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8145 SW ROSS STREET r p 1X Y UD N IQ Ln Vl cn 8145 SW ROSS STREET `� CITY OF T167A IR® CERTIFICATE of 4�* OCCIJPAN(',:Y ' W CJNOFTWM ID f",CIT #. . . . . . . . COMMJN[TY DEVELOPMENT DEPARfM 09200N 556 SW HW BW. RO.RM 23397,TOW,Or*W 97223(503)63"175 D01ZS353UFInd 05/29/91 SITE ADDRESS— i 8145 SW ROSS G1 PAPCr-.ZLi 2G112-'C8 -6A42 SUBDIVISION. . . . GOOD ACRES ZONING: BLOM. . . . . . . . . . . . . . . . . . . ----------------------- CLASS OF WORK. :NeW TYPE OF USE. . . eSF OCCUPANCY GRP. :R3 OCCUPANCY 1._OW116 4 TENANT NAME. . . i Remarks : , 1wnev"t --- -.- -. - . .. . - -- -.-- WM EVE RHART 10950 A GARDEN PARK P1. T76ARD OP 97e23 Phone Q nontractort CONTRArTOP NOT ON FILE Ohnne Ps ppm R. . .. Occupancy of the ,shove referenced building in hereby given, and certifies he compliance with the Itate Of Oregon Specialty Codes 14", the group, )CCUP&TICy, and ur-P under which the referencpd pprmit Wa-? ilssupd. FIRE. DEPARTMENT Bull-.01 3, INS-34-,FCCTOR I'JOST IN CnNSPICUOUS PLACE i 1NSPEC'P10N NOTICE City of Tigard Building Department 13125 SN Hall Blyd. Tigard, Oregon 97223 Inspection Line (Rec-O-•P?on )� 639- 175 Bueinees Phone: 639-4171 Inspections � Footing Plbg �op i.relab Meeh. Auugh-ir, ( Appr/Sdw1Y. Found. Plbg. Out Gas Line `FINAL: Poet/Beam Struct. San. Sewer Framing -Bldg. Poet/Roam Mech. Rain Drain Insulation -Plumb. Plba. Under•!loor Water Line Gyp. Bd. -Nech. Dr.t.o Regueetc+dt-- Address: �/ -215 t a -- — Permit #s � 10/9' Y - - Buildert— TNR FOLLdiING CORRECTIONS ARIL REQUIRED= All OL-- ef 7 Inspectors �Jl� Date:�� — _„`-APPROVED - r plSAAPPPROOV&D APPROVED SUEJECT TO A90VE Call For Reinep. INSPBCT1(N_NOTICE City of Tigard Building Departoent 13125 Sri Hall Blvd. Tigard, Oregy:n 47223 Inspection Line (R.3c-o-Phone): 639-4175 Buui�,ess Phone: 639-4171 Inspection: _ _r_---------- — -- Footing Plbg. Underelab Mech. Rough-in Appr/8dw1k Found. Plbg. Top Out Cas Line FINALt Post, Beam Struct. San. Sewer Framing -Bldg- Post/Beam Mech. Rain Drain insulation -Plumb. Plbg. Underfloor Water L^�inee Gyp. Bd. -Mech Date Requentedt _y_ -e= Tinier* AN PH Address: �J ��� �Rt.it ft�LGLL.�_ Builder• — THE FOLLOWING CORRECTIONS ARE REQUIRED: _,APPROVRD _ ,'` JI 'APPROVFD APPRO'VF.D SUBJECT TO ABOVE y Call Por Reinsp. NSPECTION NOTICE r City of Tigard Building Department I '?i 131.25 SII Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone)s 639•-4175 Puniness Phone: 639-4171 Inspeckl.cn:—^— Footing Plbg. Underelab Mech. Rough- •.n Appr/Sdwlk Pound. Plbg. Top Out Gas L`ne FINAL: Poet/Beaux Struct. San. Sewer Framing •-Bldg. > Poet_/Bean Mech. Rain Drain Insulation -Plumb. Pl.bq. Underfloor Nater Line Gyp. Bd. -Mech. 1 Date Request_4(:_. Address:_ A �L�J /L �.� — Permit #S. e!— Builders____, _416��._9THE FOLLOWING CCL CTIONS AAE REQUIR20t F\ Inspectors_ ..—_� — DatasL hPPROVP.D DIFAPPROVMD 11PPROVEri LUBJSCT TO ABOVE --Fall For Reinsp. kNgkRCTION-NOTICE City of Tigard Building Dopartment (...�. 13125 Bw Eel) Blvd_ Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phoa:::, 39-4171 Inspection:__ _ Footing Pl.bg. Undermiah Mech. Rough-in Appr/Sdwlk Found. 111bg. Top Out Gas Line FINAL: Post/Beam Struct• San. Sewer Framing -Bldg. Poet/Beam Mech. Rain Drain Insulation -plgatb� i Plbg. underfloor water Line Gyp. Bd. -Nech. Date Requested: Addrese:_�y�_ �� Permit #8 Builder:—` Jtlt�t K.J THE FOLLOWING CORRECTIONS ARE REQUIRED: --..-ROVED DISAPPROVED APPROVED S11BJECT yM ADM --Call For Reinap. INSPECTION NOTICE City of Tigard Buildiny Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested P.M. Address r PermitLot Owner � Builder — "- The follovhng Building Cor N deficiencies are required to be corrected: ------------------ Presented to _ - l 1 Approved Inspector Datey�}-� —C j_,, HDisapproved CALL FOR REINSPECTION ❑ YES ONO INSPECTION NOTICE 1 City of Tigard Building Department P.Q. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Ins,)e"ton /`Ct_�� 7711 L__ Date Requested —_ �D Time_— A.M. h P.M. Address Permitjz Owner - —--- � Lot Builder ' sa ��- --------- ------The following Building Code deficiencies are required to be corrected: Presented to — >� -- V"f4pproved Inspector - —. _------._- ❑ Ditrepproved Date _ � CALL OR REINSPECTION ❑ YES 0 NO MEFLWXVW W WAMRZM INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Cregon 9722.3 Phone: 639-4175 I Type of Inspection ___, .62 a Date Requested__ /—._-_-----._-- Time__)(.—_ AA.M.�'' P,.�M�.- Address Owner_ _. _ �_ Lot Builder �_�fc� 3rLL.----•---- The following Building Code deficiencies are required to be corrected: r Presented to _ —�� ',.Approved luspector _ ❑ Disapproved Date 1 _..—� �!! CALL FOR REINSPECTION ❑ YES ❑ NO _ � r INGPECTION NOTICE City of Tigard Building Department /r P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 C �/ Type of Inspection Date Requested _ ( ^ -:,) 7 Tlme ✓-1 A.M!(/ p M. f1�_ Address �L..__ Owner _ Lot #_- BuilderThe following following Building Code deficiencies are requited to be corrected: Presented to -- Approved Inspector I� --►�.� i l Disapproved Date CALL FOR RE IWSPEMON YES ❑ NO INSPECTION NOTICE � City of Tigard BUi Jing Department P.O. Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection Date RequestedTime__— A.M. P.M. Address . 9145TSS �r _T^� Permit Owner_ — -�— -- Lot #_ Builder _hAi cll,#2t") e_L_k' _� —_--The following Building Code deficiencies are required to be corrected: --- --- ---- - —ro Presented to _ Approved Inspector _ �/". ❑ Disapproved Date CALL FOR REINSPECTION YES ❑ NO INSPECTION NOTICE City of Tigard Building Department y P O. Box 23397 Tigard, Oregon 9721;3 Phone: 639-4175 Type of Inspection _ �.s J`/'°S5 v/�40 — Date Requested T '� U nme A.M._ P.M. Address % �(�� `� -S-/' Permit #1►77r�1L1 •u�4 j Owner_._ �. -- Lot #_ — Builder_ The following Building Code deficiencies are required to be corrected: � YJZ Presented to a [] Approved Inspector —1 r_ _ 'Q: isapproved Date CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone 639-4175 / r n Type of Inspection Date Requested q Time ( A.M,_ P.M. Address _ L 7 - / Permit #� Qvmer _ _ Lot # Budder The following Building Code deficiencies tare required to be corrected: /A-'S";PZ-C—,—1 —.. 4 r" ''D C� 4:✓.tom c.,: .____ Presented to ��rrC--],,__,A,,,.pproved Inspector K ✓ approved Date �-- /7-- 5wU CALL FOR REINSPECTION ❑ YEE 0 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 -✓ Phone: 639-4175 r Type of Inspection Date Requested / �Z- �y _ Time A.M. P.M. - Address _- -- yam Permit ��LL1� Owner Lot # Builder The following Building Code deficiencies are required to he corrected: - --- -- - ❑ Approved I+ Inspector //� '� roved Date -may/- CA. FOR REINSPECTION YES ❑ NO INSPECTION NOTICE City of Tigard Building Department r.O. Box 23397 Tigard, Oregon 97223 Phono 439-4175 Tape of Inspection �1c '-rslL.'' - at.Qg _ Date Requested '1U `��j Time A.M. P.M. Address Permit Owner Lot #_ Builder The following Building f:ode deficiencies are required to be corrected: Presented to �_... n Approved Inspector .-4-f" i pproved Date _ ALL FOR REINSPECTION kYES ❑ aO INSPECTION NOTICE City of Tigard Building Department r �) P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection __ �°�_/%( ��' .L .� Date Requested___ ^� _ Tl me _ A.M.__ P.M. Address ` � �� Permit # Z Owner_ , Lot Builder_ The following Building Code deficiencies are required be corrected: Presented to _. Approved Inspector - - _ � Disapproved Date CALL FOR R NSPECTION I YES 0 NO INSPECTION NOTICE / a_ ' a City of Tigard Building Department N.O. Box 23397 Ti W, Oregon 97223 tone: 639-4175 / Type of Inspection Date Requested_._ r IGS Time A M. P.M. ' Address Permit # `� -- Owner Lot # Builder The following Building Code deficiencies are required to he corrected! 09 v Presented to _...-_ Approved �iytJ Inspector / I// �'� ❑ Disapproved Date ''1 r CALL F9R REINSPECTION YEs C..l NO INSPECTION NOTICE / City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Pione: 639-4175 Type of Inspection Uate Requested-- / _CrL� Time� A.M.,_ _P.M. Address AL1 /`' -10 or-2-1 Permit 4 Lot #Owner,------7— Builder wner, ----_ Builder _ / ��� • —� _ _ _. The following Building Code deficiencies are required to be corrected: c I � Presented to Approved Inspector _--.— Disapproved Date CALL FOR REINSPECTION ❑ YES ❑ NO i I INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 igard, Oregon 97223 Phone: 639-4175 Type of Inspection _.—__ Z.(l`/ Date Pequeste(d��ff�� 2' - - 7 a Time A.M._ P.M..�c� Address __ 1Z5__ � __— Permit Owner Lot # BuilderThe following Building Code deficiencies are required to he corrected: r Presented to Approved Inspector isapproved Date _ -- C'ALL FOR REINSPECTION Ca YES U NO INSPECTION NOTICE/ City of Tigard Building Department P.O Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection Date Requested �`� - Time /11,1101M Address -- /�%:p e- -- Permit #C/G -11)19.3 Owner ---- --- -- - -- -- �— Lot # Builder _ _ _ __--_-✓ -----_--- _--The following Building Code deficiencies are required to he corrected: -T - Presented to __—__.___.__—.____.._..�._ "pproved Inspector —1i'_ —. _ _ U Disapproved Date e:, 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 �_------–_�`_.� d Get ;'-7 t.._-/ Date Requested 7 /D c'CJ Time K A.M.__...._(}._P.M. Address _- � Permit Owner _--— Lot #�� e_ Builder The following Building Code deficiencies are required to be corrected: Presented to _ XApproved Inspector _ [J Disapproved Date _ CALL FOR REINSPECTION El 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— 7 1/� _ Time—_/� A.M. P.M. Address '�C/yJ Permit 0� ? Owner_._ --_� Lot #-- Builder __ __ _ ..-.----._—. The following Building Code deficiencies are required to he corrected: i Presented to f — � I Approved Inspector Disapproved DateCALL FOR FOR REINSPECUON YES 11 NO C'TYOFTIFARD PI()STE R V,E R M I J, CITY O F TWARD P E R III I:1' It.. . . . . . . ... 11 S'T 9 0 01`:);:3 COMMUNITY DEVELOPMENT DEPARTMENT Oaeoc>tl I PRIM. FIERM11 H. . MS'1`90­0193 13125SWHWI Blvd. P.O.Boot 23397,Tip rd,Omqon 972M(W3)889A 175 I)A*T'I: TS)SIJED.- 106/06/90 J. I L ODDRUSE.3- SW ROSS ST aN EL- 2 St 12 Cl B U A#2 C, 14 DIVISION. " . . : GOCH) ZONING.- IOCK. . . . . . . . . . . L(:),I.. . . . . . . . . . . . .......... EJUILADING .......... ...... SS,U E C DWE;L.LING UNITS.- I. El P S E MENI . .. ., -0 sf OF WORK. nNEW BEDRIIS::3 P AT*14,13 is Gr*4161::*. . . . . . . . . . o.420 S-1 ,' S REQUIRED C;E*TFI()CKS--.--------------------------- T'Y PF:- (IF' USE. . . SF FLOOR (-)F"LA 'T Y pl 1::. OF ('0 N ST. '5 Iq FJ R S'T*. . 1.6G4 S f LEY'T'. . :28 ft IR IGHI'. -20 ft (.)C;CU ANCY GRP. -.R3 SECOND. . . -0 sf FRONT. :20 ft REAR. . .-20 ft ST'O R1 ES. . . . . . . ..0 'I"HIND. . . « -.0 sf HEIGHT" . . . - 18 f t T O'T'A L.---­---,------- -. :1.6 6 4 5f SVIOKE DETECTORS. I Y V()I_tj[::,. qj 77448 P()R K I N G S V)n C E S,. . 0 Rpnia,(+s u I..................... PLUMPING ........ �3;T III K S.. .. . . . . . . . 1. F( O()R DRAINS. . .. . ::0 BACKFAL..OW PREVN*TRS. . -0 1 0 v P)I'C)R I L.S. P WATER HEAl'ERS. . . 9 :1 'TRAPS. . . . . . . .. . . . . . . 00 I(314/91.1 0WERS. :2 1 OUMDRY 1'R()Y'3. . . 1. (1(111,1.-,1.-1 D A S I N S. . . . . . .. ..0 W01"FiN CLOSETS. . 2 SLWER I INE (ft) . :0 0 R E(I S E 1'RA PS. . . . . . . ..0 V, 1.13 11-1 W n S 1-1 E R'G.. . . . :1. W0 'T'FR LINIE (ft) . 1.00 01IAI:':.R FIXTURES. . . . . ..0 (30RFIAGE DIST'. . I RAIN DRAIN (-ft) . »0 W 01n)1-4 1 N G 110 G H., I GF R(11:11 1)R flINfii. « : 1. FEES -It - V LIE:,L TYPES .................... ............ UNIT I+ToRS. '.'0 type anIOU) I)y date recpt /C)$)S VC.'N"I'S . . . . .. :0 1:1()Y 11 $ 100,. 00 JL.H 015/29/90 20.1.1.34 4TU 1*F F( -0 - 67. 00 0 X I N r,U I _.0 L V 1.':.1 INS. . '3 1.4 1."r 11; 3 1.)1�N < :1001. 1. HOODS. . . . . . .. I B PLC: $ 238.55 1. R N > ::;:1.0("')11, 0 WOODS*TOVES. -0 1?5 F'(" 1.(3. ;.35 11 0OR F 1111111. . 0 (,L 0 D R Y I*"*RS. - 3. STD(11 600. 00 III F, < ::31.1 F, 0 OIAAFR UN11"S90 S IS D(" 11; 2150. 00 (:iACi 0U I'L E*T S I I VIORK 250.00 ........... . ...... ......... ............ ................ - M 1:1 R I q, 36.00 W III F.:'V V:R H fl R I $ 1.14'.`)50 fl 0f)RDL-11 F'ORK, PL $ V,P R,r $ 125. 00 T .1 U()R D OSR' ` 7223 5 PC $ 6. 25 PIorle 01 P A Y 111 1; .1.801. 95 11-1`4 1&-,/06/`90 W 1\1 t'%R/C 0 NI'R P G R CIWNE':.R This perAit is issued subject to the regulations contained in the REQUIRED IMSPUJIUNS Tigard Municipal Code, State of Ore. Specialty Codes and all other FOOt/fOU)"Id IIISP Mech,aiiieal Ilisp applicable laws. All work will be done in accordance with approved W t'r P r a c)f i ri y Efs ni PILiniti 'Top (lLt.t- plant. This permit will expire if work is not started within 188 Post/Fleanl 11.1sp F-(,anii.riq I)isp days of issuance, or if work is suspe for more an days. C.'rAwl D-rAiri Fi-rep.Iaee Irlsip 'ornli.ttee i.I I-Ii. Ufl(`.-�". s n) t G 1.a 1.) Gas I i I'l e I r)S p I I III d e-r s I a b i vi 111131.tlatiWl II-Isip P L.M/U ri d P-r-f I I-)o r Gyp Boa-rd Ivisp I,SSUel ............ d 4 Ft)1 1)'r a j.1-1 F'4 r..;III id t Ra .ri y•iw.ki.ii Irlisp Al ­­­ af .1. car inspection 639--4175 SEWIFCONNECTION ONNE CTIONC' YCF TIVARDi9�\� PIER111:1, oFnbAm ,E ; 11T. a. , . . . . . .. Sw ,9 w 0208 COMMUPtTY DEVELOPMENT DEPARTMEYcmmoa 'ST9001a3 rar26SWHWIBlvd, RO.Box 2339;,Tigard,a.00n QZM 176 DATE:. TISSUED: 06/06/90 I.I.TL ADDR11 t.;::,. .. . ; 8145 SW ROSS S1 F'ARC;ELc 2S1 ].r CB -Ci0#2 GOOD ACRES Z0N:p.hG.— 1.1 I._0 C:K. „ .. . . h I._Cl T ,. . . . . . . . . . . . . . '11-*NANT NAME::. . . . . USA NO. . . . . . . . . . .. 406`44 FIXTURE: UNITS. . . : CL—ASS (:1F WORK.. . . -.NEW DWELLING UNITS.. . „ 1 TYPE: OF 1JSE:. — . . a fiiF NO. OF BUILDINGS.- I � :I NST'AI_1_. TYPE. . . . s BUSWR IMF'{:RV SURF ACF. , p Re IIIA r I.S: WM E::VERNARI type anIOUIlt by date rec�P1, :I.0950 A CARDE:'N PARK Pl.. r'RMT $ 1250. 00 1.1,113I•' `ti 35. 00 11.GARD OR '.9 T223 F'Fi0re ax C;ra n t r a r.t ra-r a _...._._.__....__...._....._..... _..._.._._._.......__.._..._..__. C:CIN"T'RO C:-l"OR N0'TON F li...E F11-101-le fl;; >F _.._._........... R F:::(.d U I R k:1) INSPECTIONS lh;> Applicant agree< to rrimply with all the rules and regulations Sewe-• Iii-,pec:t:irai7 Of the Unified Sewage Aeency. The permit expires 128 days from _.._._.............__ ..__.___....._... ._....... _......._..._-____.. .._._ the date issued. The total amount paid will he forfeited if the permit expires. The Agenc, does not guarantee the arcuracy 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 liven. If not so located, thl installer shall purchase To and 5k'e Sewer" Permit and the wile jngtalatera -_. ..................___............_...._...._..__...._... ._._....._....._....----- i.is t;ca(? fi i.la , t:u r c':, __._..._. t._......._.....:. ................. _.__ _............. _..._..._»................_.._.._.._._..._ ___. ._..._...._.__..._._........._.........._. 1:riSUe!d C;a:I :I. rev a.rrs,p)eeti.on - 639--•41'7 cure or' Tl(.-)i)Pf) PECL'IPT' OF' PAYMENT PECEIPT NO. C;IAEC'f: AMOUNT' a 3108d"). 95 EVERHART , WILI-AAM/GEOPGIA AMOUNT s C) 00 rWOPESS z tog!,jo-f) BAF.I')F-t4 F'W: PLAC'E PAYMENTDATE SIM IV I S 1 CIN 01415 514 ROSS Sl REF T TIGARD, OR .' JIPPOSE OF F'AYMENT' AMOUNT PAID OF F;'AYMFNl' AMOUNT PAID H D 0 F EPH KST S0•-Cl 19 -.1167.00 PLLIMPmu Ri-,,,ii 5. 0(3 16.00 Sl . B Ll I L 1) PE R 26. 40 Pi i-M CHE-('l r t 147.'55 SFIAJF'r U6A 190 (J.'00 -10 )00.( -:d7WF::.F,l- TNSF'El-l' 00 STREE'l SDC' S sr)c Z.50.Of) ST(JRtl DRAM SEC AMOUNT FL*('.J.Ti) 6. `5 L ` CITY Of'" TIC76f,"D F'E(7,F,.- -" '.IPT OF" � AYIIENT F0:-.lCE.rFT' W. Li I 4 CHECK PAMOLIIA T 100.00 WILL.40 EVERHART Gi-�!:.,H AMOUNT t 01. 00 /-19/HCl IC)950A ofW)EI'l PARR..:. PL F(irtlrrtlT Di�TE' O,li - TIC-3ARD. CIP F:I.JFF-*'OS-E OF F."AYME"NT AMO 1,.)N,r PATD P.,WPOSE OF F,!-)Yt4iENr A001-111T PAID '1 i"ITF1L AMOUNT PAID 100. 00 CIIYOFT117ARD t3t2b sw�BlvdP.O.Box 23397 QiL7C1C 11I'f'I,I(1�TION COMMUNITY DEVELOPMENT DEPARTMENT � � )639-4171 I ATE IS-CUED `� JOB ADDRESS: S1/`f ti S fti�`�`' �- _ —""—� 1T11dD USE: SUB: Ilyl': — VAUPMCtd: 7;7 qi(/ >WNFR /� / SpDQA.L tpl- S C RLZSSUE OF: LAST REISSUE: - _ FIDW PLAIN/ ---- SIIuSITI'VE LAND: i'1 ic1NE: >" 2� A—PPROVAILS 12F,7�RRM PL WING: mumpam: ADDRESS: ` FIRE - PfitJNE: y` -76'k 1 DATE: LTSr/ -- BUILDERS B� #: ` — BUS TAX: �_ _II CMJCUT �TICNS: - TrdLS DL3'ATI.S: NAIKE: _ fit: — ADDRMS: 1'f IOhTE: C _ aze sLffK rRAC'PCJi1S: PILI` : y j E't --- ;: t AMX PD. BAL. DUE YE43�(IT # AC Cr # DESaRIPI'1: J ✓ _ 9.3 10--432 00 Building Permit Fetes -12 -� _ 10--431 00 Plumbing Permit Fees 10-431 01 Mechanical Permit Feer- 10-230 ees10-230 01 State Building Tax (5%) - - -- Building Plumbing L,�'- Moch �s 10-433 00 Plans Clock Fee --- Building Plumbing Med-i —�-,rte----+ � )2 30-202 00 :'_ter Omncction - ----- --J-5 30-444 00 Sewer Drpor-'t icn ►�----- 51-448 00 Street `'Y'stem Dev ClvwW (SDC) lJ 57.-449 00 Parks SY'stem Dev M-Arge (PDC) 31-450 00 StO m Drainage Syst De.v C". (SMC) -- 10-2:30 06 Fire TUML ( ' RDC l` ��. Ai'F'LTc11NP STCNA111RE / 1k:�oeived By: _ v Date Peceivied: of/3587P.WPF h F- Permit No: -- .----------- Address: _.--- ' Issued b - - Date: N : = Y - -- — \ STATEMENT: INFORMATION NOTICE TC' PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. Licensed Arehitect and Engineer applicants, xe ptstate from (egtswal Ibe under wOtRS 7 permit) need riot submit this statement. Fill in the applicable blanks, and initial box 1 and either box 2A or 2B: own, reside in, or will reside ir, the completed structure. 2 A. © My general contractor is -- - - Contractor registration number I will instruct my general contractor that all subcontractors who work on IhE? structure must be registered with the Construction Contractors Bard. OR B. 1 will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Con:-truction Contractors Board. If I change my mind and do hire a general contractor. I will contract with a contractor who is registered with the Constrssuinguthisr�building permit Board and I e name will l Contractors of immediately fify the office the contracorp I hereby certify that the ancve information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. g/a4f Permi leant DateSinoPp CONSTRUCTION CONTRACTORS BOArID 0244) 10124189 WHITE COPY -TO ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT J;BAD1NG/EROSION CONTROL INIiORMADON GENERAL CQNTRACT'Ol NAME&ADDRESS: CASEFILE NO.: ��. I ►ic- h y.� _, PERMIT NO._ ? APPLI NAAAQ EXCAVATION CONTRACTOR (74 77, - r " ' NI,�.� � 7 74 NAME&ADrDRESS --1 `�, �` ��� OWNER N L ~ AN ADDRESS: TELEPHONE NUMBERS: — APPLICANT: PROPERTY DESCRII'TION: OWNER;-, STREET AT)D!7 ItA NU �{tOSS STREETA OCATED GENIERAL CONTRACTOR: zj'!Y 5 SS 5 EXCAVATION CONTRACTOR: -- E 1--, �- ssl STIF/JOB;� LEGAL DESCRIPTION: 24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: CO P R§O ,TITLE,TELEPHONE- 1/4 SECTION: ti . v'k H�Ham."r SITE SIZE,ACRES: -- DISTURBED/WORK AREA,ACRES: LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WILL BE TAKEN \ SITE RUNOFF DRAINS TO:(CIRCLE ONE) (NOTE:PMMM. MAY BF.R.EQUIr(FD) _CATCH-BASIN 11`CH PIPE. CREEK i — (CIRCLE ONE) fRLVATE PROPERTY PUBLIC RIGHT OF WAY ERQ5.1QN/SEDIMENZ'ATlQN CON"IROL (ESC) MEASURES MINIMUM ESC REQUIREMENT'S MINIMUM FSC REQUIREMENTS DURING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES S STABILIZE EXPOSED SURFACE STABILIZE 1)CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC PERIMETER RUNOFF CONTROL FACILITIES CLEARINr AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS COVER PRACTICES ENSURE OPERATION OF PER MANT FACILITIES CONSTRUCTION SEQUENCE OTHER _ OTHER _ PLAN FUR EROSION CONTROL PREPARED AND Sl1BMTTTED IN ACCORDANCE WITH'TECH?lCAL GUIDANCE HANDBOOK". EROSION CONTROL PIAN DRAWING,AS REQUIRED.HAS PLAN CONSTRUCTION NOTES COMPLETE.INCLUDING EMERGENCY PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND y ..v� n n►vvrrc