Loading...
HomeMy WebLinkAboutPermit Building 1983-6-16 ~ ,-/ ~ <f,CO ~ \o~~\ ~\\~ to)lS' FOR for: OFFICE USE ONLY Lane County Authorization ..0(lYc !'Y\rYI1 n ~ ~ 17 RANGE o;;r 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 ~Z()(J SJBD~ARn.lON (~f apPh~ LOT/;tY\EL~, ; ~I;"'~~ Vl ~ ~~ c;~9.kf'{'(' '(,-:TO,", ~.~~~ , . J~h~~ ~OO\ "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 :@~)/~r'~4~. dJi;PMO '; _ L 0 16~~' r~() 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 ...1...., 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 _ /~ =~ ~"'.~ S. 1. # CO~lHENTS : ~ANS EXAMINATION: {,-/~b Use '6uJ lMM, ~ P U-Jt- COMHENTS:6~ ~ I='O~ HJ.s~OOS S( Ff, {~P~-r+- 1i;SrJ~ - r.Alk-f"fLAU ~ O!-HE12- lIJSPE:C.;fJmS L.t~~ OJJ,Pl!JJ~- Gate: t;,/iW&3 - . Date: , ~ Type Group M-2- o 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 r ~l 1b ~' f!IJL1 ~'r/ r ?Mdt (per ORS 'Tf6 .805 (1)) LANE COUNTY DEPARTMENT OF PLANNING & COMMUNITY DEVELOPMENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON 97401 SEE REVERSE FOR INSPECTION INFORMATION I ~~ ...-- ,.... ... w...... II [I" " { I .' (, I' i 1, '- rl t. ":1 () r -, ~ tl.J: ~? !... f:~'! j\.!'E: ~~:: [) !...! r..rr \( j) E pt. f::: i"~! \l i"lj G T i:;~ I::: [: ElF: T ::i:. I) ~j (.;):::;: :..~; I) (:';'i T E:: ~.:} {::I !.:} (" ;;;;i \..t AF~i::li...:!:(:;AN1' I:::ME~I~AI._I)! SW:!:MM:!:NG !~(:)~:)I...S AD DR 1~3~~~~ N~ l~l.J(;I~NI~:}. (:)~~E(;()N 'l'!_.~ 1703230000200 SlJBD:I:V L.OT :0:",1< i...J r: !lJ [:.L. D G "r 'Y P E l.JSi~: !:~ BI)RMS 0 lJNI1"S 001 '.S'T'(:}!~]:E~:S :~B!_.D(;S 001 i::'f'~()Ni~ A~~~~ 10Y~ CJ f....j ;-...! 1::: F: (.! j\"! E: ~: JCO~E APPL. NO ACTIOU DESCRIPTION (:',D DF~ SO FT ,UNIT COST VALUATION FEE: .UFi, '( 1:-:- E{F' " fF' rip F;P f.:P DP LC 91983 POOL. !:~I... N{:)~ F:':I:X'T'l.JI:~E:S:. i"jECH S:i..,iF: F'C!<, .' /::' () . (j (.) -.- .. .. - .. j\.! Cl~. C~ U i\~ ~.\~ E:.C of Ci F~ S' : 1 ::~: .'. (:) () E (:'j C~ I""; :::: j'-'!E:CHtl!"') I Ctil... FEE" ::';: T tl TE S'!..,! F: C Ht! F: G E P!...(:'iN CHE::C:!< FEE: ,{':} ~.~;'; /1::'11/ C:I ...~ .";1 :.;~::;> . (.) (.) 00.. ., ,. '0 ~~o )) 1:':' , i I '.\.1'" I" ," S'F;~EF ' .1 (-) .., () (.) CtITC. ; .:,;:E:QI.J : T td< E i',,! (iPF: lOOt l.. rl"I"j FP ...J...... ,"I 1\ .l} 1:':' 5.'1 ,::1[:1< UTH I'S' :~'.~ () I"f ,j E:"-{ Cf::',D E~ :s: or ^ CUl"lPLE:'r I OJ'.,.,! :0 i:'~ T t::~ To'r{~L. ,FEE:'H(' 'f (-) ::,;:: t, (;) .(:) IH :,..'!"" 'IfI '" !'I i~ .J , ~ , ~ 11 ,r' .'. " . kl: ,.." APPLICANT EMERALD TL_~: 1703230000200 . f",,! E: t!.J Bl.::OG T'YF:E: , CJ !i,J j',,! E R (1 i'lj E : '1 ' , CUDF (iPF'L NU E,:P t-:p , HP BP BP PL NO. FIXTURES: , 1':'iECH SI...iR' I::: C~t( I~L_ L..(:: 919~~3 Sl.J~::II:: r......... "l''{'. . I....r'! I I.:{. (:'!F:tFt !:;~ i~:.! SEG~I..J : " '..:i 'f t! I< E 1',1 I,j Y. . F.~ L. t..t " ! 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 f~:ic'r I C)N SI..J:OD I V US.IF f:;: B.D F: l"'1 :s.t (.) tJ ?...! I 'r s () () 'j ;:.;.1 T tJ F: I I::: Sl , t'J :0 :0 F~ D E is.IC~ E~ I p'r I fJi\! 5,'(;.) FT' Ui\J IT rj\! C}... c:: D j'...! j\! E.C T.eJ i:;~::;' : j.....i E~ C~ in! (:) i\i I C; () L F' E~ E~ Sl T () "r E ;:.~ tJ i:;~ C I.,; {::'i F;.~ (.~ E:: F'L,(iN CHECl< FEE :::'1:) ; I .::: i'\ .::' 1........1... S.'1 I F~C;I< E~S.I.A.C:(:)M!::I!...E~:.rION DAT[~: I ("IT ~ii: :B L. ':0 G S (-) (:) '1 - P t..i C) r".1 E c: C) s: r \/ r:}! L l..J {:'i T I Ci f\! 'i :::; ., ~) (-) E [::! c:: i..1 .n' -4 :.~~: . I:'S :::;:;~ nTH IS.'S. () \ T CJ T t.! L. r:' E I::: .)1: .ji:' .~ j'.: I"': c'>::).;::, F:'EE :::; :. (-), (.) 'J {:~, ,'. ~5 0 i':: D::: '.:.11: I 'j ::~; ... ::?;::'5 ..... ..... .j6:. ..54 PI I~ . 1 r r- I" (.) l;. () .? ::::- ... :E{L.!< "i (-)(?<-:. Di:~iYS: . , (I f! i; "1 (::,( .. , LANNING & COMMUNITY DEVELOPMEN'I ACTIVITY INFORMATION SHEET Idne county COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! '-- " .~" ,. .... - '.' ". .0'''''' , "'"''_''_'_''''''' '" '. ,_",,_,"', , "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 ** <'j" D ~ A IYI e f,:J'fl., /'Y1 ~ 0 j)~J1~/\Yri:~ ZONE/LAND USE: BY: DATE: NUMBER ~-7 DATE , ."... --i :;0 V> ~ --i ..r-: TIME IN: OUT: .. (:7-0)- 23 -,12-00 \, \ ' , \ i ~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 '''') i,? TOTA~ AMOUNT TO BE REFUNDED CV~I! ~. Gd Ii V'V\. v <--' i I -, --- -- -'I 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~ ~~..~ ~9.e;'" /' ~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 ~