irep,lac;e.s, sh~mney~, ..add" ven ts are c,?mr;,let~ ,:pd all ~r,o~g~
'electrl.ca-l, 'and plumbl.ng are, a8proved,/, All 'wal,l ~l.nsulatl.on and tvapor barr,l.erL.are l.n 'place'. 'f
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4. "La t'h' and/or' Gypsum Board Inspection: To be made at.ter a'H-'::la tl)ing ..'and gyp~'um:' b~a~d,' inted..or',
"'and' exte.rior, is in place 'but before any plastering 'i.s .app:].ied and"J;>e'fore gypsum, board join't's..' ,
ana ~fasteners are taped arid finished. -. ~ -, ..,..,.~ ..' J ..'.. J, ., -~, >' '..
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5.' Final Inspection:, To be made' a(ter the building iscomplete"a:,n? pefore qccupancy,.
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APPROVAL REQUIRED. No work shall be d'one on any/part, of the, building or' structure beyond the point,
indicate~'iri'ea6h successtve inspection'witho~t;~ir~t obtaihing the approval of the building official.
Such approval '"shall b~ given only a~'ter an,inspectibn shal'l have been made of' each suc~essive st'ep :,,'
in the construction as indicated by each of the' inspections' required. .,
.!'WTE: _~p, /b'(iiding ~ermits requi~e/inspecti~r/~ fpr;'the Y'c{~k authord'e~..; "su2h :as,tJ~~; n.?t lim,it,e<.1 t~.: 'f"
_ _ ...... . _ , ,;.. .,; >" J.. 1". J,... ,.. .~ . - " _ . '.. ." ~ " \
A., Block Wal'l: To be made aftE!r 're'inforcing ,i'!;' 'in. place, but before any grout is poured. 'This -..:.
inspection'is, requirE!c; for ,each', bon'q bea,m pou:t;',. ,There ~ill be no ',Cl;p,PEoval ur;til the plumbing
and ele~t,rical.i.nspecti'oris hayebe~n,made.and ~,ap;proved. , ' ,
B. Wood Stove:' To be made after completion of masonry (if applicable), and when installation is
complete.'.' .Instal,la tiqn shall" be in accorpance, with an approved,' na tionally recogni zed tes ti,ng'~
agency and the manufacture~'s installation instructions. -: " .. ,
C. Mobile 'Home i, An in'spection, is requ'ired, ii.fteJ:"'the mobile home -is.,connected to an approved
sewer.or's~ptic system,for s~tbacl5. -requ\#ell}ents, ',blockiri:g', fcio,ting ccj'nnection'" ti,edowns"
skittil1g ;'-and':.pl'umn.tng~connecti'ons.-~ - ~ 1", i " ,",.' ,-' ", - - -' - -- -,
'1 F.?o;tings and piers.. to comply w:j.th State, follpdat;ioI1:requirements for mobile homes or as
, '~'.recommei1ded by the manufacturer. '
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2:. Mobl'ie home mi:I'\lmUm finish floor elevation shall'be certified when required by a flood-
plain management, lE;ltter.
3. Mobil~ home tiedo~n~, when required, and'skirting shail
tion within at least 30 days after occupancy. Tiedowns
per, enclosi.f:fe.;
D. Swimming Pool: Below grade when stee~ is in place and before concrete is poured. Above grade
when pool'iS'~nstalled.
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be installed and ready for i'nspec-
and skirting shall be installed '
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APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORK~NG HOURS. THIS PERMIT WILL, EXPIRE
IF WORK DOES NOT BEGIN WITHIN 180 DAYS, OR IF WORK IS SUSPENDED OR ABANDONED FOR MORE THAN 180 ,D~YS.
SUSPENSION OR REVOCATION,'MAY deCUR IF, THIS PERMIT WAS ISSUED ON THE BASIS OF'INCOMPLETE OR ERRONEOUS
IN'FORMATION "
ANYONE PROCEEDING P,AST,'THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
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1., pe.rmi t~ ~hal~ be, effec,tive ~o::: one year, fro!ll the 'date of issuance.
2. ' : Upon ;co~'pieti"~g the cbn'~truct:roh for iwhl'ch a' permi t, h~,Jl)een- issued "tHe 0 permi tAdder-, shall
notify the Lane County Depa;r:tment of Planning and Communi ty'. Development by, submitting the
installation record 'form. The Depa'rtment shal'l inspect the cqnstruction to det'ermine if it.,
complies with'the rules contained in this division. If,the construction does comply with such
..rules, the 'Department- shall issue' a certificate of satisfactory completion to the permi tl holder.
. If tne construction does not cpmply with such rules, the Department shall notify the permit
holder and shall require s~tisfactory comp+etion before,jssuing the certificate. Failure t?
me~~ the requirements for satisfactory'completiofr within a reasonable time constitutes, a vio-
lation of 'ORS 454.605 to 454.745 ,and this rule.
Setbacks -Subsurface Sewage Disp6sal
-, 'Fr~m: ,Interior property lines'
. -' Edge of road - r igh't-of -way
,~.. c Building' founda tion
t~' ~"~ Wells,~o~her,~ater,source~
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Septic Tank
.~~ 10 '.
10 '.
5 I,
50 .
Drahifield'
10 '
10'
10'
100'
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C'14'-25' :
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CHECKLIST
PLUMBING / MEeHAN ICAL
OFFICIAL USE ONLY
Appli. /
Pennit #
APPLICANT INFORMATION:
~~oc.-lA-"Ttn ~.A 4., J\-k
(Name or Finn-Please PrInt)
\1) . t9. ~(9'i-. 4- ''2-
(MaIlIng Address)
Eve. ~}Q...
(C~ty or Town)
q:1 ~4<)
(LIp Code j
PLUMBING CONTRACTOR
D Yes Finn
Address
Cont. OSR#
MEGIANI CAL CONTRACTOR
o NoDSelf
~es Finn ~'60( J ""'Tt~
Address P.O. ~'1.. 4-~ 1..,
o NoDSelf
\A..-'t' ~ J ^,l~ont. OSR#
t="v S Q'14.-40
Type of Fixture
PLlJJ'vIDING
Nwnber of Each
,...
Sink
Lavatory (Wash Basin)
, Tub (with or without shower)
Shower, separate
Water Closet (toilet/urinal)
Dishwasher
Disposer (garbage grinder)
Washing !\'Iachine
Water Heater
Floor Drain
Sewer--lst 100 ft.
each additional 100 ft.
Water Service--lst 100 ft.
each additional '200 ft~
Stonn and Rain Drain--lst 100 ft.
each additional 200 ft.
Special Waste Connection
Sewage and Swnp PL@p (eiector)
!\lobile Home Sewer and Water
Other (specify)
SUB-TOTAL (Minimwn $15.00)
Fee On Each
$ 7.50
7.50
7.50
7.50
7.50
7.50
7.50
7.50
7.50
7.50
30.00
15.00
20.00
15.00
30.00
15.00
7.50
7.50
15.00
Total
J, TOTAL FEE
,,,. .... ~
T)~e of Equipment
j\\EGlAN I CAL
l\umber of Each
~.... --......
,
Fee on Each I Total
I S 10.00
S 6.00 I
7.50
3.00
3.00 .
4.50
6.00
6.00
6.00
6.00
2.00
.50
i'>lechanical Permit Base Fee
Furnace up to 100,000 BTU/H
Furnace over 100.000 BTU/H
Clothes Dryer Vent
Bathroom Ventilation Fan & fuct
Range Hood with i'>lechanical Exhaust
Wood Stove nvood Stove Vent $3:00)
Air Conditioner Only
Heat Pump
Floor Furnace
Gas Piping System 1 to 4 Outlets
Per Outlet Over 4
I~
~
: Other (specify)
SUB-TOTAL
'!DTAL FEE
3/"
C74-200
AC'llVITY INFORMATIO~ SHEET
lane cou.nty
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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1 '1\~60G I ~1:t ~ ~ \' ~ ~ I\-- i C
PERSON MAKING RIQUEST
tp~O. ~~ 4l'L
MAILING ADDRESS
\ G0C. 0(2. CCJ4--4-0
-tITY---'-_...._- , STATE ZIP CODE
1)"Q.W~'A.\) {-bot.{ LS'S
- PROPERTY OWNER
~4 v5 'GbHl.~'y \lieu..; L,u
MAILING ADDRESS ' ,
'5Pg.l~C~FleLf) "
~~. Q (L o}l~ 77
CITY STATE ZIP CODE !
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G?~~_ Z-SC(O
BUSINESS TELEPHONE #
_ (~<<o ~ ~~qo
HOME TELEPHONE #
-Z4-6 'B 4-4-d
BUSINESS TELEPHONE #
(., tUo ~ 4-4-4
HOME TELEPHONE #
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2 , PROPERTY ADDRESS
(IF DIFFERENT FROM MAILING ADDRESS)
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3 MAP & PARCEL NUMBER (from tax maps in Department of Assessment and Taxation! '
1
(REQUIRED INFORMATION) IF. or from tax statement) , 1
'f1.-v'P--R.lf:IJT rOl..V<=t. Pr?fLyYI'''''' 'e>29re."3 I
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TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
d-BO
TAX LOT(S) OR PARCEL #
/7 3 J-3
TOW~SHIP RANGE SECTION
ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL #
ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
ACRES
! 4 SUBDIVISION (if applicable)
i 5 REQUEST (state exactly what you plan to do)
i
LOT BLOCK
JZud~cJ) r~
6 DIRECTIONS TO SITE:
t".. ','.
** FOR STAFF USE ONLY **
NUMBER
DATE
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ZONE/LAND USE:
BY: DATE:
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TIME IN:
OUT:
LAND MANAGEMENT D I V I S ION / 125 E. 8 th AVE., EUGENE, OR 97401 / 687-4061
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LANE COUNTY VEPT ENV MGT RECEIPT
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SQ FT UNIT COST VALUATION
FEE
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