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11558 SW TWIN PARK PLACE t 6 d ~ ;P i I f i G i i �I i - 11558 sw TWIN PAF,P: PLACE INSPECTION NOTICE (� City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phoma: 63q-4175 Type of Inspection �� 49 c!—rt 44zz 42— Data nequested__— — `Zlz_ Tuna.-- A.M..--j"L P.M. 7 Address Z. � Permit Owner __ Lot Builder The following Building Code defici-,rcies are required to be corrected: t Presented to N—A bPrnved Disapproved Date --- CALL FOR REINSPECTION L_7 YES 0 NO FAF1 wx/ TIi C11YOFTIGARD CE.rt7'IF'ICATE OFOCCUPANCY �CiTYOFLi6��RD PERM T 11. . . . . . . r M$'r'�0-0 y.>?•t' COMMUNITY iDEV'ELOPMEI T DEPARTMdT aw4o.; 131266WHWlWn1 RQ Hox?3397,Tigard,()ratpr 97223(5W)MA176 / VN t C ISSUEDo 10/226/90 crVIE ADDRESS. . . I 115!ja SW TWIN r..fIR< FAL PARCELS 16134DC-W® 5P0 SUBDIVISION. . . . I TIUARD PARK :ONINGs BL.00K. . . . . . . . . . I LOT. . . . . . . . . . . . . tii CLASS UF' WOkK. INEM .r'(r,E OF USE. . . i9F OCCUPANCY ©TtP. IR3 OCCUPANCY LOADr1tA 4 TENANT NAME. . . a Remark%I Owners DON 11ORISSETTE BLDERS, INC. P O 'BOX 19504 PORTLAND OF 97819 Phone K I %3­244-9314 Contractor t »._..._.__.._.._.._........._._.- DON MORIS`3E'1 'rk BLDERS, INC:. P 0 BOX 19.524 I t1KTLAND OR 97Y.19 Phone ra a 503­620-75.33 Rep ". . s 35533 Occupancy of Cin ab(+ve refp�rencr-d huildinq in hereby given, and r..twrtifires the compli.an:.!e wi �R ;,he State Uf Or'egr,n 9pec,ialty Coder for the group, occupancy, and USW under which ,`hw rpierenced permit was issued. F"IRE r.F.r'NR'rMENl' BUILDING 'i�»I•S-PECTOR T4 I L. POST IN CONSPICOOLTS PLACE I N 1W I W INSPECTION NOTICE. City of Tigard Building Derartment -2 13.0. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection r3 Date Requested 122 Time A.M. P.M. Address ,Vs. .� �C Z s Permit - Owner---- _-._—. — Lot Builder— The following Building Code deficienciNs are requires', to he corrected: ,.; - - Presented tq _ -----.-.- Approved Inspector`'/ — -- --- ----- Disapproved Date a--- --- --- CALL FOR REINSPECTION DYE$ ❑ NO INSPECTION NOTICE tt.. City of Tigard Building Department P.O. Box 23397 Tigard Oregon 97223 Phone: 639-4175 Type of Inspection 1f22 i_ 17 Date Requested Tlme A.M._.�—P.M. Address �'�-TX—,,.. 1��t3.1_ l-'- Permit Owner -_— _ Lot Builder The -- The following Building Code deficiencies are required to be corrected: Presented to --- —_ /��Approved Inspector ❑ Din approved DateCALL FOR REINSPECTION [] YE! �10 nr we F"MIMI raw I INSPECTION N177ICE City of Tigard Building Department P.O. Box 23397 I Tigard, Oregon 07223 Phone: 6394175 Type of Inspection Date Requested / r_— Time_ A.M.---P.M. /-,? Permit ` lll� Address _//�{� 7 L �k .�. Owner _ -- - Lot Builder ►) lGa,2IZc sS � -cT�= --_- __ The following Building Code deficiencies are required to be correc ta,d: L7_ no✓etc' (? i-�.�i�lI'l_..j o L 11-41Z ee .vC DL Presented to _ Approver! Inspector Disapproved Date CALL FOR REINSPECTION DYES ❑ NO N� INSPECTION NOTICE , City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requcasted_____ / ��—l�.�i Time A.IN:�1�_ P.h1. Address % .5 1Z?t � �_ Permit # 5 Owner -- ..-- -- - - Lot Builder The following Building Code deficiencies are required to be vorracted: t Pis vIntod to Avproved Inspector Disapproved Date CALL FOR REINSPECTION C.` YES o �I J r INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection z d yrs- -- --•- Date Requ,steel_— Address _ ���SS 3 '�!Z�3�_ - Permit Owner _ _ Lot # 9� ' 0/ S Builder_ _ �— The following Building Code deficlencles arb A to be corrected: `+��JT c�l�L1/._�✓moi 1�i4_,�/a—„/�•1_�0�. 1^'t�t�� �,i�G.�-L11� v t Fresented to Approved Inspector �” J __ _ ❑ Disapproved Date - CALL FOR REINSPECTION 0 YES ❑ NO INSPECTION NOTICE � Z/ City of i igard Building Department P.O. Box 23397 Tigard, Oregon 97 223 Phone: 839-4175 ,✓1 .Type of Inspecticnn Date Requested_ Time_. A.M. P.M. Address V, Permit #qD"-FJ I � Owner Lot #--_—� Builder The following Building Code deficiencies are required tj toe corrected: Presented to / _—_— -- _ Approved Inspector �I_�+ _–_- Disapproved Date (:ALL FOR REWSPECTION yea L NO .� WIN- INSPECTION NOTICE City of Tigard Building L7npartment P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection —1p—�_�_�_�^c�c'°r c — Date Requested_ �1-3 _L�__ Time A.M. 111116— P.M. Address f/,ZJ� --Jcrz24 �� Permit # . Owner-____ _ _ Lot BuilderThe following Building Code deficiencies are required to be corrected: IV resented to _—. _ — --_--.- ---------- --- `Approved lns)(-,:tor -- L] Disapproved CALL FOR REINSPECTION O YES C] NO •i 4 INS►'EC;TION NOTIG- City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 y1� Phone: 6394175 Type of Inspection ------ Date Requested _ �( ` [:� — Time V A.M. P.M. Address _.�� S' � Lr1��,� _ Permit Owner – – – - –---- Lot Builder The following Building Code lefici ies are required to be corrected: Presented to '�Iapproved < 111 Inspector --- ❑ Diapproved Date CALL FOR REINSPECTION 0 YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested �, .�C'� `'G Time A.M._ P.M. Address _____�� 15.5 cl — .� -rat- 4 G! — Permit Owner _ Lot # BuilderThe following Building Code deficiencies are required to he corrected: Presented to Inspector ❑ Disapproved 02 Date ell -- CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phones: 6/39-4175 Type of Inspection _ MELvs/ _ —_— Date Requested —4b Time A.M. P.M. AddressPermit Owner Lc t4d-61 Z5 Builder _ The following Building Code deficiencies are required to be corrected: ^ ' ovi F/ Lr ia !Dc. - 6$4 ZaC, 'ac.icy=T c Ac �'Ircr=ntr•r� fn proved � -- Inspector _ �U ❑ DisepproYed Date CALL FOR REINSPECTION ❑ YES ❑ NO 111111F f l� t• INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 l Phone: 639-4175 Type of Inspection `- �� Date Requested. Time — A.IIA. .� P.M. Address _1�• ..�j �y Permit Owner _ /'') Lot Builder..--1-� U (5 I z j The following Building Code deficiencies are required to be corrected: ell Presented to roved Inspector � – ❑ DIs+spproved Date !" — CALL FOR REINSPECTION CJ YE= ❑ NO w R N wj=! liffr INSP!7-.CTIUN NOVICE City of 'i igard F,uilding Derartment P.O. Box 23397 Tigard Oregon 971.23 Phone: 639-4175 Type of I nspectior, _L�L�► _. ±� /� !�_ , �i Date Requested _-..1_ �L!__. Time-2SL A.M. — .M. Address _,�L .----- �1 »- htr�� _-���-_------ -_...._ Permit Owner _— ----- --- ----- _ Lot -----ThBuilder e folle.ving Building Code deficiencies are required to be corrected: --- — - I Presented to --- ---------- yy� Approved I , Inspector — pe isappraved Date - CALL FOR REINSPF,C7'ION U YES I --J' NO C17Y OF T'GA RD mnsTE:,R rIEFA11T COMMUNITY DEVELOPMENT DEPARTMENT - - " - 111!3P 11!3 P?W---01 13 In 6W Hell Blvd.P.O.BCW 23397,TOW,Oregon VM(600)630-1176 F."RIM. PERMI*T fl. - NST'J0­ 1,25 1QGUEdD0@ 07C/16, JO, I I'F. ADDRFSS. . . 1 11558 13W 'TWIN PARK r1I PARCELs 1S134DC---09'.'j0F) TIGARD PARK ZONING: P I OCV. . . . . . . . . . I LO'T. ....•....... ...... . ........x.. ....... i. IS('-,;LI DWLLl_ING UNITS.- I PASEME1,11... . . . . . . » 0 f t",I ASS OF WORK. NEW DEDRMS:3 BATHS:2 OAROGF.'. 400 5 f FYF1E OF' USE. . . RSF FLOOR AREAS------- REQUIRED ryr,E oi.- CONS'I'.. v5N F1'.PST . . . 1.816 S,F L.EF: 1'. . :5 1'i; F.;1(31.1 1 . :1.f3 t * 'Ur -Y GRP. i R3 .K.,(.', )CINC SEC OND. . . 10 S f F"RON% :20 ft FiEAR. . :53 ft 1'0 R S. . . . 0 t�I I R D. (1 f, RFULITREV ---- I 1[.JGH*T. . . . . [:A_tJOR 1.11AD. . . . 240 Ptif VAL.UE. . $ L3:347,' POR'KING Tal-'ACES.. -0 PI.-UP11ING INKS. . . . . . . r r : I FI_OOK DR(41N�;. . .. . r PACKF1.0W PREVN'TRS. . o 1.(AVA'TURIES. . . . . 4 E., WATER HEATERS. . . r :1. *1 k A V,S. . . .. . . . . . . 4 » . . to IUB/131.1 IWERS. . . g2 L.f•IUIIIDRY I RAYS� . . .0 i.1ATCH BASINS. . . . . . . i Fj WA'T'ER CL.M..-A S. » A 20 !.';L.'WER L.INE (U0 . a@ GREASE I RAPS. . . . . . . 90 DYSHWNSHERIG. . . . it WO'Tl::"R I_TNr (+'t) . a 1 0P.1 0 T 1-4 k F� F 1:Y I U R ES. 0 ''RDPOE DISP. , 1 POIN DRAIN (ft) . i@ I 3HING MACH- » R I E I:- RAIN DRAINS. » : 1 MECHANICAL. F*I.:.,E.1i [_(jFL TYPES--- LIN 11* HTRS. . P0 typo- amount by date T,e C 1:1 /GlAs/ i 1 vk:.N,I*S . . . . . R PAY11 $ 1pjpj. 00 JLJI 0:-11/28/90 1138077 IV)X Irml."'U'Tup) P I'Ll VENT f"ANS. . -2 BPR r $ 33`3.00 U R N < I(a 0 V% I HOODS. . . . . . R 1:21.•'1_(., $ P,50. 25 i.i r�Iq >::-1001: tj WOODSTOVES. -.0 P 5 P C. $ 19.25 1._00K F U R,H. 0 CL.O DRYERS. : J. S'TDC $ ('00. 00 _011 M/CIIP OTHF"J_e LINT T S;:0 11 S 1)C q' ?:;(%1. 0307 GAS OU*TLLT9nt PARK $ c7'50. 00 Uvine'r,". mr,R I" t, 3 0 0 DON I1UR1SSL*TT1. KDERS, INC. mr,L.c. s L. 5 0 P('.)X 195r2/4 1115 F"C $ 1. 65 Pr-`R T $ 117. 50 UR11J.'M OR 1.,,7P19 1:15FIC, t 5. as 1:11-ione #41 '50,3 -244-9314 B P L.C $ 221. 9 .................... PAY11 41 0. 00 JI...W 0f:,/1 ;'/90 VON MORISSUA-1E KDE'R5, INC. PA Y M $ 2042. 13 JL.I­I 06/17/90 0 PDX 1952,,,' 1*.1Fe'TL.AND OR 9723.9 i'110­le ": ".50,3-620--7,538 $ 2142. 73 To,rw_ This permit is issued subject to the requ'at7nrs containto in the REOUIRED INSPECT-IONS Tiqard Municipal Cide, State of Ore. Specialty Cooez Plid all other Foot/found Iiisp Plumb 'Top OUt applicable laws. Al, work will be done in accordance with awivb! Wt-r Proofinq I?snv Framing Iiisp plans. This PPTNit kill expire if work is not started within 180 Post/Beam Insp Fireplace Invp days of issuance, or if work is susp d d for pore than 1P days, "rawl Drain Gasi 1-ine Ills).) ,��tl V _ PI.-,/Itindsiuki, TnFjp 11.1---it.t1ation 1), ',ee 'i4l­ 1 , "P PL.M/Onde-rf Toay- (3yp Poard TJI:,J.) j.f:t S !. 1;' 1 F tn q Dr a i n Psm I t Rain cl*rain Ins p J.siSL(ed By:: ........... ......_.__._._.___.x, mectl an i C, I In s p Wate-r Insp L Call fa-v insiptac.,tivri 639--41*75 11 N N E C 71.n iq ,�EWF7R CirlOFTIFARD 1' COMMUNITY DEVELOPMENT DEPARTMENTRD F-ERMTT #. . . . , . . - SWR90-01.'35 13125 BW Wil Blvd.P.V.1k*2.'!397.lVwd,Or*W 97 (643)0344176 1"'RIVI. F'ERMI'T' 0.. . 1111i'T'90 0 1.21�:) GO,) 4,1 /.1 lli�S(JLD,, OL/18/90 1.1558 SW TWIN V, RK F'I_. ZONTM34 I'LOCK. . .. . . .. L.C) . . . . . . . . . . . . . . 11, (j(.,A NO. . . . . . . . . . ..4161*1 FIX'WRE. L)NITS. . . CLASS OF' W(JRK— 1,1 E'.bJ DWIE"LLING Wqll'S. . -. 1 'TYPIE OF-- UBE— . . »1.)F NO. OF WRLDINGG. J. i*Yi--,,i.--*— ,, ,. D us w r� TMF�ERV (;URFACE.. f ma -r k tB c FEES DON BLDERS, INI.I. t Y P t-? amoulit by date -rec r,)t 1-?C)X V,R 111, $ 1.250. 00 "PTLMD OR 97719 I:`MAI $ 1.285. 00 JLH 06/17/90 V,1-fc)r1e 01 ',503-244-9314 ccm--(,acto-r—. ............... ...... CC)NTRf1G'T'OR' 1,101' C)H FILL*. $ 1.285. 00 TOI'AL REWIRED 11%1Sr,ECT'1DN$7, This Applicant aqTees to comply with all the rulrs and regulations f:,ewe-r lri!;pectitiri of the Unified Sewage Agency. The permit expires 128 days fTrA the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of ti,ra zide sever laterals. If the sewer is not located at the seairemei,4' giving the installer shall pros!ect 3 feet in all directions from ............ the distance liven. If nati so located, the instiller shall purchase a "Tip and Side Sewer" Permit a.id the Agency will install a lateral. Vle r11 i ),tee VI.Atk.k-Pe Td B y. ................................................. .................................. ............--.......... ............ ........... C a I I for, inspec�tioii 639-4175 �-"VTY OF TTGf)Fkf) RECEip"r, OF PAYMENT RECE-.'TF*T NJ2. CHEAJ AMOUNT t W;PIE s MORI SSE_TTE. DOW CASH AMOUNT r PAYMENT DATE SUSD 1'.)ISS I LIN r-cip7i.-ANL). op r i q.- i vnia -r'wTN F'ARK F-L PUPr"OSE OF FAYMEIAT AMOUNT PAID PL)PPOSE f.'T PAYMENT AMCIUNT' rAID Ct1rT-- 0 5. Fl.L'I I Ff r N i E FM 1 i-c6i�i6 F-E P'M MG Tl7?() 0 1 .!) MET,10NICAL RE. ''3.00 ,;'T, P1,171-D PER PLON CHECP: FE 45, SUWEr. I Ss:) I SEWEP'.' lll,.F',FTCT STREET GDC 6('07 1=AF4 SDC STOPH VPAIN GLA' Tf.)-Ii!. AMOUNT PAID 2327. 7- View comments for selected item 6AMASTER PERMITAAAAAAAAAAAAAAAAAAAAAAAAAAAaAAAAAAAAAAAAAAAAAAAJ�AAAF�AAAAAAAAAA�C :MST90-0125: PROJECT:TIGARD PARK STATUS:I : UPD:06/17190: :JLH: ° PERMITTEE:DON MORISSETTE BLDERS, INC. PRJM. . :MST90-0125: ' SITE ADDRESS:11.55B SW TWIN PARK P'- 6A L6A CASE HISTORY AAAAAAAAAAAAAAAAAa.AAAAAAReq/SerltASChd/Due&E:id/DoneAAByAStatAAAC A705 Foot/found Inep 71(,/y A707 Wtr Proofing Bem't Walls A710 post/Beam Inep //Z5/70 p j.,p w. A713 Crawl Drain A717 PLM/Underfloor. 07/25/90 MS PASS ° A718 Ftng Drain Bem't Walls A720 Mechanical Insp A722. Plumb Top Out 09/14/90 4S PASS A725 Framing Insp A726 Framing <REINSP> 09/18/90 KS APP A730 Fireplace Insp 10/25/90 KS N/A A'135 Gas Line Insp r/4//rj0 Nvv lcX A740 Insulation Inep 09/21/90 KS APP ' A745 Gyp Board Inep 09/25/90 KS PART A745 Gyp Board Insp 10/10/90 KS APP ° i,3aAAAAAAAAAA€aAAAAAAAAflAAAAAf�AAS��AAAA/i�►`1fiAa3/.:AAAAaAaAAAAAAAaAAAAAAAAAAaAAAfiAAi I I W I I W i! 0FTi6A*' RD PLAN CHECK APPLI:ATION C1TY A.. PLAN C1{ECK N NT PERctIT rr s COMMUNITY 01=VCL01'MENT OEPAI3TM E �n DATE. ISSUED - �r p,rye..srm.(sa�lo �]xrSi.w.w�e�.d_IA.aert nv'^� 7AX P1nP/Lor 3 Y VC - �S-u v J00 AOORESS: � LAND USE: �• LOT: VALUATION: _ SPEOA� U 11_R 11'1' RES•iSE Nntit:: � y LAS:ii- RREISS SUE: AOORE:SS: U ' (Q©�—y 7 ►--�- _ I:L(:K)O PLAIN/ 0 - AO _ SFjw.ITIVE LAND: P1K>nlE: 2 � CrZ(K i1 C(C�t t�GE/�-``�` - APPROVALSRL`QUIREO_ PLANNING: _ OONTRn�OR / �� `j - ENGINEERING: _ - NAME: 1 ; FIRE. DEPT _ ADDRESS: _ --- a?1 ('�Lt'L�✓ OT11ER: --- -_~ ._ --- - ,.�,•(� ITF1'�i5� RE�l1IRE0 PRONE• LIST%SU1300NTRACTORS: 13US TAX: ARCH, /ENGINEER j ,�Q - CALCULATIONS: NAME: TRUSS DETAILS: AOORFSS: ----"- PARKING PLAN: -- - -------- LANDSCAPE PI-AN: OTHER: PNON- --- ^ �Em Com DESCRIPTION 10-437 AMOUNT AMOUNT PD. GAL. DUE pFRP1IT H AOCT b M 10-432 00 13ui.lding Perenit Fees 10-431 00 Plumbing Permit fees :,� c•c. ` �✓ , � U 10-431 01 Mechanical Permit Fees 10-230 01 State Building Tax (51) Building Plumbing neck 10-433 00 Plans Check Fee Ouilding Plumbing �D. e/� Jtci Mech 30-201 00 Sewer Connection5L 30--444 00 Sewer InspectionOD — —'r-- ;0 7 51-448 00 Street System Dev Charge (,OC) � - 52--649 00 Parks System Oev Charge (POC) C st Dev Chrg (SSUC) J`J 31---450 00 Storm Drainage y 10-230 09 TQF0 10-230 06 6Jashington County Fire R1 (9=,7-, -- 10-220 00 smart/Wedgewood ,, ��a_ "• (�" S( 1 01nF tel. r7 3 APPt_ICntir 51(.NnTuaE r,v�ni�(-� nv' - ---- -- — Uatc Received: v w a w CITY OF TIGARD RECEIPT OF PAYMENT PEC NO: 001OB077 CHECK AMOUNT 100.00 LjON MOR ISSE TTE CASH AMOUNT .00 RE5,a PAYMEN)' DATE t 07-.-'W'8--90 PORTLAND, OR 77219 K.00NO,'ADDRi 11518 siq rvlrri PARK FI_ PUPPOSE OF PAYMENT AMOUNT-PAID PURPOSE OF PAYMENT------ -- AMOUNT PAID ------- -- ------ PL�0 CHFCi- FEE ("--76Ri 100.00 TOTAL (-,,MOtjNT F,All,i 1013.00 IR A m ! 1 CITYOF TIG;A,'wRD aTYOFDFA RD PLAN CHECK APPLICATION , COMMUNITY DEVELOPMENT DEPARTMENT ° / PLAN CHECK N 13125 SW.HM Bird.-P.O.6oR 73391•Tigud-Om m gr.rn.(500)60!-1175. / PERm,rT NS- r, , 0/ITE :ISSUED JOB ADDRESS: ; S w T t,.,�,., P/1�� – TAX MAP/LOT S,UB: 1- _jT Q.I�- LOT: _– I 1 LAND IISL: VALUATION: _.��1-- _ — OWNER SPECIAL 'NOTES NAME: 1 Str Llu LY�s I/�c ___ REISSUE OF: ADORE. : 14�> LAST REISSUE: – > _ FLOOD PLAIN/ SENSI C IVE LAA10: APPROVALS REQUIRED CONTRACTOR PLANNING: NAME: _�-- _ ENGINCCRING: ADDRESS: �✓ �,�- FIRE DEPT _ GTNER: PHONE: _— _ ITEMS REQUIRED BUILDERS BOARD ll: 5 53 3 - _ EXP DATE: - l�y y LIST/SUBCONTRACTORS: _ BUS TAX: ARCH/ENGINEER CALCULATIONS: IJAME: -- �('�1 ! 1('i _ TRUSS DETAILS: ADDRESS: ~ �—�— _ OTHER: —-- ------..-� PHONE: c COMl1EN1S: (LIC _•DJ Il..n(,((, PC, w. I T L '�/ SIYBCONTRACTORS: PL-UMB: J6 ;�',!v „�,!" , ----- MECH: ,i r 'k /U•02 PERMIT y ACCT N DESCRIPTION AMOUNT AMCONT PD. BAL. DUE 10-432 00 Building Permit Fees 10-431 00 Plumbing Permit Fees . 10--431 01 Mechanical Permit Fees � 10-230 01 State Building 'Tax (5%) Building /y'. v Plumbing Mech 10-433 00 Hang Check Fee ✓ Qa "" ? /. �' Building — - Plumbing Mech i s(<< •, •0011 30-202 00 S,awer Connection �-5 30-444 00 Sewer Inspection __ a 51-448 00 Street System Dev Charge (SOC) — _- 52-449 00 harks System Dev Charge (PDC) 31-450 00 Storm Drainage Syst Dev Chrg (SSOC) 10--230 06 F ire -T--- 5 1 \ TOTAL_ .3.2 UG• y: ' REC H dJ ', APP . .ANT SIGNATURE Received By: _yell Date Received: Y �� cn/3587P/18P GRADIN(:IEROSI(, N CONIR01, INFORMAIJON GENERAL COrnRAC FOR NAME:&ADDRESS: CASEFILE NO.: 140) i.5�r_([S' --.— PERMITNO.:_ r= APPLICANT NAME AND ADDRESS: EXCAVATTONCONTRACTOR NAME"& ADDRESS: 4X E�-art !Z. e-) r_ khyV , < OWNER NAME AND ADDRESS: TELEPHONE NUMBERS: - — --- APPLICANT:. ti I : d i x PROPERTY DESCRIPTION: OWNER: STREET ADDRESS AND CROSS STREET/LOCATED GENERAL CONTRAC'OR:_ t (•2/ EXCAVATION CONTRACTOR: i I I / - SIT'i;/JOB_ _ Li GAL DESCRIPTION: IS I 9"4r>(._ 24 HR/AI'I`ER HOURS EMERGENCY TAX LOTNO.: PIA CONTACT PFRSON,TION:TLE,TELEPHONE: 1/4 SECTI � SITE SIZE,ACRES:_ -cNoL, vm DISTURBED/WORK AREA,ACRES: [.)CATION&ADDRESS WHERE SPOILS LEAVING SITT,WILL BE TAKEN SITE RUNOFF DRAWS TO: (CIRCLE ONE) (NOTE:PERMITS MAY BE RrdU1RED) CATC11-13ASIN DITCH PIPE CREEK ILC► � (CIRCLE ONE) PRIVATE PROrERTY PUBLIC RIGHT Or WAY LItOSIQIV[SEDIMEN'TATION " ,TIROL (ESC) MEASU L MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS DURING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE STABILIZED CONSTRUCTION FNTRANC'F REMOVE AND RESTORE TEMPORARY FSC PERIMETER RLFNGFT CONTROL FACILITIES CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DFBRIS COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OTHER PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH-TECHNICAL GUIDANCE HANDBOOK". EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETES INCLUDING;EMERGENCY PHONE.NUMBER, SCHEDULEJSTAGING FOR INSTALLAITON AND REMOVAL OF EROSION CONTROL MEASORES,AND APPLICABLE STANDARD NOTES. 1 HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY TO CONTAIN SEDIMENT ON THE CON CTION SITE- OWNER ITEOWNER SIGNATIIRF. — A.PPLICA SIGNATURE 0TiCIAL USE ONLY. RECEIPT DATE ACCEPTED }'`-1----- - - NUMBER __ RECEIVED BY 1 MEN Q i ' 1 P.O.Bcx 195,'4 Portland,OR 97219 1 (503)241-9314 The Found at Ion For A.frordahIe Home OSE R—YIN * 5C PL . 7igdf Lor I I T►G ACS ►0A►QL� Tf6A�►� -- err otic N — was ��ING7bN CC)v� rc)4t ZZ j A140 Cole u _ � sn FFC ►0 5 I i Za' 10,opajN t . Lkm 0 rF&, I0s.I � ra ur 0 Xlo A4770 �1 N C�IQr W (> I o4 w , �Ca, � - e 0 W'' tOr Z 13 r