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12370 SW NORTH DAKOTA STREET I Lo 3 ,j a s H x I I i 12370 SW NORTH DAKOTA STREET - city of Tigard Building Departami '. 13125 sm Ball Blvd. Tigard, Oregon 91223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: --- —� --- Footing Pl.bg. Underelab Mach. Rouqh-in �`Appr/Sdwlk J Found. Plbg. Top Out Gas Line FINAL: Poet/Beam Struct. San. Sewer Frdming -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Hoch. Date Requested: eiI Time: ,—__AM Address: 4o�J/ /C.'� � Permit 1: Builder: THE FOLLMING CORRECTIONS ARE REQUIRED: it Inspector.:__ Ih u--7 1C C- — Date: 75 ,APPROVED DISAPPROVRD APPROVED SUBJECT TO ABOVE For Reinep. iw w w s sUr MM M INSPECTION NOTICE City of Tigard Bulldig Departient ` 13125 SM Ball, Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O--Phone): 639-4175 Business Phones 639-4171 Inspections____ �...-1---\— Footing Plbg. Underslab Mech. Rough-i.nAppr/Sdwlk 1 Found. Plbg. Top Out Gas Line FINALS Poet/Beam St.ruct. San. Sewer Framing -Bldg. Poet/Beam Mech- Rain Drain Insulation -Plumb. Plbg. Underfloorwa�t7er Line Gyp. Bd. -Mach. ff Date Requested:__ lL' 1 ------Ti—: AM PM Address I 3 - Permit 1s __ Bul Y_�C0 1 G' a�,t der: ----- q 5 3:t ovw4') Pfi ov C1 2( I THE FOLLONINQ CORRECTIONS ARE REQUIRED: .GU � L _ _ Tnspector:__ AI nate:--.� LO-91 __ APPROVEDDISAPPROVED APPROVED SUBJECT TO ABOVR all For Reinep. 1 CITYOFTIFARD A � I CERT I' �� IGATE OF COMMUNITY DEVELOPMENT DEPARTMENT o�FT OCCUPANCY 13126 SW tWI Blvd. P.O.Ba 23397,Tip M,Onpon 97223 1W3)a*4A 76 PERMIT' 0. . . . . . . r MS T90--02.31 - -- DATE IFJ")J`Pa 06/07/91 -- S I rE ADDRESS S. . . r 12370 5W NORTH DOKOT'A T PARCELSSUBDIVISION. . . . ANT ON PARK 1 a 1 3403-05kr@ ZON GLOCK. . . . . . . . . . a LOT. . . . . . . . . . . . . .. I o CLASS OF WORK. aNHW "TYPE OF' USE.. . . OCC;:PANCY GRP. ,R:3 OCCUPANCY L OAD a 20'0 4 TENANT NAME. — Remmrksa Owners THE WANTLAND COM 1"HF. WANTLAND COMPANY '3411 SW MARSHA 57' PORTLAND OR 97021••-0000 Phone #c ;°503,-e:45-' 599 Cont ract or-a WANTLAND CO 5311 SW ORC.HJD ST PORTLAND OR 97219 Phone Mr 244--61316 Reg #. . r 33200 '-ccl.lp&ncy of the above referenced builc.i:ing if, hereby UJ.vr.n, and certifies the ccrlrplianre with the StOt" Of Oregon Specialty Codes for the group, occupancy, and use undwr which the referenced permit wwas iaesued. _ 7 _..._._.....,..._ FIRE' !)EPARTMEIJT.___.�.__,....._.__.._. BUILDING I XTOR 1��rt'[ D I Nr, i POST IN CONSPICUOUS PLACE INSPSCPIQ(��larzcx City of Tigard Building Department 13125 811 Hall Blwd. Tigard, Or4non 97223 \ Inspection Line (Roe-0-Phone): 6351-4175 Business Phone: 639-4171 Inspection,_________ Footing Plbg. Undernlab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line Poet/Beam Struct. San. Sewer Framing -Bldg. Post/Roam Mech. Rain Drain Insulaticn -Plumb. Plbg. Underfloor !- Water Line Gyp. Bd. --Mech.7 Date Requested: to "' / - q I _ Timet _ AN Addceee:_�� ' ��. Permit #t_go.-oZz Q Builder: Z 9 y -C,'i k (p THE -FOLLOWING CORRECTIONS ARE REQUIRED: --- Inspector: _ 7_ -- Date:APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVE Call For Reinep, t INSPECT ON.NOTICE City of Tigard Building Departaent 13125 am Nw11 Blvd. Tigard, Oregon 97223 1 Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 539-4171 Inspect ion s - Tooting Plbg. Underslab Mach. Rough-in Appr/Sdwlk. Found. Plbg. Top Out Gas Line FINAL: Poet/Beam Strurt. Ban. sewer Framing -Bldg. Post/Beam Mach. Rain Drain Insulation Plumb. ll Plbg. Underfloor Nater Line Gyp. Rd. -Meeh. Date Requesteds y <r Time: AM PN Address:__j,-,_2 .3�Lt' Permlt: Builder:_ _ 'CNS FOLLOWING CORRECTIONS ARE REQUIRED: d Inspector:_ 7 - - �Y Dates� '�'�-� APPROVICD DISAPPROVED Y APPROVED SUBJECT TO ABOVE gall. For Reinsp. A37 � 1! ea• ! � � Iwlf � INBPECPION NOTICE City of. Tigard Building Departoent �J 1312S SW Ball Blvd. Tigard, Oregon 97223 Inspection Line (R�-e-0-Phone): 639-4175 Business Phone: 639-4171 Inspection:--- - -- --------_—_,.. _. Footing Plbq. Underelab Mech. RoughItsAppr/gdwlk Pound. Plbq. Top Out Cas Line FINALs Post/Beam Struct. S,�n. Sewer Framing -Bldg. Poet/Beam Mech. Rain Drain Insulation -Plumb. Plbq. Underfloor Nater Line oyp. Bd. -!loch. Date Requesteds_ - l _Times ___ AM _PM Address:- // ��, -��L.7 Permit #: " X& Builder: (.(zc 1• t.C_.G�iti`. l.L. THE FOLLOWING CORRE/C-TIONS ARE REQUIRED: � `aC.l-11, - _&/7 �rrCT rreirrF{ L�17e��L -r �-K"a�it�c Inspector: --. ---_- Dates��s%�_APPROVED -- APPROVED -` DISAPPROVED SUWNCT TO ABOVE --call For Rei.nap. IN�SPP.GTION NOTICE City of Tigard Building bepartaent 13125 9W Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phons): 639•4175 Business Phone: 639-417 Inspection:_ Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Cas Line FINAL: Post/Beam Struck. San. Sewer Framing -Bldg. Post/Beam Mech. Rein Drain � Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mech. Date Requested:+� '7 n - -- TLme: �AM —__—PM Address: 2-z7 Perm/it_ 4: guilder:, ----- THE FOLLOWING CORRECTIONS ARE REQUIRED: inspectors_ ' _ „ Date° L/" APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE For Rei.nsp. INSPECTION NOTICE city of Tigard Building Detpartiomt 13125 Sit Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone: 639-4175 Business Phone: 639-4171 Inspection:._. Footing Plbq. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldg. Post./Ream Mech. Rain Drain Insulation -P'_umb. Plbq. Underfloor Nater Line Gyp. Bd. -Hoch. Date Requestedt L_/ 1D ___Timet -4X---AN PM Address:__ r _yam Permit #t �Z�. Builders_ Lz �% THE FOLLOWING CORRECTIONS ARE REQUIREDt 37 r mit '_ w,4 S 11 7'y Inspectors Dates APPROVED DISAPPROVED AYYROVED SUBJECT To ABOVE Y—Call For Reinep. INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 Tigard, Oregon 972.23 PhQne. 639-4175 Type of Inspection _ Date Requested._ lU t1 'yl/ 1nnA.M.__.—_P.M. Address _ Z 201_ Permit Owner Lot Builder- The uilder_The following Building Code deficiencies are required to be corrected: r ki Presented toApproved Inspector �-1 proved Date CALLREINSPECTION YES ONO i INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested Time A.M._. P.M. Address l;;? 3 Permit - Owner _ Lot L !.' Builder Q The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector _ _._ _ U Disapproved Date _/0 Z, 4iL 7 0 � CALL FOR REINSPF,CTION ❑ YES 1 No wor r r wir r r r r •eo INSPECTION NOTICE 14 City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 1 Type of Inspection OeE6-'s�-G---- Date Requested U �/� _ `✓ Time— _ A.M.___ P.M. Address _ A) 3 7 Permit # Owner_. -- ----._-,--- Lot #_ Builder (-�•r -1��—The following Building Code deficiencies are required to be corrected: �/, Off" --tG -r-i-�xzo,a7-- i'�H?o✓�. ��a,�'.t� -- Presented to __ _. 4Approved Inspector l _�__._. --� Disapproved Date CALL FOR REINSPECTION I O YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 i Type of Inspection lig' Date Requested �� Time J`' A.M. _.. .—P.M. Address _ . �.��/�5 •�i ��' L�7Z Permit Owner _. _ Lot # f Builder The following Building Code deficiencies are required to he corrected: i Presented to P Approved Inspector G� FJ Disapproved Date / r' CALL FOR REINSPECTION YES 0 NO I INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection TLr 417 Date Requested_ 2-' Time _ A.M. P.M. Address _ _ �_ Q _<–�_ Permit # _ Owner Lot # — Builder ----- The following Building Code deficiencies are required to be corrected: Presented tor/06 4-- Approved Inspector �=/��i'---- U Disapproved Date �- CALL FOR REINSPECTION ❑ YES (_l NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 6394175 Type of Inspection Date Requested M. P.M. 7s P, Address Permit Owner Lot #__ -- _-` Builder The following Building Code deficiencies are required to be corrected: Presented >eAppruved Inspector Disapproved Date CALL FOR REINSPECTION YES ❑ NO wi � Iw sssr ssss ss• s� INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested ime. — A.M. P.M. Address - --_„/� �' — ..di;.,Permit #J Owner Lot # Builder The following Building Code deficiencies are required to be corrected: 1 Presented to `,Approved Inspector _�----- Disapproved Date CALL FOR REINSPECTION ❑ YES 0 NO INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested -._)_. _ Time— -7 Address .—_/o� 3 / _-_ 1 � _ Permit # —U` - Owner-- —_ Lot BuilderThe following Building Code deficiencies are required to be corrected: Presented to - ----- -----� Inspector e_ -----� .�►pproved -- -- —...__ [ Disapproved Date G CALL FOR REINSPECTION F1 YES (7 NO INSPECTION NOTICE City of Tigard Building Department / P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection �1�� Date Requested �r v Time M.- P.M. Address 1-)� 7f�_ –7 _ / Permit Owner__-_-_ _ Lot # Builder lC it The following Building Code deficiencies are required to be corrected: Presented to _-__ YApproved Inspector —. 7 ------- -- Disapproved Date CALL FOR REINSPECTION ❑ YES C_] NO i INSPECTION NOTICE 06 City of Tigard Building Department C /U P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection �/� 1 Date Requested_ �� L �X!PA-M._ ' Address , lye_—_ Permit __.J�— Owner_.— – -- Lot # Builder The following Building Code deficiencies are required to be corrected: `� '-' sC 1 c.✓ ?tee,arm. J�d� �" Presented to f __ Approved Inspector Disapproved Date. ---- CALL FOR REINSPECTION ❑ YES EI NO C17YOF71FARD PIASTER PERMIT CITYOFTMAND PERMIT 0. . . . . . . .. Ih9T'90 •0L..t1s COMMUNITY DEVELOPMENT DEPARTMENT ��+ FIRIM« PERMIT N. : MST9O-O238 131268WFWIBNd. P.O.Box 23347,7fpsrd,a.�,�k,+Taa+,Aaali76 '--_-- DATE: ISSUED: 07/10/90 SITE ADDRESS. — : 123'70 SW NORTH DAKOTA ST PARCELx 18134C D O5O00 SUBDIVISION. . . . : ANT'ON PARK ZONING: k•-.7 BL..00K« « « . .. . . ., ,. ,. : LOT. . » . » . . : 1.2 REISSUE::MS'T'9O--0237 DWELLING UNITS: 1 BASEMENT. . . . . . . . xO Sf CLASS OF WORK. :NEW PEDRMSi:4 BATHSS:3 GARAGE'. . . . » . . . . . ..41.8 Sf TYPE OF USE. . . SF FLOOR REQUIRED SE'TBACKS-.__................._... .._ T'YT=L OF CONST.. :5N FIRST'.. . » » :899 s LEFT. . : 1.0 ft RIGHT. -.6 ft; OCCUPANCY GRP. aR3 SECOND. . . .-871 f FRONT. :20 ft REAR. . :29 ft STORIES. . . . . . . :L' THIRD. . . . ..0 Sf REQUIRED --_.._....__.._..__.___....._...__._. . HEIGHT. . . . . . . . .r0 ft TOTAL_- - : 1770 .1. SMOKE DE'T•E:CT0RSi. :Y FLOOR LOAD.. . .. „ ;t 40 1:7 r;f VAL_UI:.. . . . . $ 81.864 PARK,ING SPACE13). » :0 Remarks: PLUMBING •_._.._.._.__..._._._._______.____.___..-._..___.____._._._.._._....,... SINY.S» « « « . . . ,. .• .. : 1. FLOOR DRAINS. . . . :0 HACKFI...C.)W P11EVNTRS. . .0 I...AVATORIE:S. . . . . :4 WATER HEATERS. . . : :I. 'T'RAPS. . . . . . . . . . . . . . :0 TUP/SHOWERS. . .• . :2 LAUNDRY TRAYS. . . -.0 CATCH BAS INS:i. . . . . .. WA'T'ER Cl_OSE'»:T.S. .. :3 SEWER LINE. (ft) . :0 GREASE T'RAPS.. . . .. .. . ,, aO DISHWASHERS. . . . .. I WATER LINT: (ft) ,. : 1.00 OTHER FI:XTUI-W..:.:,„ .. ,. •, .. -0 GARBAGE: DISP. . . : 1 RAIN DRAIN (ft) . :0 WASHING MACH. . .. : 1 SF RAIN DRAINS,. . : :i. PILC:HANICAL, FEES FUEL 'TYf'[ 5 - - UNIT H'TRS. . :O l;ype amount by date recpt /GAS/ / i VENTS . . . . . :0 PAYM $ 290. 00 JLH 06/29/90 2O2221 11AX INPUT":0 BTU V1---NT FANS. . :4 BPRT $ 379. 00 1 / FF'URN < 1O0K . . : 1. HOODS. . . . . . .. 1 BPLC $ 40. 00 TURN >==1.O0K . ., :(A WOODSTOVES. u O BPLC; 91 0.00 FLOOR FURN. . . . :0 CLO DRYERS. : 1 E15F'C $ 18. 95 I-.M:)IL/CMP ( 3HP-.0 OTHER UNITS:O STDG $ 600. 00 1 / GAS OUTLE:'TS: 1 SSDC; 3; r'".70. 00 Owrle•r: -_._._..__._.__._.........._... ...__.__..._........._._____........ .__..____._..._ PARK $ c?50110114 THE' WAN'TLAND CUM MPR'T• $ ;39.00 THE WAN'TLAND COMPANY 11PLC $ 7. 75 3411. SW MARSHA ST 115F'C 11 1. 95 P0RT'I...AND UR 9722:1-0000 PPRT q. 1.40.00 Phone. Et: 5O3-•245•-5999 F'SF'C: $ 7. 00 C.:01.1tracto.r: _......___,._______._._.._.._...._._______._.._._.___.___ PAYM $ 1.445. 65 JL_H 07/1.1/90 OREGON CITY PLUMB R HEATING 611. 7TH ST OREGON CITY OR 97045 F:'horle H: 503-656-8558 $ 1735. 65 TOTAL This persit is issued subject to the rejulations contained to the --- - REQUIRE=D INSPECTIONSi - - Tipard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp mechanical Ir1sp applicable laws. All work will be done in accordance with approved Wt•r P•rorlfir7g PTm P11.1mb Top Out pl-r,. This persit will expire if work is not started within 188 Pc),-•t;/Beam Strl.lct Framing Insp days of issuance, or if work is suspended for sore than 180 days. Past/Beam Mec:llan F• i replace Insp Crawl. Drain Gas I.. rrie Insp f'er'mj.ttee Si.griatt.l•re-. _...___.._ ..__.....__...._._ .---. __._._.._ PI111/Unds.lab Insp Insulation Insp PLM/Underfloor Gyp Board Insp T.S l u e d B y _.........._ .._......_-_._-___._..__...._...._ ..._...__...._................................. Ft)-)q 1)r a i 11 B sy m" t Rain d•r a j.n Insp Call for iimpeetxfJn 639 4175 ITY OF TIGARD OF PAYMENT PECEIPT NO. s ',W34 CHECk' AMOUNT : 3037.65 PJAME WANTLAND COMPANY C';f)5fA AMOUN7 - ().Q(') I ADDPESS I SW ORCHID 'STREE'T PAYMENT DATE e 07/1 (" 'Prl PORTLAND. OP 9722:!,--- SUBDIVISION PURPOSE OF PAYMENT f"fllClUNT PAID PL.RF,'OSE nF PAYMENT AMC)LINT PAID "18C . of.) ii-i�iTi�T�C73 1 7FF—� PLUMPI NG PERM A; MECHANICAL PE 70. ('10 PUILD PER Sri. 80 PLAN CHECY' FE 165.05 STREET SDC PARf!:F SDC C)111 12171+ SW NORTH Df)�-�.OTA S-,'T, 1197'90-02`18. S4JR90-1,1284 1 BW NORTH DAV.07A ST . M�-.3790-CP237.SWR90 C)All 8 TOTAL AMOUNT PAID 30-7,-7. 64j . aE.WER CONNE C 'rIONC17YOFI1VA� PERM II C11OF E.RM I T t. SW R 3 H 0 E B 4Ya6 COMMUNTY DEVELOPMENT DEPARTMENT PRIM. PERMIT' M. IrS'r90 -02313 13126 sw Hall Blvd. P.O.Box 23391,TOW,Oregon�22P76 1 �j « I?Are: ISSUED: 06/29/90 S II E:: ADDRESS. . . ; 1.i:'::i/F) SiW NORTH DAKOTA 13T PARCEL_s I S1:34CI:c-050P)0 SUBDIVISION. . . . � A1+1*ON PARK ZONING: R--7 BLOCK. . . . . . . . .. . ., L..C)'T.. . . . . .. . . . . . . . a l.r USA NO. . . . . . . . . . :42338 FIX7'JRE:- UNI'T'S. . . CLASS OF- WORK. .. ., -NEW DWELLING UNITS. . a .1. I'YF'E: OF: USE... . . . . :SF' NO. OF BUILDINGS a 1. INSi7'AL..I.., J'Yf-''E. .. .. .. -BUSWR 1111-:'ERV SURFACE. . RcemarP.S a C)wrier —. _..._....__.._..__.__.. .._ _..__..........._.._._...._.._._....__.._._ FEES __..__..____...._..__....___ rHE: WAN1'I...OND COM type amcal.cnt; I:iy cute rrerF)t THE: WAN'TL_AND COMPANY POYM 1285.00 JL..H 06/29/90 r202221 5411 SW MARSHA (:)'I' P,RM1' ? 1.2150. 00 PORTLAND OR 9'7221 0000 INSP !h 3`5.1 00 Phc11.1Ee On 503--24 ...5999 C;o 17'!;'r a r.:t ca r a -•--_..----......... CONTRACI.OR I1I0'T' ON r-"tio1-1e Ma $ le83.00 TOTAL R Fe tj ii,. ., __......_._.... RFClUIRE1) IMSP C'TION S ........... .__.._.....-- This Applicant agrees to comply with all the rules and regulations Sewer Ir1r'pecti.on of the Unified Sewage Agency. The permit expires 128 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement _._._._.__......._..._.......— _...___.._._ given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchasr A "Tap and Side Sewer" perait and the Agency will install a lateral. P e r,n1 i t t:e e S i.ri r1 a.f.1.1 r to a ____...________................_......__...._.-_ L'i5il.led By: L:.'a1I fo-r irlspec�t1l.cni7 639•-4175 I CITY OF TINA RD U125&W.I 3 PLAN aD APPI.IC�AI'ION P.a. re sm 9 1'fAN (IiI]CZC # i, �o b n / n COMMUNITY DEVELOPMENT DEPARTMENT (50)639-4171 I'EFd�II'r # ' r `j�' ` G 2.3,Y DTE IS:�7Fr' JOB ADDRESS: TALC MAP/1 yr / ;V C SUB: A r+c- v'A IUP: I"L— LAPID USF.: VALiffiffICIN: i owfmz SPE)= NUM NAME: REISSUE OF: ADDRESS: IASr REISSUE: FIOOD PLAIN/ _ SENSIZZVE LAND: _ PHWE: C,b L RE IRED _DONIRACrOR PIANNIM: _ NAME: .Tc �- �n.' rzT �..w, �L� �-� JG• _ ADDRESS: t FIIZE DEPT r PICNE: ZA4- L� I'rm__ Mum- BUILDERS BOARD #: S 2-c--)o _ W OATS: 12-- 1 r.- ri d I=/ . BUS TM: _ NAME: rt-s� �ri►'7 TRUSS E3AUS: ADDRESS: _15 r 5 z3 arfm: _ Z,t 2: 2 1 C.� PHONE: Z.L_5 STB: ./%r Gni�L u.t Cy G�9,E✓ — „�;.1'��iZ�.�'�.a,`- i'-.,-�ij��l �,,�._, Ei3BOOtM3ACDORS: PH": (4� � � 1�E;: 1 e 1'F MT if ACCP # DF-S R.IPTICN ANDURr AMOURr PD. HAL. DUE 10432 00 Building Permit Fres ✓ ,__.j - -7" y 10-431 00 Plumbing Permit Fees —" ' 10-431 Ol Mechanival Permit Fees t, -— ^- 10-230 Ol State Building Tax (5%) U 2? Yv Building Plumbing -- 10-433 00 Plans Check Fee _ Building j c Plumbing Melfi 30-202 00 Sewer Clonnection j l L ST `.� ,O 30-444 00 Sewer Inspection -- 51-448 00 Street System Dev Charge (SDC) 52-449 00 Parks E�ystem Dev Charge (PDC) 31-450 00 Storm Drainage Syst Dev Cu-q (SSDC) --3✓ S 10-230 06 Fire A-t�- /5 715, v APPIIICANT SIGW=E Raceived By: 1_.'._---- _--- Date Receival: of/3587P.WPF GRADING/EROSION CONTROL INFORMATION GENERAL CONTRACPOR NAME&ADDRESS: CASEFILE NO.: PERMrrNO.: c — APPLICANT NAME AND ADDRESS: EXCAVATION CONTRACTOR NAME&ADDRESS: OWNER NAME AND ADDRESS: TELEPHONE NUMBERS: APPLICANT 2�`! X71 PROPERTY DESCRIPTION: OWNER- STREET ADDRESS AND CROSS STREETILOCATED GENERAL CONTRACTOR: -- EXCAVATION CONTRACTOR: — SIIFJIOBL LEGAL DESCRIPTION: 24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION: SITE SIZE,ACRES; DISTURBED/WORK AREA,ACRES: LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAWS TO:(CIRCLE ONE) (NOTE:PMUOM MAY BE REQUIRED) CATCH-BASIN DITCH PIPE CREEK (CIRCLE ONE) PRIVATE PROPERTY PUBLIC RIGHT OF WAY EROSION/SEDIMENTATION CONTROL (ESC) MEASURES MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS DURING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FA(.LITIES STABILIZE.EXPOSED SURFACE STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC PERIMETER RUNOFF CONTROL FACILITIES CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OTHER OTHER PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH 177.CHNICAL GUIDANCE HANDB06K". EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGE14CY PHONE NUMBER, SCHEDULEISTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND APPLICABLE STANDARD NOTES. I HAVE READ AND WILL COMPLY WITH TllF, OVE AND WILL CONSTRUCT AND MAINTAIN ESC MRASURESECESSARY �— /TO CONTAIN EDIMFNT ON THE NSTRUCTION SRT. �7 OWNER SIGNATURI: APPLICANT SIGNATURE • • • • • • • • • • • • • • • • • • • • • • • • • • • • • w • • • • • • • • • • • • • • s • • • • • • • e • • • • • • • e • • • • OFFICIAL USE ONLY. R ICE 1 PT DATE ACCEPTED hiI NUMBER RECEIVED BY