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15644 SW 82ND AVENUE 15644 SW 82ND AVENUE w ■ lwjlw FE CERTIFICATE OF CITY OFTIGARD OCCUPANC.Y Tw lim C"YOF RD COMMUNITY DEVELOPMENT DEPARTMENT offacm . . . . . . . .. MST90-0130 13126SWHWI Blvd. P.O,Box 23397,TlqmM,0r6pn QrM MM69475 SITE ADDRESS. . . - 15644 SW 82ND AVE PARCEL: SUBDIVISION. . . . s LANGTTEE ESTATES 7(IN I NO s R- I z� BLOCK. . . . . . . . . . i LOT. . . . . . . . . . . . . :50 t, -)SS OF WORK. -NEW TYPE OF USE. . . :SF OCCUPANCY GRP. :R3 CKJ,'UPANCY LOAD i220 4 i ENANT NAME. . . P-MAl ks: Own err TITAN PROPERTIES 01) BOX 6835 ull-OHA OR 137007 I-'lhunp 0: 6456477 Contractor: TITAN PROPERTIES PO PLIX 6835 01.004 OR 97007 Phune 6456477 Req #. 30,538 Ocr-ttl3vinry of the above referenced bi.Atldinp is hey- eby given, anti certifies Hie compliance with the State OF Oregon !lpecislty Codp% for the group, ucc:r.tpsnry, and uFp under- which the r- eferpim"d permit wss irail-ted. u IL2.Di.N6 I PECTOR POST IN CON SPICUOU5 PLACE w 1 �3NSPEgCTION NDTICF f city of. Tigard Building Depactscnt ! 1:1125 SN Hall Blvd. Tigard, oregon 97223 Inspection Line (hec-o-Phone): 63y-4175 Business Phone: 639-4171 -- Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line PINALe Poet/Beam Struct.. San. Sewer Framing �Q• Pi- 11/ �Yi�• Poet/Beam Mech. Rain Drain Insulation /w 1 -Koch. Water Lina Gyp. Bd. f ' Plbg. Underfloor AKA'PK Date Requested: _-_Time _ > �_ Permit Addreee: Builder: THE FOLLOWINGAA coRRECTIONB E RNOUIRED: Inspector:_ ---- — - — APPROVED DISAPPKIV,SD APPROVED SUBJECT TO ABOVE. Call For Reinsp. LNSPRCTION NOTICE City of Tigard Building Pepartment 13125 M Bali Blvd. Tigard, Oregon 47223 Inspection Line (Rec•-O- one,): 6.39-4175 Business Phone: 639-4171 Inspection: Footing Plb%(. Underslab Mech. Rough-in Appr/Sdwlk Found. Pl�. Top Out Gas Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldg. Poet/Ream Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mech. moi} Date Requested: �iL, l Time: AM PH Address: CC-�14Permit �t p Builder: THE FOLLOWING CORRECTIONS ARE REQUIRED: InspetStors -- Date: L � /APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVF. _Csll For Relnep. V . IN&PECTION NOPICE City of Tigard HuLld!jag Department �� 13125 SW Hall Blvd. Tigard, Orerlon 97223 Inalwar"_ion rine (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: Footing Plbg. Underelab Mech. Rough--in Appr/Sdwlk Pound. Plbg. Top Out Gas Line FIMALt Poet/Beam Struct. San. Sewer Framing -Bldg. Poet/Beam Mech. Rain Drain Insulation � Plbg. Underfloor Nater Lina Gyp. Bd. wh. / r Date Requested: /J 7 Timet AM _,2 PM Mucous: 1,5- ,`�7 ,�� h' Permit #: Builders --,� -�/ THE FOLLOWING CORRECTIONS AM REQUIRED: Inspectors`__------ Date;___ _`' / APPRCP41 DISAPPROVRD APPROVED SUBJRCT TO ABOVE Call for Relns,). � it urs � �► � ur � MFF$ T,JON_NUTICE ' City of Tigard Building Department 13125 SW Hall Blvd. Tigard. Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-417' Inspection: Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gan Line FINALS Poet/Beam Srruct. San. Sewer Framing -Bldg. Poet/Beau) Mech. Rain Drain Insulation Plumb. Plbg. I)nderfloor Water Line Gyp. Bd. -Hoch. DAte Requested: 1_0 / / ` Timor AM —PM Addrede,_ �7 �, __ Permit Bu i Ider: THr FOLLOWING CORRECTIONS ARE REQUIRED: APPROVED DISAPPROVED APPROVED SUBJECT To AW7VE d __:7(_, Call For Reinap. INSPECTION NOTICE City of Tigard HW(ding Dtepar—_nt " 1312'+ SW [tall 31vd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business ^hon 639-4171 Inspection: Footing P.bg. Underslab :tech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Poet/Beau SL ri, .t.. Nan. Sewer Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Cyp. Bd. -Koch. Date Requested: =�� - Times x _AM __PM Address: 1- — +h Permit #: Builders ' THE FOLLOWING CORRECTIONS ARE RSQUIRED: Inspector: _ Dates / Z. L/ � APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE Call For Reinsp. 4 INSPECTION NOT'}QE City of Tigard Building Depafrtaent 13125 Sit Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639•.4li5 Business Phone: 639-4171 Inspection:_._ Footing Plbg. Underslab Hoch. Rough-in /Appr/Sdwlk i Found. Plbg. Top Out Gas Line FINAL: Post/Beam Strurt. San. Sewer Framing -Bl6g. Poet/Beam Mech. Rain Drain Insulation -Plumb. Plbq. Underfloor Water Line Gyp. Bd. -Mech. Date Date Requested: / -��� -f� _TLse: AM PH Address: 5 Gtr 7f;f �c7 h4 Permit #-7%L_�-(J 3ZI Builder: THE FOLLOWING CORRECTIONS ARE REQUIRED: ZY Inspector: k-e— r Dater APPROVED D2811PPROVCO APPROVED SUBJECT To ABOVE ��Call For Reinep. EI { INSPECTION NOTICE City of Tigard Building Department 13125 Sit Hall. Blvd. Tigard, Oregon 47223 Inspection Line (Roc-O-Phone): 639-4175 Buotness Phone: 639-4171 Inspection: -- Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Struct. San. Sewer Framin -Bldg. Poet/Beam Mai.-h. Rain Drai.i Insulation f J -Plumb. Plbg. Unduriloor W:.�.or Lino Gyp. Bd. --Mach. Date Regtivotced: _ _�_ Time: AM �_PM Address:_�_�� Permit t/ G-4-31-_�- Builder:___-„_! ---THE FOLLOWING CORRECTIONS ARE REQUIRED: Inspector:_ ----_ ___-- -- _----__- - Datet APPROVED _ _ DISAPPROVED - _- APPROVED SUBJECT TOAAEOVE Call For Reinap. r INSPECIION NOTICE City of Tigard Building Department 13125 SW Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-o-Phone): 639•4275 Business Phone: 639 11 Inspectiont__ --- Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk Found. Plbg. '.lop Out Gar: Line FINAL: poet/Beam Struct. San. Sewer Framing -Bldg. Post/Ream Mech. Rain Drain In.ulation� -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Koch. Dote Rocpi ested: /J /LJ-LG� Time: /r 11M ) PK Address [�' J �� N� Permit is Builder:--- THE FOLLOWING CORRECTIONS ARE REQUIREn: �� Date:LL Inspect r,r: - —__.---- ------------ -- PROV>!O DtSAPPROVRD APPRc7VKU SUR.IECT TO ABOVE Call For Reinep. INSPPCTION NOTICE l Clty of Tigard Building Department �/ 13125 BW Ball Blvd. Tigard, Oregon 97223 �,; Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-417). Inspections -- Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top out Gas Line`` FINAL: Poet/Beam Struct. San. Sewer Framing J -Bldg. pont/Beam Mach. Rain Drain Ineu RETon -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mech. Date Requested-c_ /'_; --"/::[a ____Time: _ _AM Ph Address:_ � L Permit #1-//,/ !G Builder:, _ THE FOLLOWING CORRECTIONS ARE REQUIRED: Inspector:__ APPROVED DISAPPROVED APPROVED SUR'14iT TO ABOVE _Call For Reinsp. INSPECTION NOTICE City of Tigard Building Department F.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 1 Type of Inspection _ Date Requested l :/Y. Y _ rime A.M._J _P.M. Address 4 6 ' /��� _ Permit /,;- Owner � ��y 'c, �� h G _ Lot # Builder er f�aa✓� The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector1-2-___-1 ��� C..] Disapproved Date 1�-� /// CALL FOR REINSPECTION C7 YES ❑ NO i i INSPECTION NOTICE ` /f City of Tigard Baildissg Dcpartnent l� 13125 SN Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: _ -•--- Foo .ing Mg. Mech. Rough-in Appr/Sdwl;k Found. / 11s bq. TOp W 1 Gas Line FIN&L: Poet/Beam Struct. ( San. Sewer / Framing -Bldg. Poet/Beam Mech. Rain Drain Inslsl.ation -Plumb. Plbg. Underfloor Nater Line Gyp. Bd. \/-Koch. Date Aequeetedt ,/�=� 4 1� _Time: JL_._. _AH FH Address: -v f i Permit ♦s_� Ru i 1 der• THE FOLLOWINC. CORRECTIONS ARE REQUIRPD: Inspectors / / / _ Date:�_.e!___:L.�..�Y �APPROVRD DIaAPPROV%D _ APPROVED SU&1RCT TO ABOVE Call For Reinap. _&MIA INSPECTION NOT- c' City of Tigard Building Departsaent 13125 SN Ball Blvd. Tigard, ort:gon 9733 Inspection Line (Rec-O-Phone): 639-4175 Businean FP 1 Inspection i �.-- \L Footing Plbg. Underalab Rough Appr/Sdwlk Found. Plbg. Top Out 'Ole Lists FINAL: Post/fleam Strur_t. San. Sewer Framing -Bldg. Poet/Beam Mech. Rein Drain Insulation -Plumb. Plbq. Underfloor Water Line Gyp. 9d. -Mech. Date Requested: / 7 G Times �AK PK Permit +t cl>-e/ ac,)_ fluilder:_ THE FOLLOWINC CORRECTIONS ARE PEQUIRED: 5,041119 14,11 f, Inspectors ,_____ Date: �l✓ 7 v V APPROVED DISAFPROVED _ APPROVED SUB.IECT TO ABOVE Call For Reinsp. INSPECTION NOTICE '\ City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection Date Requested �U _$ / G Time A.M. P.M. Address ./5� L�'y �/� h ---- Permit Owner __— _—.. Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to �.Approved Inspecior _ _— // Disapproved Date C:I LL FOR REINSPECTION YES 0 NO EMEMUFFB INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection - 4 .c/�-V,,.t-� Date Requested Z0 S X10 Time 6' A.M. _P.M. Address S G' �V d h Permit Owner Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to _- Approved Inspector _--_-- _ - --- ---- - --- ! Disapproved Date CALL FOR REINSPECTION ❑ YES f_A NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23391 Tigard, Oregon 97223 Pho 639-4175 Type of Inspection Date Requested /,/ Time. P.M. x-A.M. Address eL`7 � �� Permit # —0/ 3 Owner Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to �;4-Approved Inspector _ ❑ Disapproved Date CALL FOR AMPkKTION El YES C_l NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 2.3397 Tigard, Oregon 97223 Phone- 639-4175 Type of InspectionC { �� Date Requested ,� l �Q Time_ — A.M._. P.M. Address _� 11y �'z h d Permit # Owner_ __ Lot #, BuilderThe following Building Code deficiencies are required to he corrected: Presented to Approved Inspector x Disapproved Date _~ U CALL FOR REINSPECTION l_7 YES 0 NO a� � i■r �v � w I� its IIR � INSPECTION NOTICE �T•-/ City of Tigard Building Department I P.O. Box 23397 Tigard, Oregon 97223 a Phone: 639-4175 Type of Inspection —.— Date Requested !/ [ Time /_ A.M. _P.M. Address S `'x _17.�___�_ Permit #[ '� Owner—_—___ ____,�_. Lot # U / 3 Builder The following Building Code deficiencies are required to be corrected: i Prasented to Approved d' Inspector --- I Disapproved Date — CALL F )R REINSPECTION Cl Y18 Cl NO � C17YOFTIFARD � MASTER PERMIT Cftlf PERMIT ##. . . . . . . .. MST9O (x):1.;:30 OF i167r 4RD COMMUNrTY DEVELOPMENT DEPARTMENT OREGON [:'RIM. PERMIT 0. : I*IST9O-••O:1::30 13125 SWlWIBlvd. P.O.Box 23397,Tood,Or Wn 97=f4N)ONA175 DATE ISSUED: 08/08/90 3:111_ ADDRF.::SS. . . -. s':,i;44 SW 82ND AVE: PARCEL: 2S112CC•-•1:1-800 S)UDDIVIS.1.C)N., ,. _ .. : LANGTREE ZONING: ItLC)C1'.. . « . » ., .• . . « : L01.. . . . . . . . . . . . . ..50 BUILDING ••__._._._.._.___._____._. __._.__. REISSUE: /GA DWELLING UNITS: 13 BASEMENT.. . . . . . . . :0 3 sf CLASS OF' WORK. -NEW BEDIRM S:3 BATHS-9 GARAGE.. . . . . . . . . . :88O 5 sf TYPE OF' USE . . :SF" FLOOR ARE:AS_•-•___._._.__......_ REQUIRED TYr'E: OF' COhST•. :SN 1- IRST•. . . . :75 G sf LEI=T. . -.52 ft RIGH'T . :O3 ft, 0C.,CUPANCY ERP. :R3 SE:COND. . . :98 sf FRONT. :1Y ft REAR. . : ft STORIES. . . . . . . ..2 THIRD. . » . :0 1.6 Sf• IRE LIUIIRE D I••IE.IG1-1T. . . . . . . . ..20 •Ft TOTAL.-..----._._.....:73 S SMOKE DETECTORS. : FLOOR LOAD. . . . ..40 psf VAL.UE. . . . . $: 77250- PARKING SPACES. . : PLUMBING '3:I:NKS. . . . . » . _ „ » :2 FLOOR DRAINS. . . . .0 BACKFLOW PREVNTRS. . : I...AVATORIES. . . . . :31 WATER HEATERS. . . -. 1 'TRAPS. . . . . . . . . . . . . . ., TUI+/SHOWERS. » . . : 1.1 LAUNDRY TRAYS. . . :O CATCH BASINS. _ .. - .. •. ., e WATER CLOSETS. . -.0 SEWER LINE (ft) . :00 GREASE DISHWASHERS. . . .. : 10 WATER LINE (ft) . aO 0 OTHER FIXTURES. ., C,ARBAGE DISP. . . :O RAIN DRAIN (ft) . : 1O WASHING MACH. . . : SF RAIN DRAINS. . : MECHANICAL _.______. .__..___.__ _M._ _____.._ __.___.__... FEES F=UEL TYPES------__.-______ UNIT HTRS. . aO type amount by date rer_pt VENTS . . . . . :41 PAYM $ 100. 00 J'LH 03/30/90 108146 MAX I:NPUT:O100 BTU VENT F7ANS. . :01 BPRT $ :367. 00 1' URN ( 100K . . :0 HOODS. « . . . . v0 BPLC, $ 238. 55 ! / TURN >=1.00K . . :0 WOODSTOVES. : Bt5PC: $ 18. 35 FLOOR TURN. . . . : CLO DRYERS. : 1 ST'DC `b 600. 00 I?0IL/CMP ( 3HP: OTHER UNITS: 1. S13DC $ R50.00 GAS OUTLETS:4 PARI'. $ 250. 00 / ! Ownera ___.__._...._._...__.._..___.___._.._._....._._.__._.__..___._.._.._.._._. M I SC $ 11:,.00 TITAN PROPERTILS MPRT $ 39. 00 PO BOX 6835 MPL.0 9• 9. 75 MEPC � 1. 95 ()LOHA C)R 97007 APRT $ 1.40.00 Phc)ne H: 6456477 F'SPC * /. 00 t"arltr<:tr.,tor: _..._.........._........_.............._.._....-_......._._.._._...__..._..... .-• PAYM $ 250. 00 JL.H 06/28/90 TITAN PROPERTIES PAYM 9; .1.586. 60 JLH 08/08/90 00 BOX 6635 OLOHA OR 97007 1-1hane ##: 6456477 1"eq N. . a 30558 $ i.936. 6O TOTAL •his permit is issued subject to the regulations contained in the - --- REQUIRED INSPECTIONS --- Tigard Municipal Code, State of Ore. Specialty. Codes and all other Foot/found Insp Plumb Top Out applicable laws. All wore will be done in accordance with approved Wt•r Proofing Bsm Framing Insp plans. Thi� permit will expire if work is not started within 189 Post/Beam Insp F•ireplar..e Insp days of issuance, or if wore is suspended for more than 189 days. Crawl Drain Gas Line Insp F'lm,'Undslab Insp 111191.tlatiall Insp) i-F.,rmittee 5 giiature: PLM/Underfl.aar Gyp Board Insp Ftng Drain Bsmlt Rain drain Insp Issued By: __..____.......__._. ___.._.._..._____................. Mechanical Insp Water Line i rl s p Call frar inspection _ 639-4175 -ITY OF TIGARD RECEIPT OF PAYMENT RErEIPT NO. -qC.)---2C)`52Z CHECk' AMOONT Me-1. b() NAMEz TITAN PF,'OPEN RIJES PAYMENT DATE a SUBDIVISION ALOHA. OR P U PF I 0S)E OF PAYMENT AMOUNT PAM PUF�POSE OF PAYMENT AMOUNT PAID MECHANICAL PE, 39.00 ST. BUILD PER 127. 1,-., PLAIA C�HEC-F FE 167'. 7-0 STREET SDC PAr"[.G SD. P5644 13W 132ND A',,,E TOTAL AMOUIAT PAID ® SEWERC(JNNG:C:T:I:C)hi CITYOFTIFARD I:rril rL-� CnYOFTMRD PERMIT f3. . . . . . . : SWR90--01.4.1 COMMUNITY DEVELOPMENT DEPARTMENT ommooN PRIM. PERMIT #. : I*IST90 0.1.3 1-) 13126 SW Hell BW. P.O.Baa 23307,Tipwd,Orpon+ (t l P4.76 DATE ISSUED: 06/26/90 SI1 IW ADDRESS. . . . 1.5644 SW 82ND AVI:-- PARCEL: 2S112CC-. ;I.:Lt:si.01 f:iUEID:IV:1CiIC1N. . . . . LANGTREE ZONING: BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :50 TENANT NAME::. . . » . USA NO. . .. .. . . . . . . .-41688 FIXTURE: UNITS. . .. CLASS OF WUI K. . . »NEW DWELLING UNIT(:;- . 1 TYF"E: OF USE. . . . . ..SF NO. OF BUILDIWiS» 1 INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . .' :sf F?eIII arir.s» Owner: _.._.._.__._,_..__...__._._._____._._._.._..... .._._._.._.._.__._._.._...._. ...... FEES I T. TAN VROPERTIES tyke amoctnt by (late rec:pt [:10 BOX 6835 P1RM'T $ 1250.00 I NSF $ :35. 00 ALOHA OR 9*1007 PAYM $ 1.285. 00 JL..H 06/28/90 Phone N» 6456477 Contraeto•r » __.__ ___...___....._._....___..___...__...____._......... . CONTRACTOR NOT ON F I I...E I?hc)ne N:: $ 1285.00 TOTAL REWIRED INSPECTIONS -_..._..__..__ . This Applicant agrees to comply with all the rules and regulations Sewer Inspection of the Unified 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 qiven, the installer shall prospect 3 feet in all directions from the distance given. if not so located, the installer shall purchase i "Tap and Side Sewer" Permit and the Agency will install a lateral. Iermi.t:i•:ee £ii.yri�atc(r.e» C1 sue(i F!y" CAII for insper,tiori 639•-41'75 Iov w t � I� en► A I•r � C11YOF TIGARD,. �- ra PLAN CHLCK APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT PLAN CHECK H 13125 S W Hall Blvd P O Boa 23397,Tigard,Oregon 97221,(5/03-)639-417 PERMIT N y� 5` P t e1 DATE ISSUED JOB AI ItESS: S `7 .I TAX MAP/LOT s,7..5/-/Z Cr- - "FeT _ I.OI LAND USL: VALUAfTUN: OWNER (! SPECIAL NOTES NAME: �_ 'e -- _-_ REISSUE OF: _ ADDRESS' _ _ LAST REISSUE: — — Qr7 FLOOD PLAIN/ SENS111VE LAND: PHONE: ---._— A_PPROVALS REQUIRED CONTRACTOR PLANNING: NAML: ,_ _ ENGINEERING: _ ADDRLSS: _ _ FIRE DEPT _ OTHER: ITEMS REgUIRED BUILDERS BO;"RD N: _—^ EXP DATE: _ HST/SUBCONTRACTORS: BUS TAX: ARCH/_ENGINEER CALCULAfIONS: NAME_ _ _ _�—,— _� _ TRUSS DETAILS: ADDRESS: —� OTHER: PHONE.: _-- COMMFN 1-S: -- _- SUBCONTRACTORS: PI 11M8: — --_— MECH: PERMIT # ACCP p DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE ftp 0.030 10-432 00 Building Permit Fees 367_-- _ �_ 10 -431 00 Plumbing Permit Fees /(/O _ 10 431 01 Mechanical Permit Fees _ 10-230 01 State Building Tax (5%) _x, 36 Building Plumbing Mech 10-433 00 Plans Check Fee - 4,3.3V ILL. `.j. Building 3 — Plumbing Mech 30-202 00 Sewer Connection _/,50 _ �Z 5O ,I 30--444 0(' Sewer Inspection _ 51-440 00 Street System Dew Charge (SDC) 52-449 00 Parks System Dov Charge (PDC) / _ ,50 31-450 00 Storm Drainage Syst Dew .,hrg (SSDC) ,/ �S o 10--230 06 Fire =� DOTAL a -� - �0 l I4EC M APP TCAN SIt;NATl1RE /5-If 6 1�'� Received By: _ (`ate Received: :� .,o C11/3597P/18P GRADING/1-AMSION C0NTRO1, INFORMATION GENERAL CONTRACTOR NAME& ADDRESS: CASEFILE NO.: :>> �1 • PERMIT NO.: APPLICANT NAME AND ADDRESS: EXCAVATION CONTRACTOR —Ll,rnfjR1.P-.n `TI F NAME&ADDRESS: p C'' p1 OWNER NAME AND ADDRESS: T ELEPI LONE NUMBERS: APPLICANT_ PROPERTY DESCRIPTION: OWNER: ( - ? . — SIFFET DDRESS AND CROSS STREETAM.ATED GENEiRAL CONTRACFOR: �, ,1 '1 w 9 .� --'� - EXCAVATIONCONTRACTOR:�,' ? — SITE/JOB: LEGAL DESCRIPTION: 24 IIR/AFTER HOURS EMERGENCY TAX LOT NO.: —,— CO J'ACr PF:RS(>N, 'ITLE,TELEPHONE: 10 SECTION: SI.11:SIZE,ACRES: _ D:STURBED/WORK AREA,ACRES: LOCATION& ADDRESS WHERE SPOILS LEAVING SITE:WILL BETAKEN SITE:RUNOFF DRAINS TO:(CIRCLE ONE) (Nol li:PERMITS MAY HE RE'Q(11RED) CCATCI I-BASIN DITCH PIPE CREEK I _ (CIRCLE ONE) PRIVAILPROPERTY PUBLIC RIGHT OF WAY :R( 161:1)INI-!r1 (QV CC)N'ROI, (ESC)MEASURES MINIMUM ES('RI:QF11REMEN'I'S MINIMUM ESC REQUIREMENTS D(.1RING CONS I'RtR71ON. FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE STABILIZED CONSTRUCTION ENTRANCE, REMOVE AND RESTORE TEMPORARY ESC PERIMFTER RUNOII:CON'1ROL. FACILITIES CLEARING AND GRADIN(; RESTRI(_'TIONS CLEAN AND REMOVE ALL SILT AND DEBRIS COVER 1'RA(-I'I('I•S ENSURE OPERATION OF PERMANT FACILITIES CONS1R11(."PION SFQI JE N(T OTIIER 01'HI:R PIAN FOR EROSION CON FROE.I'REPARED.AND SUFiMETT EIS IN ACCORDANCE WITH'TECHMCAL GUIDANCE IIANDBOOK". EROSION CON'I'ROI,PIAN DRAWING,AS R1 0111RUD,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY PIIONI NUMBER, SCIILDULIIST:,UING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL.MEASURES,AND AITI.ICABLE STANDARD N(>ITS. 1 HAVE READ AND WILL COMPLY WI I'FI'I'Hl: ABOVE AND Will.CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE. y OWNFR St s AI'IIRI,. APPAA A NATURE 0111CIAl IISI ONLY RECEIPT DA"IT ACCEPTED FI:F; NUMBER RI ( VIVF.D BY