HomeMy WebLinkAboutPermit Building 1983-6-16
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OFFICE USE ONLY
Lane County Authorization
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RANGE
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9&;i{ION
83
Appl~ca ti01}ft-1 () <::::J <?...
Perml.t # L1 ~ - D )
o Two Copies of Plans-
o Three Copies of plot plans
DMech/Plumbing Checklist
DLegal Interest Document
D Plan Check Info Sheet
TAX LO;~ J:]OUT OF
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SJBD~ARn.lON (~f apPh~ LOT/;tY\EL~, ;
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"nm~. +01 fyarLmOY\'lcL ~~1r 16
~1\..1 DECLARED $ VALUE
= OF BED~. S OF S~I,ES . ~ ~,JlDU. WATER SUPPLY ~ Proposed
If) \lJ (f) .=J Existing
OVi'(~';:~O;lnd: ~6L\;Ld '~.' F) .. VlQU) Lr\'J7V?dI.~J:-N~
C~R's;U~;r~#,~~_~rn Q~ ~ ,. J ~ciq,-\,~NUMBER
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION F~'ERMIT, and do hereby ce t1 that all 1nformat1on hereon 1S true and correct, and that I
.have the follow~ng legal interest in the property: Downer~ record; 0 contract purchaser; Dauthorized agent with eVldence of authority attached.
I f~rther 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
~pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur-
.ther certify 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 cornplia e with ORS 701.055 will be use~ on this project. I HAVE READ AND
!CHECKED THIS APPLICATION THOROUGHLY.
TOWNSHIP
PROPOSED USE OF PROPERTY
~eside_ntial D Industrial
o Commercial D Public,
NAME (please print)
'~A~/~,~~/ L ~/1Z~~--./
~... SIGNA~ "" ~ f
t/7/~
, DATE
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READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS~
o PLANNING/ZONING: zone~ Partition # Parcel # Parcel Size (~.SC
C . I C , Ir;;:::..,./ //A f
~1~~~;~"~\Uh'O:~;;o~~pi0 ~
/ 0 . / -- \'\ ,. .,'.. Date:~m.o J ~~~
~OODPLAIN: In flood hazard area? ~ No D Yes, SEE ATTACHED SHEET. Date:U ~- I::<'~ 8 '3 ~
~NITATION :
Installation
Specifications:
Gallon
Tank
A?L1 0 h A All ../'
B. P. # Installation Record Issued? DYes D No
Lineal Feet Maximum Depth
()' , /. ;/;~rai~eld _ /~ =~
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S. 1. #
CO~lHENTS :
~ANS EXAMINATION:
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Use '6uJ lMM, ~ P U-Jt-
COMHENTS:6~ ~ I='O~ HJ.s~OOS S( Ff, {~P~-r+- 1i;SrJ~
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Gate: t;,/iW&3
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Date: ,
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Type
Group
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TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PERMIT
Sq. Ft.
Fixed Feel
Unit Cost
IOICO
Subsurface Fees $ 1l7.~
Building F;'ee $ f(xJ, m
M8ch/Plmbg Fea.oe~~
pl ans Check Fe~.t1f 52. .~~
State Surcharge L. z4
DEQ Surcharge ~1 ~ ~ . ro
TOTAl Fd $$ J45.s4~
~"~E
19-Mi~~~~2J
Floodplain Fee
$
Ee:RJ~p~l95
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE
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(per ORS 'Tf6 .805 (1))
LANE COUNTY DEPARTMENT OF PLANNING & COMMUNITY DEVELOPMENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
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APPLICANT EMERALD
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LANE COUNTY DEPT ENV MGT RECEIPT * 91983 DATE
SW:[MMING 1~(:)OI...S} AI)DR i~~~EJ~~ !~WY.99}f l~lJGI~:Ni~~} (:lRE(;()N
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, LANNING & COMMUNITY DEVELOPMEN'I
ACTIVITY INFORMATION SHEET
Idne county
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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, "1'..'.. ""'~ rJiV' (\~ /lJ <.2..e! '1 b U fZ--lUAd 8 e>C/ Ie <;
-rc;.. PERSON MAKING REQUEST I '# PROPERTY OWNER I "
i$<gS- f/'fJGf ,0/''1 N()Rr'1r 3. f/5 EA/c!~ V/eUJ //.1
, MAILINB A~RESS- MAIL1NG ADDR~S
CVc;etJ-e. (J)/Z-oe 97 ~6 SPILI;'~ ;:;:cl :
&:, ~~ _( 090 STATE ZIP CODE ) ) ;;v 7~O C) STATE ZIP CODE'
BUSINESS TELEPHONE # HOME TELEPHONE # ~USINESS TELEPHONE # HOME TELEPHONE #
j 2~ PROPERTY ADDRESS
. (IF DIFFERENT FROM MAILING ADDRESS)
'\
TOWNSHIP
(from tax maps in Department of Assessment and Taxation i
or from tax statement) ,
Cb d~ LCC)
RANGE SECTION TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TAX LOT(S) OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
5 REQUEST (state exactly what you plan to do)
TAX LOT(S) OR PARCEL # ZONING
ACRES
LOT
BLOCK
6 DIRECTIONS TO SITE: 7Sr!..lr t/~e.
fP.Vlftv) ,.,.:> R tt'4 1//i'?.'vJ
'. ' . .. (. . ** FOR STAFF USE ONLY **
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ZONE/LAND USE:
BY: DATE:
NUMBER ~-7
DATE
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TIME IN:
OUT:
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(:7-0)- 23 -,12-00
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~AN0E~~kT~~N1REFUN~ AUTHORIZATION
PERMIT II 9( 9-83
NAME (PLEASE PRINT) Vol2JJJAeD :EnYLE~
ADDRESS 34/5 BALDY VI aU GJ. J sp.
APPLICANT >><l OWNER (X).. CONTRACTOR ( )
REASON FOR CANCELLING PERMIT (OR APPLICATION)
OUffL pAYJv1EJJf O~ '~I\.
SIGNATURE DATE
FEES PAID FOR WASTE DISPOSAL SYSTEMS (SITE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE SEPTIC
TANK AND DRAINFIELD) ARE ORDINARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE BUILDING, PLANNING,
OR PLUMBING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT/APPLICATION PROCESSED.
/lJ/4
$ 7.95
~-/~-xh
24-0B-74/ACCT 42120/PROG 041 Receipt II~ ~ ~~~~
24-0B-74/ACCT4~~~~/PROG 041 Receipt II
\1 '\ '.J.i.
24-0B{7tl ACC~i :~'~~~33('P,\\~~ 043 Receipt II
24-0B-74fJACCT' 42,13'4\7.:gRQG 043 Receipt II
\' , "/\',:.\, , 'i
24-0B-74/ACc&T 42150/.)pRqG 035,,,Receipt II
24-08-74/ACCT 42150/PROG 013 Receipt II
24-08-74/ACCT 46202/PROG 034 Receipt II
24-08-74/ACCT 46210/PROG 035 Receipt II
24-08-74/ACCT 46202/PROG 035 Rece~pt II
24-0B-74/ACCT 44419/PROG 034 Recei;e~,
AUTHORIZATION FOR POSSIBLE REFUND:'
% BUILDING PERMIT FEE $
% MOBILE HOME FEE $
% PLUMBING PERMIT FEE $
% PLAN CHECK FEE $
% STATE SURCHARGE FEE $
% SEPTIC DISPOSAL FEE $
% SITE INSPECTION FEE $
% LAND USE APPLI. $
% PPA OR NPA (PLNAMD)$
, % PRE-APPLICATIONS $_
% RECORDING FEES $
% PARTITIONS $
% COPIES & ORDINANCES $
FOR PROCESSING FEE $
MINUS $25.00
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i,? TOTA~ AMOUNT TO BE REFUNDED
CV~I! ~. Gd
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TO DEPARTMENT OF tWANCE: 05
BUILDING PERMIT REfUND $ I? 7~
STATE SURCHARGE REFUND $ ~
SEPTIC DISPOSAL REFUND $
SITE INSPECTION REFUND $
LAND USE APPLICATIONS $
PLAN AMENDMENTS $
'PR~-APPLICATIONS $
RECOR.DING FEES $
PARTITIONS $
COPIES & ORDINANCES $
SIGNATURE
DATE
TOTAL AMOUNT REFUNDED
$
7~
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~E>\SE MAK~ECK PAYA~,...:?? T~ L? # / r
i NAME h~~~~~ /") &A ';' .
" ADDRE~)/??S-Af;~~ :?I9f~ ~~~ ~~',~f?7p?l2-
'f r ;It-E-(ARTMEN~eylPLANNING & COMMUN7ifDEVELOPMENT /f' \,
, COURTHOUSE/PUBLIC SERVICEl/"BUILDING 1/ .....
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
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