8222 SW PATTI LANE o
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CITYOFTIGrARD \1 CEPTiF IC ATE OP
\cm&T1Gvm OCCLJPAN(.''Y
COMMUNITY DEVELOPMENT DEPARTMENT MOON PE PMI T 14. . . . . . . : ms r90 --wn
1312G SW Hell Blvd. P.O.&ix 23397,Tip M,onpon 9�2�,(603�93D 4176 �1
ITE ADDRESS. . . : Offil-22 SW PATT I LN PARCEL v 2G 1 12CL ►11 i 000
-;UBI).►VTf:;ION. . . . : LANOTRCE ESrAT'E:S 70NINGA R--12
1ALOCV. . . . . . . . . . . LO r. . . . . . . . . . . . . :2
OF WORK. ;NEW
C.. Of' USE. . . r SF
FICCUPAWC:•Y GpP. A R3
OCCUPANCY LOW' .-220 4
TF 114ONT NAME. . . :
Frelna�r•kt� L
l)w►ner L _.._....._.__.._.._.._..__._ ...__..__.. _..__. ._._ _ ......____ ._. _..
r 1..TAN F-1ROPE RTIES
00 BOX 6835
lal_OHA OR 97007
Phorm #: 6456477
TITAN PROPERT IE:S
PO SOX (.,a35
0L.UHA OR 97007
Plh oriv #: 6456477
Reg #. _ L 30558
I Ouc:•upanr..y of the above rPfPrrnr:ed bUildinrg 0 heret)y given, and cort, ifies
the compliance with the 5timte Of Oregon 1pecialty Codes for the group,
occ i.tpancy, &,0d CIS*- W)der' which the referertred permit was iQa1.led.
F"TI2F DF..PAPV4(::NT l IL- Nt; ±=f:C'T
f�U I l_ G l7F F'AL
POST IN CONSP I C11C111C PLACE.
�pgF CT_ 024
NOTICF_
Clty of Tigard Building Departsent
13125 SW Hall Blvd. Tigard. oregon 97223
Inspection Lina (Rec-o-Phone)t 6'19•-4175 Business Phone: 639-4171
Inopect).on: — ---- — - -----~
Footing F1bg. Underelab Hoch. Rough-in Appr/Sdwlk
Pound.
Flbg. Top Out Gas Tine 71NALt
poet/Beam Struct. San. Sewer Framing
!,:)at/Ream llech. Rain Drain
Insulation t -Plumb
Plbq• Underfloor dater Line Gyp. Bd.
h.
Date Regtteatedt
��,� � Time$ AN PM
Address: A C Permit
0
Builder:-
THE FOLLOWING CORRECTIONS ARE REQUIREDt `
1
^ —�, Dates
Inspector:s --- --
ROVED _- LISA.'PROVED _ APPR(?4RD Bl1R.TRM To ABOVE
Cell For Peinap.
NOTICE
City of Tigard Building Deportment
13125 OW Bell B1 . Tigard, Oregon 97223
Inspection Line (Re+'-O-Pho s 639-4175 Buninean Phone: 639-4171
Inspections—
i
Footing Plbg. r}Herslab Mach. Rough-in Appr/Odwlk
Found. Plbg. Top Out Car Line IPINALs
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Meoh.
Date Requested: •� �G Tinwi AM PM
Addrenss e� �,
Perm.l #: q
Builders 9 e) !
THE FtiI.1ATWIM, CORRECTIONS ARE REQUIRM
Inepertnr:�L /�
_ Date:
—_APPROVED DISAPPROVEb
APPROV_'D SUPJSCT IO ABOVE
—_Call For Reinsp.
UELLPF
�iSPTC �.ON—�iOTICE � I
City of Tigard Building DaportaeMt
13125 8N Hall Blvd. Tigard. Oregon 97223
Inspection Line (Roc-o-Phone): 639-4175 Business Phoney 639-4171
1napection:_ ------ _-----
Footing Plbg. Underslab hsch. Rough-in Appr/sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb•
Plbq. Underfloor Nater Lino Gyp. Bd. -Hoch.
AH
Date Requested: Time: PH-
Address:
Permit I:
`_� 2e
Builder:__ _ --
THF. FOLLOWING CORRECTIONS ARE REQUIRED:
i
-,Z
Inspector: i —�---- Data:
APPROVRD DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinap.
1�.J'ECTION NOTICE /
amity of Tigard Building Department
1517.5 IM Ball Blvd., Tigard, Oregon 971.23
Inspection bine (Rec-o-Phone)z 639-4175 Buainene Phone: 639••41
Inspection: _
Footing Plbg. Undcralab Mech. Rough-ie �App�/Sdw1k
Found. Plbg. Top Out Gas Line FINAL:
Post/Ream Struct. San. Sewer R_-aming -Bldg.
Post/Ream Mach. Rain Drain Tnnulation -Plumb.
Plbg. Underfloor Water Linn3Gyp. Rd. -Mach.
Date Requested:_ _ / �� � -Time, _PN
Address: ees���+�. /' / - L 2 / Pe-mit �
Builder:
THE FOLLOWING CORRECTIONS AR= "WIMMg
Inspector:
APPROVED DIBAPPROVBb
_ APPROVED SURJECT To ABOVE
call Por 1Ieim%p.
�a�
1115P1FCTION_HOT�IC6
City of Tigard Buf.le*ng Departnen-
13125 SW Hall Blvd. Tiga.d, Oregon 97223
Inspec'.ion Line (Ret-O-PY -)no): 634-4175 Bueinese Phones 6
Inspections—__.� -- — ---- - -- —
Footing PIlig. Underslab Hoch. Rough-iu Appr/Sdwlk
Found. Plbg. Top Out Gas Line FIVAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Roam xech. Rain Drain Insulation --Plumb.
Plbg. r1ndwrfloor Nater :.ins Gyp. Bd. -Meth.
Date Rern rteds__ AH --- PM
Ad,
Builder._
THE TOLLONINQ CORRECTIONS ARE REQUIREDs
t
(I
Inspectors- �� 1 - Dates
i ►PPROVED DISRPPROVED APPROVED EM"M TO ADM
-Cal For Reinap.
INSPECTION Nl1TICE
City of Tigard Building Depa'cment @I
13125 SW Ball Blvd. Tigard, Oraiton 97223
Inspection Line (Ree.-O-Phone): 639-4175 Bueineee Phone: '63 -4171
Inepoction c`-_��—���-- — ------------- -- ------ --
Footing Mg. Underslab Mech. Rough-in Appr/Sdwlk
Fond. Plbg. Top Out Gas Line FINAL-
Post/Hamm Struct. ISeu. Sewer (Framing -Bldg.
Poet/Beam Mach. Rain Drain Insul�cit.n -Plumb.
Plbg. onderfluor Water Line Gyp. ni. -Meeh.
Date Reyueetedt_ 1--a-Z-3--ell Time: AM —PM
Address: �1 .� Permit 1:C f 5c
Builder:
._—
THE PULLOWING CORRErTIONS ARE REQUIRED:
I nepector s '��•' --_-�-_
-------- Uates�_-� -
APPROVED DIRsonopVRD APPROVED SUBJECT TO ABOVE
_Call For Reine•p.
�NSPBL'TInN�I_O'_1`I�
City of Tigard Building Ik"rtmet
'125 SN Mall Blvd. Tiga:d, Oregon 97223 /
Inspection Li a (Rec-o-Phone): 63941-15 Rueiness Phone: -471
Inspection:^
rooting Plbg. Underslab ech. Rough- Appr/Sdwlk
Pound. Pibg. Top Out an Line FINALt
Poet/seam Struct, San. Sewer Framing -Bldg.
Poet/Ream Mach. Rain Drain Insulation -Plumb.
bibq. Underfloor Nater Line ay-.. Rd. -Koch.
DAve Requested:_ 7 -- Timet AK _ PK
Andress: d Permit
nuilder:
THE FOLLOWING CORRECTIONS KRE REQUIRED:
A
Inepectort
— A ROVED DISAPPROVED APPROVVD SURACT PO ABOVE
Cali For Re!.nep.
iiiiiiiiiii
INSPECTION NOTICE dy��
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
y
Phone: 639-4175
Type of Inspection
Date Request{i_f ?/ C Time A.M.
Address _ �lJ oi _ Permit #
Owner _ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
Presented tq _ - h(1 Approved
inspector` � .fes — [] Disapprove)
Date
CALL FOR REINSPECTION
C YES 0 NO
LNSPEsrao
NOTICE e
City of Tigard Building Depart.ront
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line Line (Roc-o-Phone): 639-4175 Business Phone: 639-4171
Inspections _ -- -- --
Pwting Ptbg. Underslab Mech. Rough-i:. Appr/Sdwlk
found. Plbg. Top &A Gas Linn FINAL:
Poet/Hear.) Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Draln Insulation -Plumb.
(,Vlba. Underfloor Nater Liaee Gyp. Bd. Nech.
Date Requested ��- 7�Qy� /� 1 Times AN PM
Address) /1 � �- OGt LCri.- Lei / Permit i3
Builders
TB= loIS.ONING CORRECTIONS ARE RRQUIRED: r1
Aid
Inspector: Dats:__�•'/�
APPROVED __21(DISAPPROVRD —_ APPROVED SUBJECT TO ABOVE
Call For Reinep.
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397 =
Tigard. Oregon 97223
Phone: 639-4175
Type of Inspection - /
Date Requested Iv CJ Time A.M. P.M.
-�Address -_ (' _' __.�'�_. f �_ — - `.J Permitl >
Owner— - — — -- Loc #- —
Builder
The following Building Code deficiencies are required to be co;rected:
.01
i
•
Presented to _ ❑ Approved
Inspector _ _ tpti tired
Date --— �c�2�7 —90
CALLREWPECTlON
YES C� No
INSPECTION NOTICE
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection �1d1�Date Requested Requested_l��S Ti e x A.M._ _P.M.
Address �f�a 3- �� Permit *j6
Owner Lot #
Builder —._—
The following Building Code deficiencies are required to be corrected:
Presented to __.— __ Approved
Inspector _ U Disapproved
Date ----- ��
CALL FOR REINSPECTION
DYES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection '
Date Requested T_L, �L nm ' �� A.M. P.M.
Address �-•:� -' �'� 'F� Permit #111�12v
Owner
Lot _
Builder
The following Building '.ode deficiencies are required to be corrected:
- _ I
- , I
Approved
Presented to
Inspector —. Disapproved
Date
-'2CAL FOR REINSPF,CTION
Cl YE8 U NO
i
11 P STE R PERMIT
C17Y OF tIFA RD Ai�k PIF:,R1y1IT Of. . . . . . . . MST90-10259
CffYOFTMID P[_-R11IT 0. : MST98-0259
LCOMMUWY DEVELOPMEN-r DEPART NT IT OR10011111 I
1?12"',WItWIPvd Po.Box 23397,*rigard,C,*;on 0221(5W)(JM4`t75 1)()*Fl::: IS'SUED: 10/04/90
08222 SW PATTI LN PARCEL: 25112CC-071000
I I P., I..(I N GTR E:E ZONING:
LOT. . . . . . . . . . . . :2
BUILDING
DWELLING UNITS: 1 14AS1-:'MEN*l.. .. . . . . . . go
III WORK. NEW 14EDRMS:3 P()'11-4,13 3 GARAGE... . . . . . . . . . ..400 %1'
1 , 11 1.0 USF. SF FLOOR AF(EAS._.....-.....-.__._.._..... RE:'QUIRED SE T BACKS—,--- —
1 ill 5,N I-IRST. "765 Sf E F 1' 5 ft RIGHT. : 16 f-!
1.,1.)H L,y R P''. F,3 SECOND. . . :586 !3ft
f FRONT. c20 ft REAR. . :29 f
i. TH I RD. . .0 S f REQU I RED----------
i20 f t 7 11351 s SMOKE DETECTORS. 1Y
r40 p%f V AL UE. . - 63942 PARKINC SPACES. . 2(o
PLUMBING
FLOOR DRAINS. . . . s0 BACKFLOW PREVNTRS. . -0
10 R.I.L S. . . . . :3 WATER HEATERS. . . 31 TRAPS. . . * . . . . . . . . . . ..0
I I0WI*1�5.; . . . ".2 1 AUNDRY TRAYS',. . . SO CATCH BASINS. . . . . . .. '.(4
It t..1 0 S F.' I S.. 3 SEWER LINE ( ft) . :0 GREASE TRAP'S. . . . . . . ..o
I I Lk,W:')I I1' .1. WATER [ 111E (ft) . : 100 OTHER FIXTURES. . . . . :0
: 1 RAIN DRAIN (ft) . e@
GF' PAIN DRA.*NS. . 11
MECHANIC Ai- FEES
1 .........._.__.....
i j I I I T 14 RS. . :0
. type aMOLIVIt by date r e c,pt,
VENTS 90 PAYM 1. 40. 00 JLH V)7/24/90 203044
! Hi 11r ::0 D I*U VENT FANS,. :4 PAYM $ 250. 00 JLH
10PI", . .. : I HOODS. . . . . . : l BPRT $ 325. 00
I 00V r.0 WOODSTOVES., :0 BPLC 4- 40. 00
"o CLO DAYE-ANS. o :1 B 5 PC It 16. 25
1 3141:0 OTHER UNITSIO 111'L C; 4, 1'5). 00
OAS OUTLETS: I STDG $ 600. 00
99D( 4� 25C,. OPI
k S PARK 1; 250. 00
MPRT 3`x. 00
Pit'-11C 4i 9. 75
M3PC 4, 1. `::5
P P RT 132. 51
r,5 F''1,. 1! 6.6,3
PAYM $ 1.396. 08 .)LH 10/04/90
,E:417
$ 1686. 08 TOTAL
I,; oprait is issued st.bject to the rejulations rontaiioad n the REQUIRED INSPECTIONS)
I iuve Aun'xirll Ode, State oi 0". bpcialty Codes and all other Foot/found Iiisp Mechaviical Irisp
aprI icabl? laws. All work will b# done in accordince with approved Wtr Proafiria Psm PIUMb 'TOP OUt
rials. his pereit will vipire if work is not started within 181 Post/Beam Strutt Framiriij Irisp
ti,tvs J issuance, or if work is suspended for Dare than 1189 days. Post/Peam Machan Fireplace Irisp
Crawl. Drain GAS Lj.iie .1ri-r
1:P P SJ 4 1-14A t U r e ............ P.Im/t.mdslab Insp Iristfl.atic)ri 11milp
PL.M/Uriderf loor Gyp Board I m.-ip
Ftiiq Drairi PsmIt RaindrAiv. Jris:p
...........
Cakil for i-,ispectiari 639' 4175
OF PAYNt"INT RECEIPT NO. :90-205480
CITY OF 'TIGARD RECL CHFCV, AMOIJ14 s 1396. 08
NAME r TiTAN PROPERIIES CASH AMOUNT s ().00
ADDRESS PAYMENT DATE s 10/04/'90
SUBDIVISION
9222 SW r-AITI LA
PURPOSE OF PAYMENT AMOUNT PAID PURPOSL OF PAYMENT AMOUNT PAC
LlUILDING V'ERM MGT9#,-)--,02r,r)9 127J.00 PLUMBING PERM .1 5
MECHANICAL PC 19.(m) S i) P E.R 24.(9
Pl—o'4N CHECK FE 2.4. 75 1 REET '-;DC 600.00
PAPKIS SDC 250. •10
AMOUNT PAID 1396.014
MlmmLTjLTJLq-wJLW-�WX rml wl W����
PA Y M E:N T r-,ECEIPT NO.
-TTY n(7 Tl(-�APD PECETPT OF -`()3i)44
C.iiECI-' APIOLIN'r r 12
NAME T. -T(4N CASH AMOUNT
ADOPESS PAYMUIT DATE 4.,q Q
SUEtD I V I S 1 ON
Al..0HA, OP T7(,t07--
CIAPPOSE OF PAYMENT' pjf,r.lpOTE OF F'AYMENT Awourj,r PAID
40. (%-3
FCtTtTI-HE'CJ FE 7 49P C 0 1:!LAN CHE:Ci FE
Pt AN GHEU: Fr-- 7 -51P
TOTAL AMOUNT F"AID
SEWER CONNFCTION
CITYOFCffYOFTE:R M IT
T167ARD P,1::.*R M IT
MND F- # SWR90--0096
0411119M
COMMUNITY DEVELOPMENT DEPARTMENT PRIM. VIERMIT MST90 (x)@89
13126 SW Hall BW. P.O.Box 23397,Tlowd,C#vgDn 97223., (6043)�Alr176 DATE ISSUE'Di 06/28/90
A 1)1)17i F.:9 S. N:'( 2 P.2 SW r:1 A'T TI L III F-1ARCEI c 2 S1.ii?Uc� - 0 00 P)
V 1(5) 1.011. . ., LAN(37TRLE' ZONING:
'I E.�14 0 HT 1110 11 L
U544 NCI. 4167 3 FIXTURE' UNITS—
Of` W('.)kK.. NE.,W DWELLING UNIT1,3. . - I
T*YF,1.':' 0F• U S E., . .. S F NO. OF ElUI LDI NGS i I
I III S I A L L I Y I*-1 E. D U.5)W 1--+ IMF,ERV SURFACE:. . ,,,, -.sf
R P fil ra-r k S
TT I A N I1 R()I::1 E'RTJ:I::-.s type amciuiit by (late re( pt
1::'(.) 1."0X (.,13;.35 I,RMT $ 1250. 0@
1:N S r) $ 35-100
()1 0 1-4 A (:)F; 97007 PIAYM $ 1285.00 J I...H 06 2 8/9V)
V`I-i c)r)(-7? 0;: 64`:54'7'7
(.;OH IA; NOT ON F: D.-E-
j.285. 00 TOTAL
q
R E 0 U I R E D INSPIECTIONS
This Applicant agrees to comply with all the rules and regulations Sewe-r Dispecti.on
of the Jnified Sewage Agency. The Permit expires 120 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 feFt in 911 directions from
the distance given. If not so located, the installer shall purchase
"Tap and Side Sewer" Permit and the Agency will instar lateral.
...........
r ni i.t t e e S i.q vi zA t 1.(r e
..........................1-1...................
if,�.s t,t e(I P y I .......................................
C a I I fo-r :ills-peet:iOn 639---4175
-----------
� wr 1w nr � � ISI► � �Il[ i
CIT' OF TIFARD ,
CM Of I� PLAN CHLCk APPLICATI�ONL
COMMUNITY DEVELOPMENT DEPARTMENT PLA�J CHECK N _3_S9 11
13125 S W H&H Blvd.P.0 Box 21"7,Tlgard,Onpon 97223,15031639-4175 \ PERMIT N - I-L2 0
DATE ISSUED
'/JOB E RFSS: a _ U ""_� TAX MAP/LOT _
SUB: _ �(t-U"I : _ _ ___ LAND USC:
VALUA_EIO ! V _ — 15 -7 7,.3 �.(u 0 a' �'yft4
()Wgi7F ( - SPECIAL NOTES .
NOML _ REISSUEOF V _
LAST REISSUE: 1
FLOOD PLAIN/
_ __ SENSITIVE LAND:
PHONE:
-Aa q
APPROVALS REQUIRED
CONTRACTOR PLANNING: _
NAME: __ ENGINEERING:
A 1RESS: VIRE DEPT
OTHER:
PHONE: _ _ ITEMS REQUIRED
IRED
BUILDERS BOARD N: EXP DATE: _ LIST/SUBCONTRACTORS:
BUS TAX:
ARCH/ENGINEER CALCULA I"IOTAS: �^
NAME. : _ _ _ _ TRUSS DETAILS:
ADDRESS:i� y OTHER:
PHONE:
COMMENTS: /Z
SUBCONT RACTORS: PLUMB: I _ _ _ MECH:
PERMIT 0 ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
6j 10-432 0-,j Building Permit Fees .2LL 11 3
10-431 00 Plumbing Permit Fees /f;2 -5o /le
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing
Mech
10-"433 00 Plans Check Fee �� ( ,• �,-J , 1) _� , 7�
Building
Plumbing
Mech
U--��o• 4 30-202" 00 Sewer Connection
30--444 00 Sewer Inspection _ l ��
51-448 00 Street System Dev Charge (SDC) •-1-)
52--449 00 Parks System Dev Charge (PDG) ' c, -a--5 c:
31-450 00 . torm Drainage Syst Dev Chrg (SSDC) 2
10-230 06 V- ..rre
TOTAL
APP ICAN SIGNATURE r
RP_ccived By: - ---_ - ------_-- - - D;4te Received: _
cn/3587P/18P
W ar w ■ w W w
CITY OF TIFA RD �Cof L
crfRD PLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT °M OM ALAN CHECK N rJ :5-00"'
13125 S W Nall Blvd.P O Ban 23391,1lUsrd,Oieem P7223,(503)6394175 PERMIT ly
1 DATE ISSUED
/.JOBS [ RESS: b c�1 a v� U , W ✓� TAX MAP/LOT 2J
f,ll
u _0ILAND USE:
• � — __Xl : - --_
/ VAl_UAI LON:
_`.. - SPECIAL NOTES
1
NAME: _ REISSUE OF-
J .3 - _
ADDK GS: _� _ _ LAST REISSUE:
Otj FLOOD PLAIN/
/)/,5 7 yUQ
SENSJTIVE LAND:
PHONE: ��_S_ -(c))- 77__.� . ---_.___
APPROVALS RERUIRED
CONTRACTOR PLANNING: _
NAME: __ ENGINEERING- —
ADDRESS: _ _ _ FIRE DEPT
OTHER:
PHONE: _ _ ITEMS REQUIRED
BUILDERS BOARD N: _ EXP DATE: .309/ _ LIST/SUBCONTRACTORS:
BUS TAX: _
ARCH/ENGINEER CALCULATIONS:
NAM : _ TRUSS DETAILS:
ADDRESS: OTHER:
PHONE:
COMMENIS:
SUBCONTRACTORS: PLUMB: WC—H: W!fZ&,L� • z y• 51
PERMIT N ACCT M DESCRIPTION AMOUNT 1NT PD. DAL. DUE
,y? >� lJ J1 Sof 10 432 00 Building Permit Fees ✓ .2 li.-
10-431 00 Plumbing Permit Fees
10--431 01 Mechanical Permit Fees ✓ ,?9. ��',`7>
10--230 01 State Building Tax (5X) ?y. 63 .2
t Building
Plumbing
Mech
I0-433 00 Plans Check Fee
Building 41 U /
Plumbing _
Mech
00 30-202 00 Sewer Connection
30--444 00 Sawer Inspection '; ;J
51--448 00 Street System Dev Charge kSDC)
52-449 00 Parks System Dev Charge (PDC) ✓ 2. 1� _�2 s L
31-450 00 Storm Drainage Syst Dev Chrg (SSDC)
10-230 06 Fire _
TOTAL s57 L 0 �8
\ R F:i Al -- /-5
Id
AP"ICAN
SIGNATURE
Received By: _ Dirte Received:
cn/3501P/18P
1/ y �
■
' Z ) ULI R(kIQj�LCUN.I.HQ1, l� NEC)R 1 ' IN
GENERAL.CON'1RA('11011 NAME&ADDRESS: CASEFIL.F:
'1 -tr PERMIT'NO.: --- �—
°�—�•—r�-�` r-7.0Z:7 AI'PI.ICANT NAMIi ANI)ADDRI SS
FXCAVATTON CONTRACTOR
'P.U
NAME &ADDRESS: — ToyI- 0 U 1
—
_ OWNER NAME AND ADDRESS:
TELEPHONE NUMBERS: -----
APPLICANT; „ t4<- Coll`]t _ PROPERTY DESCRII'ITON: b 0';I—
OWNER; c_ i ! &A 1'7 i STREWl"7 DD15SS ND CRO
"RF,(. .n.e(xT:U
GENERAL.CONTRACT'OR:_4,j-1 �c�—
EAC'AVATIONCONT'RACTOR:_6.9 . nH /1— —
Sl FF/JOB:
LEGAL DESCRIPTION:
24 IIR/AFTER HOURS EMERGENCY TAX LOT*NO.:
CO;4-J''AA(-I'PF SON,. ITLE,TELEF'I IONS: 1/4 SFC'TI(1N:
gyN P_K' SITE SIZE,ACRES: _-----.__.------_-_��
D1S'TURBED/WORK AREA,ACRES_M_,_.�
LOCATION&ADDRESS WHFRE SPOILS
LEAVING SITE W'1.1,BE TAKEN SITE RUNOFF DRAINS TO:(CIRCLE ONE)
(NOTE:PIM ITS MAY RE RFQUIRED) (OATCH-BASIN UI I( ii PIPE CREEK
(CIRCLE ONE) PRIVATEPROPERT'Y
-- -- k_PUBLIC RIGH T OF WAY
ER )SIGN/SEDIMENTATION CON'I'R.(�L (L•_.SCL '1L•'ASURES
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQIIIRI-NiI;.N-I S
DURING CONS'1RUC -ION: FOLLOWING CONSTRUCTION-
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZED CONSTRUCTION F NIPAN('I REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOFF CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN ANF.)REMOVE ALL SILT AND DEBRIS
COVER PRACTICES ENSURE OPERATION OF PERMANT FA\'ILITIES
CONSTRUCTION SEQUENCE OTIIER _
OTIIER _
PLAN FOR EROSION CONTROL PREPARED AND SUBMIT-TED IN ACCORDANCE WITH-TECFINICAL GUIDANCE HANDBOOK".
FROSION CONTROL PLAN DRAWING, AS RF.O(IIRED,HAS PLAN CONSTRUCTION NOTES COMPLF"TF,INCLUDING EMERGENCY
PHONE NUMBER, SCHEDULEJSTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,ANI)
APPLICABLE Sl ANDARD N(YITS.
1 HAVE RFOD AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT'ON THE CONSTRUCTION SITE. n
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OWN IT S ATURF APPLI A ,NATURET
011 ILIAL USE ONLY
RECEIPT' DALE ACCEPTED
FEE NUMItE:R RECEIVED BY