15033 SW 81ST AVENUE W w w w
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I
I
1.5033 SW 813"T AVENLZ
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6
CITYOFTIFARD ( CERTIFICATE Or
l r„1TY ,qRD OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT \ I:Rih I'T #. . . . . . , s MST90--0210
13126 SW Hail BW. P.C.Hca 23397,TOW,Onpon 972 (503 4176
SITE ADDRESa. . . : 15033 SW 81ST AVI:_ PARC ELt .-IS112CB--1.2500
SUBDIVISION. . . . a 0001) ACRES ZONINGr
BLOCK. . . . . . . . . . s LOT,. . . . . . . . . . . . . .
CLASS OF WORK. :NEW
TYPE OF USE:. . . s SF
OCCUPANCY GRP. a R3
OCCUPANCY LOADPI18 4
TENANT NAME. . . s
Remaarks a
Owner,a
BARY MCQUARY
15 A33 SW 81ST
TIGARD OR n7824
Phone ii:
DWD CONTRACTORS, INL
P 0 SOX 23A34
TIVAnD OR 97223
Phone Na 67.9--6881
Reg #- . : 41203
Occupanry of the aabove rarfeve*iced building is her~eby given, and c•ertifi.es
the c 0mPl ian+.:rt with the Stat* Of Oregon '3Peea «alty Codons fur the group,
occupancy, anc4 juste under- which thN referenced Permit war, isr.uHri.
C I jr- CI1'.�'PARTMENT BUIL51NOs; .._TOit�_.w_..� _ ..
BlJ 1 I NGS
POST IN CONSPICUOUS 1-:1I..AC;E
SIN R !S M t M— M I
INSPECTION NOTICE
City of Tigard Build`ng Department
P.C. Box 23397 / -
Tigard. Oregon 97223,
Phone: 639-4175
Type of Inspection - ----
� Time_ _ A.1�1._ y P.M.
Date Requested_-_ �— u---- _
I - —t S"� g/ S'� Permit
Address — �--
L at 4 --__--
Owner .--
BuilderThe following Building Code deficiencies are required to be corrected:
0!G
Presented to -. - --- _
Approved
Disapproved
Inspector — - -
Date -
CALL FOR REINSPECTION
[j YES ❑ NO
w W iw wq. '
INSPECTION NOTICE
City of Tigard Building Departaent / P
1317.5 Sw Hall Blvd. Tigard, oreyoe 97223
Inapection Line (Rec-O-Phone): 639-4175 Business Phonj: 61 4171
Inspection:__ —
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
Poet/Ream Struct. San. Sewer Framing -Bldg.
Poet/Ream Mech. Rain Drain J) Insulation -Plumb.
Pl.bg. Underfloor water Line Gyp. Bd. -Meeh.
DatA Requested: tie —_____Timet AN —--PM
Address* 15V 3';5 Sw (]� Permit
Builders
TM FOLLOWING CKHM TIONS AM NBQGI *
Inspecto.c. _--- — nate:..___
APPROVED DISAPPROVRD APPROVED SUBJECT To ABOVF.
—Call For Reinsp.
or Ar s sr �1[ lr rW IN
INS'PEQ'T10N NOTICE_
City of Tigard Building Departsent
13125 go Hall 131vd. Tigard, Oregon 97223
Inspection Lincs (Rec-O-Phone)s 639-4175 Bu: '-peen Phone: 639-4171
Inspection:_ --
Footing Plbg. Underalab Hoch. Rough-in Appr/Sdwlk
Fonn.d. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -sldc.
Poet/Boom Hoch. Rain Drain Insulation -plumb.
Plbg. Underfloor Nater Liae Gyp. Bd. -Koch.
Time: AM
Date Requested: / PH/ — �) t.7 "- �:.__y._-� �------
Addrees:� 'U'' :s __l:�' _ _ Permit
Huilder: _ _-- ------ --
7'HE FOL.OWINC CORRECTIONS ARE REQUIRED:
Inspectors
^�APPROVQD ^_ DISAPPROVED —`_ APPROVED SUFURCT "n AWjVE
Cell For R"insp.
11 E C,H ri N 1 L
CITYOFT11FARD I'
'90 0261*3
CITYOF RD E R ITIJ I W. PIEC
COMMUNITY I)EVELOPMEW -APARTMENT anooN
13125 SW Hall Blvd. P.O Box 21'97, ripp,;o,Oregon 07223(1503)8!9-075 DATE ISSUED: J.). 113/90
S IT E A D D R ES'S., 1,50:.3;: SW 6 1 S T A V E PARCEL: 2S112CD-1250(!:
GL)PDIVIST3H. . - -. (WOD ACRES z 0 NT H G-
BLOCK. . LOT,.
............. ...............
CLASS OF WORK. '.ADD FLOOR FURN. . . . : EVAF1 CIOLERS:
'T'YF-'E OF USE. . . . ..SF U'111 T IAEATERS. . : VENT F:ANS. . . -.
OCCUPANCY GRP'. -R.3 VENTS W/O APP,L.- VENT' SYSTEMS.-
STC.)R IF 0 1 L E R S/C 0 M P'R I.';*S S 0 R 5 HOODS. . .1 . 1. .. . -
0-::I Hl::,. . . . DOMES. 'r.IqCIN-.
./WOD/ 3-••1.;`; HF'.. . . .
IMAX 1hKUT.- 14TU 15-30 HP,. .. . .. REPAIR UNITS:
FIRE DAITIr:'EW,:;'?. . ;30-..4";0 1W. . . . - AMIDST OVES. . - 1.
GAS P,RESSURE.. . . 50+ H P'. . . .. - C.. O DRYERS. . .
NO.. OF' (JNTT*S--------------------- AIR HANDLING UN 1 TS OTHL,k 1INT FS.
FLIR.11 < 100K r1TLJ-. <=: 10000 rfm: GAS OUTLETS.
F:'URN ) 1! 1.0(,1K BTU.-. > 10000 c.,fn1-
R
1.)W1-1e".. FEES
GARY ti MOI-LY MCOUORY t-,Ype C)U.1 t Iiy date r e c,r)
J-5033 SW 81ST FlAym 1.5. 23 JLiH 11/3.3/90
FIRMT A> 14. 50
TY60RD OR 97.*.*,el 4 5PC"T 0. '13
#-. 684-0805
LUDEMANS, INC
I P67:5 SW HEAVE RD -,H RD
OR 97005 .......... .......
646--f,409 1, 1.5. 23 TOTAL
51.469
........ REQUIRED INSVIECTIONS
This pproit is issued subiect to the regulations contained in the Final Imspecti.oll
Tigard hunicioal Code, State of Ore. Specialty Codes and all other
aPplirable laws. All work will be done in accordance with
approved plans. This pewit will expire if work is not started
within 180 days of issuance, or if work is suspended for @are
than 180 days.
.1.�ii S Lk F?d D y
CA]. .1 f 0-r iris;raec. titin 639--4175
1 `
,, CITY OF TIGARD RECEIPT OF PAYMEN11' RECEIP'T NO. -90-206753
CHEU.' AMOUNT t 15.23
NAME : DR. GARY MCQUARY CASH AMOUNT ()I ot)
ADDRESS : 7996 SW BOND PAYMENT DATE s 11/13/90
SUBDIVISION
TIOARD, CIF 972'24– 1,50:33 SW BIST
FlJRPOSE OF PAYMENT AMOUNT f"A 11.) PURFUSE OF PAYMENT AMOUNT PAID
MECHANICAL PE MEC90-0216-'-7— 14750 ST. BUILD PER (:'. 7TM
WOOD STOVER PERMIT
TOTAL AMOUNT PAID 15. 23
INbPECTIOH NOTICE .
City of Tigard Buildlog Department
13125 SH 'Aa31 Blvd. Tigard, Oregon 97223
?nspe::tion Line (Rec--o-Phone)t 639-4175 Bueineas Phone: 639-4171.
Inspect Ion:,,__,��/`"�_L
a
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer (Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Naa, ,%r Line Gyp. ad. -Hoch.
Date Requested: /�- O T1aM1 -__KM
/___-PM
Addrosa: L� 57� Permit f:
Bu S L.lar:
C��J
THE FOLLOWING 00MCTION8 A" Iant
L Z
Inspector:- �—'_--- -V —A_Date:_,/�'
APPRONRD niSAPPROVED APPROVED SUBJECT TO ;1BUVE
____Call For Reinsp.
f i s fid ifB !If
CITY OF TIGARD MECHANICAL PERMIT geceipt # _ -
1312 5 SW HALL BLVD. #
P. O. BO.'( 23397 Description —
TIGARD, JR 97223
C f'-" i Table 3A Mechanical Code CITY PRICE AMT
(503)639-4175 Srj'J 1) Permit Fee -0- - -0- 10.00
� 4arne of DevelorrteM -
2) Supplemental Permit 3.00
Job Address 11 Furnace to 100,000 BTU 600
Address �/so33 Sc,J ��5� incl.ducts&vents -- _-
' Tax Lot 2 Map No t c-13 Furnace 100,000 BTI1 +
i for BroSubdivr..ion 2) incl.ducts&vents —- 7'7.50z' ck
Name(or limn of business) Floor Furnace
rt., ' tom" *- C C J/t/e 3) incl.vent 6.00
Ma&VAdd&ss phots Suspended heater,wall heater
i oww Sp-- S(� ,!s� �tS 4) or floor mounted heater 5'0 -
I l;ftyrSUle apo _ Vent not ind.in
7 74/_ Q 7 Z2 5) appliance permit 3.00
Name(or name or business) 6) Repair of heating,refrig., 600
cooling,absorption unit
Mailing Address plgry Boiler or comp to 3 HP
Occupant
7) absorp.unit to 100,000 BTU r.00
Ciw'stain rip 8) Boiler or comp to 3 HP-15 HP 1100
_ absorp.unit to 500,000 BTU
Blame9) Boiler or comp 15-30 HP 15.00
! j absorp.unit 1/2-1 million v_
Mailing Address Phone , Boiler or comp to 30-50 HP
0) absorp.unit 1 -1.75 million 22.50
Cnntrpctor City/State tip 11) Boiler or comp to 50 HP
absorp.unit 1,750,000 BTU 31.50
lata Registration No CRy l3us.Tax No. 12) Air handling unit to 4.50
10,000 CFM
I Ierel tick Air handling unit
,y rr>MAedge that 111aVn lead this aptllK:atxM that tfr?information grve�l Is 13) 10,000CFM + 7.50
correct.that I am the owner or authtwized agent of Ifwe ownw..that plans submMe.d are in --
compliance with State laws,that I em registered with the Stale Builders'Board.that ttM Non portable
number given is correct (it exempt from,State registration please give reason bek)w) 14) evaporate cooler 4.50
Vent fan connected
15 to a single duct 3.00
- + Ventilation system not
/ 16) included in appliance permit 4.50
17) Hood served by 4.50
mechanica'exhaust
rvurtum(C% or Went) .. Dat9 Domestic t)pD
Describe work [7 addition [Ialteration [1 repair U 18) incinerator -- 7.50
to be done residential l I notrresidential F1 � Commercial of industrial
19 type incinerator 30.00
Existing use of _ _
building or properly— -- L0) stovo,water her er,sola,clothes dryers,etc. 4.50
Proposed use of r
building or property _ 21) Gas piping one to four outlets 2.00
TWM of fuel- oil natural gas ❑ LPG ❑ electric I - -
22) More than 4-per outlet
NOTICE SUB-TOTAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 160 5%SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 1 IME AFTER -
WORK IS COMMENCED �- TOTAL
Special Conditions
------ ----- -----_-____�_. Date issued _ by_
t !! !t FINI• I< W 1® IN
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Reque-ted Time_ A.M. P.M.
Address Permit
3 � 5��
Permit
Owner _ Lot #
Builder
The foliowing Building Code deficiencies ,,re required to be corrected:
Presented to
. Appro"W
Inspector __— /� .1- i � _
❑ DIUpproved
DATP.
CALL FOR REINSPECTION
O YES
INSPECTION NOTICE
^.ity of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection � Q
Date Requested — 7G rime A.M. P.M.
Address _,lJ��-3� D s Permit # Q
Owner Lot #
Builder tof-)
The follrwing Building Code deficiencies are required to be corrected:
_��v�aC� /WStIIGTiQ.t� w C��j 9/IUtJ�//1 --
_�c'c�s�
AlC1 '�--
R S 7-6 Si �P�iS/
P-iaented to ] Approved
Inspector _ ❑ Disapproved
Date
CALL FOR REINSPECTION
❑ YES ❑ NO
Ir w IN
INSPECTION NOTICE
Citv of 'Tigard Building Departrr,6nt
P.O. Box 23397
Tio�rd, Oregon 97223
Phone: 639-4175
Type of Inspect,
Date Requestedon - r Time A.M. P.M.
Address Permit
Owner_
Lot #
Builder — Q 57 ?crhrC
The following Building Coded iciencies are required to be corrected: s;Tl,
Presented to Approved
Inspector I ❑ Disapproved
Date -
04 L FOR REINSPECTION
❑ YES 1 ] NO
t I
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested _y. le 1/s V-4 _ Time ^.- A.M. P.M.
Address 15—In Permit
Owner Lot #
Bi6lder 2 —
The following Building Code deficiencies are required to he corrected:
Presented to -- Appi ved
Inspector Diaapp►ovnd
Date
CALL FOR REINSPECTION
Cl YES 0 NO
fm
-"i,ry OF TInARD of rAYMENT RECEIPT NO. ;9()---2053�87+
CHECK AMOUNT : 75.66
IIAME : MOLLY MC QUARRY CASH AMOUNT t
ADDRESS c 15033 SW 816T AVENUE PAYMENT DATE a
SLJ8DTV IS TON
'TIGARD. 0R 9 722 2'
PURPOSE OF F-`AYMENT AMOUNT rAii) PURPOSE or F'AYMLNT AMOUNT PAID
BIJILDING, PEPM 44.5 ST. BUILD PER 2. 27
rl-AN CHF-CK FF R'S.9".1
1
DUILDING PERMIT #DUF'90--0297,
TOTAL.. AMOUNT PAID 75.e.)6
AL
C'n®F TIIFARD �1 BU I'LDING P[:'R1y11T
C17YOF RD P,1:--.R 11 IT ft. u F,9 0-.0 2 93m
COMMUNITY DEVELOPMENT DEPARTMENT PRIN.- ' MSI'90-021C�l
13125 SW Hell Blvd. P.O.Box 23397,Tigmid,Oregon 97223(6p3)6*41 DAI*V- T'315UF.D:; 0 0 2/9 0
A D 0 R L S 13. 1503:.3 S W 61'51 14 'L. 00R(,EL.. 26112CB-12500
3 LJ 14 D I V 10 H. (-)(:1C)1) A C,R L--!.) Z 0 N IN G
P I OCK. I OT. . . . . . . . . . . . . .
R 1::'l E)S U E FLOOR EXTERIOR WALL CONS'rRUCT10bF
C.,LnSS OF WORK. -.ADD F I.RST. . . . : X20 <.:;f Iq- S.- E W
F Y P E' OF" U G)E'. . CSF SECOND— : f PROTECT
T'-J:'F:' OF C'ONS1 . -51,1 'r ii I R D. <,f N W
C*TU P A N C Y G R V,. lyl J. 101 520 s f ROOF CONST: FT RE: R E'T':'-
0 C C U PA 11("Y L.OA1)c D 0 G E 11 E:Iq T. !;;f AREA
11T. f L. GARAGE. . . .- 5 f OCTIJ Sl:*P'. WrED:
F+"..)PIT 111'...Z Z REA-11) '5F.'f*f-+()CKS-----------------
FLOOR 1 0 A 1) f L.E-FT:5 ft RGHT ft F:1 R P K L SPIOK DET. . -
D W E.1-L 111 G UH 1: 1 1;Iq I'- ft R F'f 4 R 5 ft F 1.R L R M H bi DI('P 0 C'C:
t.",E 1)R 11 B- PAT!-IS: IVIV, SURFACE." PRO CIORR: PARK I 14G-
V 0 E. 3:':;00
FEU3
GARY & ri I y Pel C,(4(1 R y type aniOU11t by data r e c.,p
7` 9(..', 6W P(:lN 1) ST PR11T 44. 50
I'll ('K 28. 93
'TIGARD OR 972F.4 5 P(I*T- 2. 23
Phorie "- !-503-682-2242 1:1 P y 11 $ 75. 66 BPIR 10/02/90
[33ARY A 11OLLY
7996 IN 11010 !:i'T
TIGARD OR 97224
PI-101-le If.' 03-682--P.242 $ TOTAL
RE[WIRED
This permit is issued subject
ject to the regulations contained in the Foat/fot.trid 11-1sp
Tigard Municipal Code, State of Ore. Specialty Codes and all other F-rAnifiiq Itisp
applicable laws. All work will be done in accordance with Ra:07 drain Disp
approved plans. This permit will evoire if woo is not started Fi.11al Itis peetioll
within 180 days of issuance. or if work is suspended for more
than 180 days.
..........
2—PeV nl:i t t e e S 1 110 t Lt'r'L-
ISSUed Eiyi
CA-11 for ilia-Peetic)ll 639 4 175
CITY OFT16�,ARD �u O.Sm�i7 PUKK/RECD #r-I aro«,9M-3 l _
COMMUNITY DEVELOPMENT D'cPARTMENI (503)6N-40I Pi ffIL
DATE ISSUED —
ADDRESS
r' W
8: - TAX MAP/Wr
LCIT: CsU G'is j IAM USE:
OWUM -
SPEDTAL NOTES
NAME: P2 Ci ��f9I-� 12EL iUE OF:
ArURESS: - ��'Ti/� C, !lrT ..a_ LAST REL` UE:
_ FLOW PLAJIJ/
I3 OA7E: 4 - -.7SENSITIVE LAPID:
doPrl� c7trxt APP[�fJ�VATS RB'MIR
NAME: t7 C� �i PLANNING:
MESS: �.� �-
'7` r►'� - i Z On12: -
PHONE � � RDC)UII�E1)
BUIIDERS BQMRD #: EXP DME: LIST/ .
ARBUS TAX: _
NAMEC�INC��IIIF.F32 ('7rT[71iA'iTOrL�: _
- TRRS,S DETAyIS:
AoC121±'SS_ _ Oft:
Pf SONE:
0.MKENM:
PERMIT I AO(T I DE9CRZP'aCN AM)Wr AMJLW PD_ BAI._ DUE
10-432 00 Building Pel Fees
10-431 00 Pltn irg Permit Fees
10-431 Ol Mechanical Pentit. Fees
10-230 01 Strata]
Building Tax
Building
Plunging
Medi
10-,433 w Plans Check Fee „ 3 ,1,3 L3
Bulldog
Plumbing _
Meds
..__. 30-20Z 00 Sewer QxmecLion
30-444 00 Sewer Irr;pertirn
51-448 00 Street System DI C2ta� (SDC) --- —�
52-449 00 Pmts SY:-,tem L,ev L2 r (PDC)
31-450 00 Stvtm Dra nge _S) t Dev Chry (SSDC) _
10-23CI OG Fire `-
tba3eivea By: Date P,eoeiwc�:
.eF/3587P.WPF �` —
V
\\ Permit No: —
'�• ;�� Address:
F r Z Issued by:_.__. Date: _
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO 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 Architect
and Engineer applicants, exempt from registration under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Fill ' the applicable blanks, and initial box 1 and either box 2A or 2B:
I
1. 1 own, reside in, or will reside in the completed structure.
2. A. C] My general contractor is
Contractor registration number
I will instruct my general contractor that all subcontractors who work on
the structure must be registered with the Construction Contractors Board.
OR
B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the
Construction Contractors Board. If I change my mind and do hire a general
contractor, I will contract with a contractor who is registered with the
Construction Contractors Board and I will immediately notify the office
issuing this building permit of the name of the contractor.
I hereby certify that the above information Is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side f this form.,
Signa ure of emit ppllca . Date
CONSTRUCTION CONTRACTORS BOARD
0244) 1190
WHITE CONY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
P"
� t
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
NOTE: This Information Notice to Property Owners About Construction
Responsibilities was developed by the Construction Contractors Board in
accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature.
If you are acting as your own contractor to construct a new home or make a substantial improvement
to an existing structure, yo,j can prevent many problems by being aware of the following responsibilities
and areas of concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons riot registered with the Construction Contractors Board to do labor in constructing
or assisting in the construction or improvement of a residential structure, you will, in most instances,
be ruled to be an "employer" and the people you hire will be "employees". As the employer, you must
comply with the fr.:lowing:
Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages
at t et me employees are paid. You will be liable for the tax payments even if you don't actually withhold
the tax from your er,ployees. For more information, call the Oregon Department of Revenue at 3783390.
UnempiglTent Insurance Tax_: As an employer, you are required to pay a tax for unemployment insurance
purposes on N wages of aTf employees. For more information, call the Oregon Empinvment Division DHR
at 378-3224.
Workers' Compensation Insurance: As an employer. you are subject to the Oregon Workers' Compensa-
tion Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers'
compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of
Your employees is injured on the job For more information, call the Workers' Compensation Division DIF
at 3737434.
U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees
wagesYou- W-11-1 be IiablrT6r the tax payment even if you didn't actua'ly withhold the tax. For more informa-
tion, call the Internal Revenue Service at 221-3960.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code Compliance: As the permit holder for this project, you are responsible for resolving any failure
to meet code requirements that may be brought to your attention through inspections.
Liabilityand Proe�rty Damage Insurance: Contact your insurance agent to gee if you have adequate
insurance coverage for accIdents and'omisslons such as falling tools, paint overSpray, water damage
from pipe Punctures. fire, or work that must be redone.
Time to Supervise Employees; Make sure you have sufficient time to supervise your employees.
Expertise Make sure you have the expertise to act as your own general contractor, to coordinate
t P worTc of r0LIgh-in and finish trades, and to notify building officials at the appropriate times so
they can perform the required inspections
If ,,ou have additional questions, write to: Construction Contractors Board
700 Summer St. NE, Suite 300
Salem, OR 97310-0151
0244) 10/24189 Phone 503-378.4621
a� � +a � a w ■I�r er ils � iw
iNSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Tyra of Inspection -.---- —-- - ---- ...... - --
Date Requested �,— cQ Time X _ A.M.__ _P.M.
Address _-_ -_.� n G s Permit #4i11
Owner--_- ------- _ Lot # _.
Builder
The following Building Code deficiencies are required to be corrected:
I
I
i
Presented to L"P-prov9d
Inspector ❑ Disapproved
Date �Ly
CALL FOR RIFINSPECTION
L1 YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223
Phone: 639.1175
Type of Inspection --�G'�" (�
Date Requested _d - 3 _ 7 G Tim A.M. P.M.
Address ��S 3_3 �/ s� Nrmit # _/U
Owner— Lat # _
Builder
The following Building Code deficiencies are required to be corrected:
Presented to __ _ _ Approved
Inspector __. Disapproved
Date Z3 -
CALL FOR REINSPECTION
ES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
of
Type of Inspection
Date Requested G Time A.M. �j P.M.
Address -s �, � S� -- Permit
Owner _ Lot # __
BuilderThe following Building Code deficiencies are required to be correctod:
Presented to _ �.Approved
_ I Disapproved
Inspector _._— __4fALL:FOR
--- I
Date REINSPECTION
❑ YES IJ NO
Wig MR W �Wr
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 `
Type of Inspection ` 21.3—�� ---- —
_ r
Date Requested Q— Time A.M. P.M.
Address 33 Permit
Owner - — -- ---- — Lot # ---
Builder ___ --
The following Building Code deficiencies are required to be corrected:
Presented to — .9 -Approved
Inspector _.� I] Disapproved
Date --J CALL FOR FOR REI SPECTION
❑ YEa ❑ NO
ff i flt! s f4w rw
INSPECTION NOTICE
i
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 f
' 'S� Permit
Owner _ Lot #
Builder '
The following Building Code deficiencies are required to be corrected:
Lim c�h -��7--
Presented to _ Approved
Inspector _—. /disapproved
Date -_---
CALL OR REINSPECTION
YEs fl No
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date. Requested-__ �- r�- `� Time A.M. P.M.
Address __ �� a 3 �l S� _ Permit
Ownet Lot #
BuilderThe following Building Code deficiencies are required to be corrected:
�? 7
i
/ — -
Presented to — — rr II Approved
Inspector ��� u Disapproved
Data � ,� a
--p— F
CALL FOR REINSPECTION
❑ YE• ❑ NO
INSPECTION NOTICE "Y
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 Permit #1w lr
Owner___________ �_ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
_ _ 1
Presented to 'Approved
Inspector I Disapproved
Date �` )
CALL, FOR REINSPECTION
YE8 C7 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection � � ��t 2� ti� SIJ t�c,yc% '0
Date Requested _SQ - Time/ LL A.M. P.M.
Address �_�O �_�______t2�5±—. - Permit
Owner Lot #
Builder-wThe following Building Code deficiencies are required to be corrected:
Presented to Approved
Inspector _ _ - -_ ___-_ I I Disapproved
Date —12-- - -- - ------
CALL FOR REINSPECTION
C7 YES ❑ NO
CITY OFTIFARD MASTER PERMIT
A Pl---'Rlll,r % . . . . . .. .., msTgo &21 o
COMMUNITY DEVELOPMENT DEPARTMENT PRIM. PERMIT It.. . MST90 021.0
13125 SW Hall Blvd. P.O.Box 23397,Tigard,Oregon 9722
DATE ISSUEDt 06/14/90
SITE 1tsW33 SW 6151AVI:: PARCEL: 2S112CD---GA3
SUBDIVISION. .. .. -- GOOD ACIREAS ZONING:
BLOCK. . . . . . . .. . O LOT. . . . . . . . . . . . . ..3
...._...__»....___._..__..________......_._..._.._....__._ BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . .. . . :0 Sf
CLASS OF WORK. :NEW BEDRMS-.2 BATHS:2 GARAGE:. . . . « .. . . . . :7 5 S f
TYPE OF USE. .. . -5F FLOOR AREAS-------- REQUIRED SETBACKS.............
TYPE OF CONST. .-5N F1 RS*T. 2188 S f I EFT. . :5 -ft RIGHT. :20 f t
OCCUPANCY GRP. .-R3 SECOND. . . iO S-f FRONT. -.20 ft REAR. . -.30 ft
STO R I E S. . . . . . . .. I TH IRD. .0 S f R E Q U I R 17.D
HEIGH1.. . . . . . . .. .. 18 f t TOTAL- 2188 5-f SMOKE DETECTORS. SY
FLOOR LOAD. 40 r.)Sf VALUE. . . . . $ 1.05504 PARKING SPACES. . :0
Renia-vks-.
PLUMBING
SINKS. . . . . . . . .- -. 1 FLOOR DRAINS. .. . . :0 BACKFLOW PREVNTRS. . :0
LAVATORIES. .. . ,. .. .'.3 WATER HE . . -1 TROPS. . . . . . . . . . . . - -0
TUB/SHOWERS. . .. . :2 LAUNDRY TRAYS. . . :2 CATCH BASINS- -. -- -- --0
WATER CLOSETS. . :O SEWER LINE (ft) . .-O GREASE
DISHWASHERS. . . . : I WATER LINE (ft) . . 1.00 OTHER F I XT U R E"S 0
GARBAGE DISP. . . .- J. RAIN DRAIN (ft) . .(%l
WASHING MACH. . . : .1 SI:' RAIN DRAINS— . I
MECHANICAL LS
FUEL. UNIT HTRS. . :0 type anincti.)t by (late reept
/GAS/ VENTS . . . . .. :0 PAYM $ 100.. 00 J1.44 06/05/9"! 201371
MAX INPUT:0 U TIJ VENT FANS. . -3 BFIRT $ 448. 00
TURN < 100K — :0 HOODS. . . . . . .. .I rj P L C 291. 20
FURN >=1001', . - :: 1, WOODSTOVES. -0 B5PC ti 22. 40
FLOOR FURN. . . . :0 CLO DRYERS. n I SEDC 600. 00
BOIL/CMP < 3111::-.0 OTHER UNITS:0 SEDC (1-150. 00
GAS OUTLETS: 1 PARK 250. 00
0 w n e-r MPRT k 37. 50
DWD CONTRACTORS INC. HPLC 9. 38
1�', C) BOX 23454 11 t`j I---,(", 1. 88
r,t:,R,r s 140. 00
TIGARD OR 97223 P5PC $ 7. 00
Phone #o 503-639-6881 PAYM $ J.957. 3 C', JLH 06/16/90
Cont-ractore
DWD CONTRACTORS INC.
P 0 PDX 23454
TIGARD OR 97223
Phont- 44: 503-639-4,8(31.
Req t1. . o 41203
2057. 36 TOTAL
This permit is issued subject to the regulations contained in the REOUIRED INSPECTIONS
Tigard Municipal Code, Stitt of Ore. Specialty Lodes and all other F'00t/f0k.trid Insp Me(-hanical Insp
applicable laws. All work will be done in accordance with approved Wt-r P-roof irig Brim Plumb 'Top Out
plans. This ;-*mit will expire if word is not started within 188 Post/Beem St-ri.Wt Framing Irisp
days of issuance, or if work is suspended for more than 188 days. Posit/Berm Meehan Fireplace Insp
Crawl Drain Gas I_ isle Ins p
Pe-(,nii.ttee Signatt.cre: --1-.-.-----...------.-.1.......... P)in/t.tndslab Insp 111SUlati.011 IlVill
FILM/Und e r f I oor Gyp Boa-rd Insp
Isisued Bye F t n q D-rai.n Bsm" t Raiii ti-rain Insp
Call for inspection 639-4175,
1:WE':F:SiC()N Iq C=( I 10N
w1W OF TIGA RD P 1::,R 111* I
WYOFTWARD P:1IiE-RIvI1-T' . . . . . . . . SWR90-0224
OR
COMMUNITY DEVELOPMENT DEPARTMENT CT4*N
13125 SW FW91 Blvd. P.O.Box 23397,Tigaid,CftgDn 97223(603)6394175 PF*1'I M PIE R 11 I'T' #1 111(YT 9 0—0 2 10
'[SSUEI)-.- 06/14/90
HDbrtLSb. . . :: J.50133 SW 61ST' (aVl--. I"I()RCI::'L-. 2SI-12CD G03
3UPD1VISION. . . . . G 0 0 D 0 C[;.'E'-A S z N'r 1,1(,7-
DI OCK. . . . . . . . . . a L-O'r. . . .. . . . . . . . . . :3
..-.................. ................
T,E H()N'T' 11 n N E, . . .,
Ij S 0 N0. » . . . » . . ., . .4 16.1 3 FI X'r U R E U N 1.
CLASS OF WORK. .. . , NEW D6)E L L 114 0 U 111 T 13. :1.
TYPE:: Of' USE. . . . . ..(,;F;, NO." (')P' [(L)1l-DTNGS: 1
N 1;T(I L.L. 7'Y PE 1-3 US W R 1:'E R V SURE-0 CX— . f
...........——————— ............. FEES
DWI) COH1'RAC'JOI:'( 3 111C111 t y 1:)e anic)ttiit 15y
Y date (�ecpt
0 BOX 23454 PIN M V $ 1250. 00
I N G P $ .3`,. 0(A
f'TGORD OR 97223 PAYM 1285., 00 JLH 0C,/1G/90
1:'Piaiie #- 1503-639-6881
0 11 t-r(*.A C:t a .....................
1.C)I+I'R(1C'T0K1 NOT ON F`:[IJ.:
.................
'hc)rie J; 1285. 00
REQUIRED INSPECTIONS
This Applicant agrees tc comply with all. the rules and ,regulations sewrar Illspec,tiorl
of the Unified Sewage Agency. The permit expires 120 days from
'he date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy Of the ....... ...........
.-,ide sewer laterals. it the sewer is net located at the measurement
given, the installer shall prospect 3 feet in all directions from .......
the distance given. If not so located, the instiller shall purchase
"Tap dnd Side Sewer" Permit and the Agency will install d lateral. ......
.............
f D1 I t L e 0 'i j.g Y)a t Lt Ve
1 :� ,it.ted 14y: .................................................................
C a 1 .1 -f a-r i ii%r.)e c t i a ri 639 4 V?1,15
,:IT'Y OF TIGAPD — RECEIPT OF PAYMENT RECEIP'T NO. 490-2,01680
CHECK AMOUNT » T2 4 s:. ---6
DWD CONTPACTORS CASH AMOUNT' rl. olo
ADC)RESS PO BOK -"-3454 PAYMENT DATE a Oo/14/90
SUBD I V I S I ON
TIGARD, OR 972:,�-:- 15033 SW BISTAVE
PURPOSE OF PAYMENT AMOUNT PA I L) PURPOSE OF PAYMEN'i AMOUNT PAID
PERM MST90-0210 y 448.OU PLUMBING PERM 140. 00
MECHANICAL PE 50 ST. BUILD PER A.19
PLAN CHECK FEO%l, MR SIFWE�R USA :;?50.00
Sk'-'.WER INSPECT -�3.00 STREET SDC s0o.00
-
Ps4F*5 SDC 150 ).EJC) STO250, 017)
RM DRAIN - SDC
ll--)TAL, AMOUNT' PAID 71.242.
CITY OF TIL'AR17 OF F'Ad MENT RECEIPT NO. : 90—:201:-,;"t
CHECK �kMDUITT s I OO.00
NAME s DWD C:ONTRAC:TOPIS, 11'JC CASH AMOUNT s 0. 00
r�DDRESS s PO DOX !,'1"454 PAYMENT DATE s 06/05/90
5/90
�wr1.Ir.+r�Ivr.;�Ic�r�
F I iF POSE OF- PAYMENT AMOI INT PAID PURPOSE OF: PAYMENT AMOUNT F A I D
rL.t")r1 CHF.CI F*(— 1f la. Ol:?
I
I
I
I
I
I
't 07AL. AMOUNT P411 11 — t CIO.00
jNBPBCTION NOTICE -'
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (ROC-0-Phone): 639-4175 Business Phone: 6 4-4171
Inspection:—
Footing Plbg. Underslab Mech. Ro gh-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL-
Post/Beam Struct. San. Sewer Framing (�ldq.` )
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requested: / — —„__Time: —AM �_PM
Address: !6lJ_-5_3 ,� stPermit
Builder: ------- --- ----
THE FOLLOWING CORRECTIONS ARE QUIRED:
Inapectort Date:
-PCPPROVED _ DISAPPROVED _-_ APPROVED SUBJECT TO ABOVE
Call For Reinap.
i I• w IN �
GRADINGIEROSONTROL INFORMATION
GENERAL CONTRACTOR NAME& ADDRESS: CASEFILE NO.:
PERMIT NO.: ;'�L( C C L-7 3
APPLIC 'NAME AND ADDRESS: n
EXCAVATION CONTRACTOR Cy - - AF L 1`010 Int 1¢ -
NAME& ADDRESS: -- - ��
OWN�R NAME ANDS _D L7�-t� ! C±�aLt /412tf
TELEPHONEB ! k l/ �7 A, f4 L'� l ZZ_
� c/
APPLICANT: r a '90 s �'U 2 j z PROPERTY DESCRIPTION:
OWNER: N - CLS -- Z 2- STREET ADDRESS AND CROSS ATED
GENERAL CONTRACTOR: S 33 Stv
EXCAVATION CONTRACTOR: DSS
SITE/JOB: -
LEGAL DESCRIPTION:
24 HR/AFTER}TOURS EMERGENCY TAX LOT NO.:
CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION: _
SITE SIZE,ACRES:_' _
— DISTURBED/WORK AREA,ACPES: )Q
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUN(* RAINS TO:(CIRCLE ONE)
(NOTE:PERwrs 7Y BE REQUIRED) CATCH-BASIN DITCH P,PE CREEK
r
_ (CIRCLE ONE)CPRIVA'rF PRnP
PUBLIC RIGHT OF WAY
BUSLQ.N/,5_ET)IMENTATION C'.Q TR91, (ESC) RES
MEASU
MIN►MUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE.EXPOSED SURFACE
STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMETER RUNOIT CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALI,SILT AND DEBRIS
COVER PRACTICES ENSUR?OPERATIgN OF PERMANT FACILITIES
, C
CONSTRUCTION SEQUENCE OTHER 5s / Nry 2," �f i-ei i L'
OTHER ---, $'rte' 54 licee r �c. .,��� rL
&.Z. Ll_',l/ drive' oN yrjo(.' L Ctr�tiuc�u�,ay Si/�C"
PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK-.
EROSION CONTROL PIAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
PHONE NUMBER, SCHF.DULFJSTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABLE STANUA,RD N(TfFS. `�S pr[ _ aM
h� _ est
I HAW READ WILL COMPLY WTfH'f HE ABOVE AND WILLCO�ISTRUCi AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE TNSTRUC71`10NSITU—,
OWIJSR IGNATIIRE PPLICA.Off SIGNTU F.
. . • • • • • • . • • • • • • . • • • • . •
. . . . . . . . . . . . . . . . . . . . . . . . . . . • • • • • • • • • • • • • •
0M- CIAL USE ONLY
RECEIPT DATE.. ACCEPTED
I l.f. NUMBER RECEIVED BY
GRADING/EROSION CONTROL INFORMATION
GENERAL CONTRACTOR NAME&ADDRESS: CASEFILE NO.:
DWD Contractors, Inc. PERMIT NO.:
PQ Rn4 23454
igard. 0 722" APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR DWD Contractors, Inc.
NAME&ADDRESS: PO Dox 23454
,Jim Paulson Excavation `Picard, OR 97223
Box 1.062 OWNER NAME AND ADDRESS:
Hillsboro, OR 97214 Gary Mr uary -
7()A6 SW Bond
TELEPHONE NUMBERS: Tigard, OR 97224
APPLICANT• 639-6881 PROPERTY DESCRIPTION:
OWNERL 684-0805 STREET ADDRESS AND CROSS STRFETA-OC �
GENERAL CONTRACTOR: 639-6881 15033 S'19 81st Ave. , Tiyara, OR
4
EXCAVATIUN CONTRACTOR_ 6,15-1011 Cross Street: SW Ross
SITE/JOB 15033 SW 81st Ave.
LEGAL DESCRIPTION:
24 HR/AFFER HOURS EMERGENCY TAX LOT NO.:
CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION:S.W. l 4 SEC 12, T2S, R1W, WM.
_ SITE SIZE,ACRES: ?8,(162 S.F.
Ila! C. 441ggLns - Pres. -
i l and J. Dani el�i - V.P. 639-5422 DISTURBED/WORK AREA,ACRES: 8100 SF
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAINS TO:(CIRCLE ONE)
(NOTE:PERMITS MAY BE REQUIRED) CATCH-BASINI'TCF PIPE CREEK
NO RFMOVAL
(CIRCLE ONE�BLYAIF PROPLR3:Y -
� PUBLIC RIGHT OF WA
EROSION/SEDIMENTATION CONTROL (ESC) MEASURES
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES 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 A CCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK".
EROSION CONTROL PLAN DRAWING,AS RFQIIIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,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 CONSTRUCTION SITE.
___(;a ) Oc.,"�
OWNF!: SIGNA"rURF All _!c'AN'SIGNATURE
OFFICIAL.USE ONLY
RECEIPT DATL ACCEPTED
FTE NUMBER RECEIVED by
CITY OF
TIFA
artsBo 23 7 d. PLAN C RX APP, __
P.O.RD Tigord.soK aaa97 PIAN C3�7QC ,� ,j�; -/0 - --
'Oreegon�'97223 PTFE hl 5- 9 G
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED _
JOBADO2E5S• /S�7 3 3 S. lA9. TAX MAP/IOr S/- /Z C J
SUB: •. Lt r<-.�- IDr: -r"zz.P f1 3 LAND USE:
VAIJ=ON: �9 600 0
OWNER ! SPEICIAL, NOrl'F.S
NAME: -+ Anc- REISSUE OF:
ADDRESS: f-/ LAST REISSUE:
-T L,g d 2 % z z y FIAOD PILI/
SENSITIVE LAND:
PHONE: -
aig RACPOR PLANNING:
NAME: _�W �y , tENGINEERIM-
ADDRESS: 5 v 2 �/s FIRE DEPT
9 2-
3 Crit:
PH30: l0 3 9 -61 l ITEMS RDS
BUILDERS BOARD ,f• `l 3 EKP DAZE: /- V `f/ zrsr/ :
BUS TAX: -
ARCII ZNGIIN R CALQ.ILATIONS:
NAME: T14M DEIAIIS:
ADDRESS: OTHER:
ffNPS: P�• 3 S I�A ooC ,
4
PEM'= f A= DESCRIPTION AMOUNT AMXNr PD. BAL. DUE
o 10-432 00 Building Permit Fees �'
10-431 00 Plumbing Permit Fees 0 —
10-431 Ol Medianica 1 Permit Fees
10-230 01 State Building Tax (5%) �,�y
Building a i , y u —
Plumbing
Medi _A .= -
10-433 00 Plans Check Fee = U U S�}, / 0
Building 4/.
Plumbing
meth
S(,4? V. .J z 30-202 00 Sewer COnnectian30-444 00 Sewer IrsPc(-tian
51--448 00 Street Wxm Dev Charge (SDC) o u a u
52-449 Or Parks SysteM Dev dye (PDC)
31-450 ' i Storm DraukW Syst Dev Clary (SSW) J
10-23C 06 Fire
TOTAL, U � y Z •,`'r
RDC f
APPLICMr SICNA'IURE
Received By: _ Date Reoeaved:
of/3587P.WPF
GRADING/EROSION CONTROL INFORMATION
GENERAL CONTRACTOR NAME& ADDRESS: CASEFILE NO.:
DWD Contractors, Inc. PERMIT NO.:
c
Tiaar , OR97`-3- APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR L11D Contractors, Inc.
NAME&ADDRESS: PO Box 23454
Jim Paulson Excavation Tigard, OR 97223
_Box 1062 OWNER NAME AND ADDRESS:
Hillsboro, OR 97214 Gary McOuary
7gg6 SIn' Bund
TELEPHONE NUMBERS: Tigard, OR 97224
APPLICANT: 639-6881 PROPERTY DESCRIPTION:
OWNER;_ 684-0805 STREET ADDRESS AND CROSS STREET[LOC 1
GENERAL CONTRACTOR: 639-6881
15033 SW 81st Ave. , Tigar. , U
EXCAVATION CONTRACTOR:_645-1011 Cross Street: SW Ross _
SITE/JOB: 15033 SW 81st Ave.
LEGAL DESCRIPTION:
24 IWAFTER HOURS EMERGENCY TAX LOT NO.:
CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION:S.W. 1/4 SEC 12, T2S, RIW, WM.
__ SITESIZ.E,ACRES 38,862 S.F.
Ha iggins -- Pres. 639-5744 '--
RollandJ,_ DaniQl! - V.P. 639-,5422_ DISTURBED/WORK AREA,ACRES: 8:00 SF
LOCATION&ADDRESS WHERE SPOILS i
LAVING SITE WILL BE TAKEN SITE RUNOFF DRAWS TO:(CIRCLE ONE)
(NOTE:PERMTi'S MAY BE REQUIRED) CATCH-BASINITCH` PIPE CREEK
NO REMOVAL
(CIRCLE ONE) '
PUBLIC RIGHT OF WA
EROSION/SEDIMENTATION CONTROL (ESCMEASURES
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES 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'TECHNICAL GUIDANCE HANDBOOK".
EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
APPLICABLE STANDARD NOTES.
I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE CONST
R
U
CTION SITF.
OWNER SIGNATURF APPLICA -SIGNATURE
OFFICIAL USE ONLY
RECEIPT DATE. ACCEPTED
FT.E NUMBER RECEIVED BY
vv - 92. rel z_
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