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15714 SW 82ND AVENUE N 15714 SW 82ND AVENUE -" CERTIFICATE OF CITY OFTIGAOCCUPANCY CRYOFRD TWARD PERMIT #. . . . . . . v MST90-0062 GOMMUNFTY DEVELOPMENT DEPART 0RlQwDN l3i25SWHWl Blvd. P.O.Box 23397,riga d,Oragm 97223 (503)639-4i?S DATE ISSLIEDS 01/16/91 SITE ADDRESS. . . 8 15714 SW 82ND AVE PARCEL$ 28112CC-12200 SUBDIVISION. . . . I LANWREE ESTATES ZONING R-12 BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . 154 CLASS OF WORK. 01EW TYPE OF USE. . . ISF OCCUPANCY GRP. iR3 OCCUPANCY LOAD:320 4 TENANT NAME. . . I Owner: TITAN PROPERTIES PO BOX 6835 nl-(,)HA OR 97007 Phone 0: 6455477 Contractor: TITAN PROPERTIES PO BOX 6835 ALOHA OR 97007 Phone Ot 6456477 Reg #. . % 30558 O(--cupancy of the above referenced bkAilding iti hereby given, and Certifies the compliance with the State Of Oregon specialty Codes for the group, occupancy, MTld use under which the referenced permit was isilkied. FIRE DEPARTMENT ILDING INSPECTOR le I-I IZDING FICIAL POST IN CONSPICUOUS PLACE a INSPECTION NOTICE ,✓ t '" City of Tigard Building Department 13125 SW Hall Blvd. Tigard, Aragon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 3 --4171 Inspection:_. tooting Plbg. Underelab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Cas Line FINAL: Past/Beam Struct, San. Sewer Framing -Bldg- Post/Ream Mech. Rain Draiu Insulation -Plumb. Plbq. 'tnderfiooc Water/bine Gyp. Bd. -Mech. t Date Requested: z- _ �I __Time: _ AM/ PM Address:__ Permit A/s^4 Builder:. �^ THR FOLLOWING CORRECTIONS ARE REQUIRED: Inwrwctor: _ Date: A►'PROVED DISAPPROVED APPROVED SUBJECT To ABOVE. Call For Rainsp. �iSPECTIQN NOTICE City of Tigan Building Departaent 13125 SA Hall Blvd Tigard, Oregon 97223 Insperti.on Line (Rec-O-Phone) i39-41755 ©/usinena Phone: 639-4171 �' Inepectlon• �-_7 i Footing Plbg. Und slab Mech. Rough-in Apt-,"Sdwlk r Found. Plbg op Out Gan Line FIN,L: Poet/Seam Struct. San. Sewer rraming -Bldg. Pont/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Gyp. Bd. -Mech. Date Recpiosted:_ / -�� — ! f Times AN ,[ PM Address: /L! �� Permit is e; rBuilder:— THE FOLLOWING OOr.RECTIONS ARE REQUIRED: Inspect^ s �- Dates CIP APPr.MZD M"PFAMM APPROVRD SURJECT TO ABOVR Call Por "khmp. INSP "JQN NOTICE City of Tigard Building Departmr3nt �pS� 13125 SW Ball Blvd. Tigard, Oregon 97223 `- Inspection Line (Ree-O-Phone): 639-4175 Buainess Phone: 639-4171 Inspection: Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top out Cas Line FINAL: Post/Baam Struct. San. Sewer Framing -Bld7. Post/Roam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. ad. -Nech. Date Requested: ^�5 '� _q. me: PH Addreen: :$ 21—- ��/l lL Permit i:. Builder: THE FOLLOWING CORRECTIONS ARE REQUIRED: S 4ZZKK-rte � V - f Inspector. Date: _APPROVED .. DISAPPROVED APPROVED SUBJNCT TO ARM call For Reinsp. INSPECTION ROTICE C..ty of Tigard Building Departasent 13125 SIR Ball Blvd. Tigard, Oregon 97223 ' Inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-4171 I aspect ior.:_-- — --- ---"'— Footing ?l.bg. Underelab Mech. Rough-Ln Appr/Sdwlk Found. Plbg. Top Out :as Line FINAL: Poet/Beam Struct, San. Sewer Framing --Bldg. Post/Beam Mach. Rain Drain l:eulation -Plumb. Plbg. Underfloor Nater `Line Gyp. Bd. - ach. Date Requeeted: �!/ C/ Times AM —PM Address. �.1/=SL/ J��! Permit Builder• Ode ve �I> i✓y.vI' o�'frov � _ _ �_ cs'h ?�?6 011 _7`— e� — Inepectors ��__ _ Date: — APPROVED DISAPPROVED — APPROVED SUBJ8rT TO ABOVE Call For Reinep. INSPECTION NOTICE City of Ti.gaxd Building Department r� � 131.25 SA Ball Blvd. Tigard, Oregon 97223 inspection Line (Rtc-O-Phon-p): 639-4175 Business Phr-ne: 9-4371 Ir.spection:— — __—_— ----- — Footing Plbg. Undoralab Mach. Rough-in. Appr/Sdwlk Found. Plbg. Top Out Car Line FINAL: Poet/Beam Struct. San. Sewer Framing �-Bldg*� _ Post/Beam Mech. ain Drain Innulation -Plum P-.bg. Underfloor. Water Line Gyp. Bd. �rMech. > / Date Req rested: _�— _Time: — AM _-PM Rddresst_ � 7 2�� l�C7h C� __ Perwl.t 1:� Builder:— �.,_----- ------ THE FOLLOWING CORRECTIONS ARE REQUIvRO' Inapert-or: -,1�--- T APPROVED -b I PAPVED __-^._._^., APPROVRD SuP.IECP TO AROVE Xt- Reinsp. EFMUMM INSP!'CfION NOTICE City of Tigard Building Department 13125 SU Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone)j� 639-4175 Business Phone: 639-4171 ,i Inspection:,_ ��� -- _---._-- Footin Plbq. O r�lab Mech. Rough-in Appr/Sdwlk 9 Found. Plbg. Top Out Gas Line FINAL: Poet/Beam Struct. San. Sewer Framing -Bldg. Post/Beam Mech. Rain Drain Insuiation -Plumb. Plbg. Underfloor Nater L!ne VYp• Rd. -Mech. Date Requested:_ ___LL_.1] —Tim°= Fd el- Address—~ __.—_tea jZ---C� Permit Builder TRE FOLI.(A'IING CORRECTIONS ARE REQUIREDi Inspoctur: f�L—�—. Date' + • / Ar PPROVED DIBAPPROVSD APPRfrM.D SUBJECT TO ABOVE Call For Reinap. INSPECTION NONCE City of Tigard Building Department �- L9125 Sit Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 business Phone. 639-4171 Inspections — Pcoting Plbg. Underslab Mech. Rough-in APlr/Bdwlk Found. Plbg. Top O*it Gas Lina F11"s r' Post./seam Struct. San. Sewer -1ldg. Post/Ream Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor I/1 Water Line Oyp. Bd. -Mach. Date Requested, / — Timet -'Z'—AN PN c l L I ` Z lflS Address: Permit #s 1 ,) / l ,wc_ Q l�j Rui!der:_ tV �(/l�ti.� --Xp+C 1r7 S-01 THE FJLLOWING CDRREC,TrC*B ARi RRQUIRSDILJ i IV i f-- Inspectors ^v _., Dates_1�� APPROVED DISAPPROVRD APPROVEI> 9UBJECr TO 1i90VE Call For Rci.nsp. INSPECTION NOTICE City of Tigard Building Department 13125 SIN Hall Blvd_ Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: — —— Footing Plbq. Underslab Mech. dough-In �Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Poet,/Beam Struct. San. Sewer Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. P1bg. Underfloor Water Line Gyp. Bd. -Mech. / Date Requested% 4�- 7z) Time: _Ali PM Address: h d Permit Builder: — THE FOL:.OWINO COMMON$ ARE REQUIRED% / Q ! & Inspector:___ Data /-Zlqc APPROVED DISAPPROVRD 'APPROVED BUllJtCl' TO ABOVE Call Ior Reinsp. INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 I Phone: 639-4175 Type of Inspection Date Requested__ D ' ��—n�f(f Time A.M._ P.M. Address X 71%/ Permit # Owner Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to Jrj __ Pi Approved Inspector I4 Ll Disapproved Date CALL FOR REINSPECTION ❑ YES ❑ NO 1 k INSPECTION NOTICE City o` i!yard Building Department n� P.O. Box 23397 Tigard. Oregon 9722,, Phone: 639-4175 Type of Inspection �7 , Date Requested___ 16iD Time A.M. P.M. Address Permit ko"4`i Z Owner Lot # Builder The following Building Code deficiencies are required to be corrected: Presented to Approved Inspector I Disapproved Date CALL F R REIN E ION ❑ YES ❑ No lJ V INSPECTION NOTICE City of Tigard Building Department \ P.O. Box 23397 Tigard, Oregon 97223 Phony 639-4175 Type of Inspection s _------------__—� Dave Requested_��_,�,� - lima K A.M. P.M. Address _ �� -7�y. ��`1_- Permit - Owner Lot # Builder The following Building Code deficiencies are required to be corrected: A P52r_-�"t A f f Presented to ❑ Approved Inspector Dinpproved Date CALL FOR REINSPECTION A t ❑ NO INSPECT IrJN NOTICE City of Tlqard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection - Date Requested.,�(�?�'�` Time _ A.M. / P.M. Address _ l'SW /LL h C� Permit #' = �c�J _Z. Owner— _ Lot # Ar Builder-lam"'—•��= -The following Building Code deficiencies are required to be corrected: Presented to A k oroved Inspector _ ❑ Muppro"d Date -.--- �J `�L !a CALL FOR REINSPECTION YE• 0 NO INSPECTION NOTICE a / City of Tigard Building Department///// /7 P.O. Box 23397 Tigard, Oregon 97223 Phone. 639-4175 Type of Inspection Date Requested rL�7 /—_rte_-1�� _ Time._ A.M. P.M. Permit Address Owner ,[_,_.___ _ Lot — Builder --- The following Building Code deficiencies are requir3d to be corrected: Presented to -- N" Approved Inspecto _ ..-- ! Cisapproved Date I CALL FOR REINSPECTION ❑ YES F] NO INSPECTION NOTICE City of Tigard Building Department P.O. Boy 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested Time A.M. P.M. Address teA71—# Owner Lot # Builder The following Building Code deficiencies are required to be corrected: CS P-qsented to Approved Inspet;*or ElDisapproved CALL FOR REINSPECTION F-1 YES 0 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection ��� /" ��'75��� ' -� Date Requested i —7 G Time__ A.M._—P.M. Address / 7��'/ �-� _ Permit # U Owner_-_ Lot #__ Builder �.— The following Building Code deficiencies are required to be corrected: i Lit ee �J Presented to Approved Inspector --_ _ _ roved Date REINSPECTION Y I INSPECTION NOTICE City of Tigard Building Department P.O. Box Tigard, Oregonon 97 97223 Phone: 639-4175 Type of Inspection — [ / S ✓� 'R�' 1) — Date Requested -y Time A.M._n P.M. Address � 1 -h C— Permit ilk Owner Lot # Builder The following Building Code deficiencies are required to be corrected: ZYsylQ i Preserted to _— © Approved Inspector Date _— ICY — I CALL FOP REINSPECTION E8 ❑ NO P L INSPECTION NOTICE City'of Tigard Building Department P.O. Box 23397 , Tigard, Oregon 7223 Phone: 639-41175 � Type of InspectioneA �, ZJ /3 Date Requested �� — Time—A.M.L P.M. Address 5 ?'J h C/ Permit Owner __ Lot Builder The following Building Code deficiencies are required to lie corrected: Presented to H--proved Inspector �. -� �_] Disapproved Date - _L'S►L_�'� CALL FOR REINSPECTION G YE$ ONO t INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested �,`/�•� �U Time A.M. p.M�.�,� Address _Zy2./y �h d' Permit Owner__ -_ Lot #--- Builder —_Builder YjkThe following Building Code deficiencies are required to be corrected: Presented to T Approved Inspector — -- �. 1 Disapproved Date _ C Z V CALL FOR REINSPECTION 0 YEi ❑ NO C1T1(OF TINA RD MASTER PERMIT CffY0FTkW"j) PERMIT 111ST90-0062 COMMUNITY DEVELOPMENT DEPARTMENT PRIM. r-'1ERMIT #. .- NS1'90-0061.2 13125 SW Hall Blvd. P.O.Box 23397,Tigard,Oregon 97223(5031. 75 DATE ISSUED. 06 '2*7/90 5.1.11-E ADDRESS. . . 15714 SW 8210 AVE,.'.' PARCEL: 2S112(:(,----.122O0 SUIRDI'VISION. . .. .. LONGTREE ZONING: BLOCK. . . . . . . .. . . :54 ............................... .......... BUILDING .......- R EJAS S U E /G(4 DWELLING UNIT5: 13 BASEMENT. 0 3 s f C."L(dSS OF WORK. ::NEW BEDRMS:3 BATHS: GARAGE. . . . . . . .. . . ::400 5 sf T'YP'E OF USE. . . -.SF FLOOR REUUIRED TY1,-11:.: OF C'ONST. -.51N1 F1 RST. 0 Sf I E*F T. 5 2 ft RIGHT-03 i"t CH"CUPANCY GRP'. -.R3 SECOND. . . :0 15 Sir FRONT. c2Y ft REAR— : f-t- G)TORIES. . . -.3 'THIRD. 10 J.5 sf REQUIRED-- 1AE 161+1'. . . . . .. -PO ft T 0 TA L-------- 10 S-f SMOKE DETECTORS. : FLOOR LOAD. . ::40 1:)Sf VALUE..... $ 69540 PARKING SP'AC'ES. . R e nia-r 1--.s- PLUMBING SINKS. . . . . .. . . . . ..2 FLOOR DRAINS. . . . :0 BACKFLOW P R E VN 11,:1:) I-AVATURIES. . . . . 3 1 WATER FIE'ATERS. . . - I T R A P C.;. . . . . . . . . . . . . TU1A/SHOWk;.RS. I I LAUNDRY TRAYS. . . :0 CATCH BASIN,. . . . WATER CLOSETS. . 0 SEWER LIN[.-' (ft) . - 00 GREASE 'T'RAP'S. . . .. 1)1131.4 W A 6 1A F:R S.. . . :1.0 WATER LINE (ft) . :0 0 OTHER FIXTURES-- . . e 0 61 A R E4 A 0 E DISK'. . . »0 RAIN DRAIN (ft) . : 10 WASHING MAC.1-1— SF' RAIN DRAINS. . : .............. r1LCH0NI(,AL FE.LS F' I' [j T L)E*L UNI' RG. . :0 type amount by date -recpt 3/ VENTS . . . . . ..41 PRMT $ 34 3.00 NiIX INI--lUT:Hl 00 B41.1 VENT FWAS. . -Ol. PL(,'K $ 222. 95 ININI ( 1OOK .0 1-40ODS. . . . . . cO 5 P[.T $ 17. 15 JNN >-10011, -,0 WOODSTOVE'S. . 1-"A Y 11 $ 100.00 JLH (42/1.6/90 i-C)OR FURN. . . . - CLO DRYERS. : l STDG $ 600. 00 POTI..../ClIP' ( 3Hr-*,-. OTIAER UNITS: 1 GSDC $ 250. 00 GAS OUTLETS:3 PARK $ r -,0.. 00 Owner: P R M*1 1, .3`3. 00 11JON PROPERTIES PLCK qi 9. 75 F,0 B 0 X G 8 3 5 51::,C,T $ 1. 95 P R,M T 14 i32. 50 ALOHA OR 97007 15 P CT $ 6. 63 Phone 0: 645547*/ POYM $ 1772. 93 JLH 06/2'7/90 C,ri n-I-,i,a c.,t c)-r i _....._--••--_._...-._.......-._._.__.....__.._ ...--..-,.... TT I A N P R 0 P E R TI E 6 VIO BOX 6835 AT C)HA OR 97007 Phone #c 6,456477 #. . z 30558 1, 1.872.93 TOTAL itis permit is issued sub,lect to the regulations contained in the RE(WIRED INSPECIT IONS liqcd Municipal Code, State of Ore. Specialty Codes and all other Font/found Insp Fi-replace Insp applicable laws. All work will be done in accordance with approved Plost/Beani Insp Gas Line Insp plans. This permit will expire if work is not started within 160 Crawl D-rain InsLiiatic)n Insp days of issttance, OT If work is suspend d f @?I than 180 days. PIM/UndslAb Insp Gyp Boa-rd Insp \, , ) t 1-11-M/Und e-r f 1 c)o i- Rain drain Insp 1,crniittee �: ignatt.(re:: Mechallici-iAl. Insp Water Line Insp Plumb Top Out App-(,/Sdwltf. Insp I t.ied By .......... ......... F-ra"ling Insp Mechanical Final a Cll fc)-r i — inspection 63941'?5 SEWER CONNECTION CITYOFTIGARD PERMIT TMID 1--,E.R P1 I T 0. . . . . . . : SWR90-0070 COMMUNITY DEVELOPMENT DEPARTMENT 0014M FIR111. P,ERMIT SWR130 00*70 13125 SW Hall Blvd. P.O.Box 23397,Toud,Oregon 9�q A r)46?9�17b . .1. DATE: ISSUED: 06/27/90 (3)ITE ADDRESS— : V-5714 SW 82HI) AVE P"ARCEL'. `3UBDIVISION. . . . .. LANCYTREE ZONING: DLOCK. . . . . . . . . . 9 . . . . ..54 H N A 11 T N A 11 E 1.15A N0. . . . . . . . .. ,. :4:16 131 F*IXTURE UNITS. . . CLASS, 111' WORK. NEW DWELLING UNIT$':). . t1 I Y11f:' OF' USE. . . -.SF' NO. OF BUILDINGS: TNSTOLL TYPIE. .. . . -BUSWR 11TIPIERV SURF-ACE. . .' R P n)a-r k s tt Owrie-r,.- FEES TIJAN PIROP,ERTIES tyl:)e aniOLU)t by date r L-c:pt 1:111) BOX 6835 r-40117 $ 1250. 00 1:N S F, $ 35. 00 AL..(: HA OR 97007 1-1 A Y 11 J.285. 00 J 1 1-1 0612*7190 111-ic)rie 0: 645547Y 1-10 BOX 6835 OR 9,1007 .......... Vlhai-ie It: C,45647? $ 11;185.00 TOTAL. 1;!eq 30558 .................— REUUIRFD INSFIECTIONS This Applicant agrees to comply with all the rules and regulations Sewe'r lrlsf)ectioll of the Unified Sewage Agency. The permit expires 20 days from 0 W F4-r II-)S e C t i C))-) ........................ 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 sever is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase ......--.—............... A "Tap and Side Sewer" Permit and the igency wW install a lateral. .......................... .................. I.S-SUed By: Call. fo-r irisl:)eeti.ari 63' 9•-41'7'"; - ........... ...... Of:" TTGARUP RE.(..-,EIF,T OF PA'Yl'lf'.'NT p P 0. E-CL.—TT INI CHF Ct AMOUNT c 7,057,97, NAME s I' T"MI PROPERTIFS CASH AMOUNT c ().C)(7) A NO P ESS PAYMENT DATE Ct6/2-11'/90 SUPI)I V I ev I ON ALOHA. OR 9 70077— 4 5W 1:3 IND AVE. r-'IJPF'O':..E OM F F�AFNT AMOUNT F'AI'L, PURPOSE OF rf' "AYMENT AMIJUNIT PAID C+11IC CIT trFj,r9')—('?('.)62 747.Oo MPLUMPING PEPM 1 12. 5( MECHAH,; CAL. PE. 79. 00 ST. BUILD PUE .25. 7 PLAN CHECf! FE k"2. SEWEP", lisp, W SEP I N"SPECT I-5.0c) STREET SDC 600. CK, PAPk IS IFIDC 25t). 00 STIOPM DRAIN SDC I CI f AL AMOUNT F'A 11.) .............. D" CITYOFT167AR. D . PLAN CHECK APPLICATION �✓/ C1n0FWAIW PLAN CHECK N ' COMMl1NITY DEVELOPMENT DEPARTMENT «� PERMIT N — 13125 5 W Hall Blvd.,P.O,Box 23397,Tigard.Omgon 972223,(503)6394175 DATE ISSUED -- JOB ADDRESS: —� /_ 0,ev — J Q Ode- 'i AX MAP/LOT CC- /.22 0 LOT: LAND USE: —— VALUATION: 6 ...� OWNER SPECIAL NOTES NAME: _ TITAN PROPERTIES CORP. REISSUE OF: _ ADDRESS P.O. SOX 6835 LAST REISSUE: _ ALOHA; OREGON 97007-6835 FLOOD PLAIN/ — 645-6477 SENSITIVE LAND: PHONE: ---- APPROVALS REQUIRED CONTRACTOR PLANNING: _ NAME'—� .`7��,.;r_ ENGINEERING: ADDRESS: — FIRE DEPT - - OTHER: PHONE: __ _ `__ ITEMS RE_Ql1IRE0 LIST/SUBCONTRACTORS: ARCH/ENGINEER BUS TAX:NAM[ : _ _ CALCULATIONS: TRUSS DETAILS: -----_^___ PARKING PLAN: LANDSCAPE PLAN: 11111?NI _...._ _ ..___.— _.__— _ _ OTHER: - ---.— —_ _ CINh`1ENTS: __— PERMIT N ACCT N OTSCRIPTION AMOUNT AMOlIN1- PD, HAL D(IE �1�1G Z 10-432 00 liuil.iinq Perulit Fees c ✓ _ _ — ,_.7_.4J . 10--431 (10 Plumbing Permit Fees ,. 3 O __. — `�Z• 7-v 10-431 01 mochanical Permit Fees 10--230 01 Slate Building lax (5%) 11t6ldinr3 Plumbing ___ _1° G3 _ Mach rt 10-•433 00 Plans Check Fee Q7 0 ' IIuiId[ng Plumbing U?(�O- 2(19 OU Sew'-r Cunnec 1.i un 3O 444 00 Sewor InspocLian 35 '.rl 440 00 Strert. 3ysl em Ileo Charge (sDC) '12 -449 00 Po1rks sytilmn Dov Charge (1)111:) 31 41m (10 Sturm Draina(le Syst Dee Chrg (WIC) 10 -130 09 IRI 1) 1O 230 (16 Washin-alun County I ire 111 (95%) 11) -110 00 Amara /Wotblowuud �_- I 0-F Al X 3_.17. _..... ._ 11 _........_ .__.._—_..____ A1)P1 Wi E :c I1;Nr1114, L koruluad by : (late. Rec•clived: cr1/31)9/P/1 HP �I UENERAL CONTRACI OR NAME& ADDRESS: CASEFII_E NO.: r PERMITNO.: _ -- APPLICANT NAME AND ADDRESS: TiTl�nl rrar�I'�'Ri'I ` ' EXCAVATION CONTRACTOR NAME& ADDRESS: OWNER NAME AND ADDRESS: TELEPHONE NUMBERS: PROPERTY DESCRIPTION: APPLICANT; N�" �°; �, - STREET ADDRESS AND CROSS STREET/LOCATED OWNER• _.l..L'1_`_�." ��7 � - f � -�. /-� .-.T- ��� • .-,'`,r �, � , GENERAL CON'IRAC`IOR:_ EXCAVATION CONTRA(TOR'_4X _-Z442_[L SITE/IOB• LEGAL DESCRIPTION: 24 FIR/AFTER HOURS EMERGENCY TAX LOT NO.: -- COCT PE SON, 1'IT.E,TELEPHONE: 1/4 SECTION; SITE SIZE,ACRES:— DISTURBED/WORK AREA,ACRES: i LOCATION&ADDRESS WIIERE SPOILS SITE RUNOFF DRAINS TO:(CIRCLE ONE) LEAVING SITE WILL BE TAKEN - UIT'CH PIPE CREEK (NOTE:PWt%UTS MAY BE REQUIRED) CATCiI-BASIN ' (CIRCLE ONE) PRIVAI-F P[tOPERI-Y �_ �pUj3LI�RIGITF OF=WAY rit0 lON/�i 1Mk:NTATION CON'�'�OI. (I:'sSC)M�A�URES MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS • DURING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE STABIHZ.FD CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY ESC PFR!MFTER RUNOFF CONTROL FACILITIES CLEARING AND GRADING RESTRICTIONS CLF AN AND REMOVF ALI, DFBRIS ENSURE O E.RATION OF PERMANTFAC _ILITIES COViiR PRACTICES CONSTRUCTION SEQUENCE OTHER OTHER____ PLAN FOR EROSION CONTROL PREPARED AND SUBMTIT'ED IN ACCORDANCE WITH"TEGNNICAL GUIDANCE HANDBOOK'. EROSION CONTROL PLAN DRAWING,AS REQUIPED,HAS PLAN CONSTRUCTION N(7TES C6MPLETE.INCLUDING EMERGENCY PHONE NUMBER. SCHEDULE/STAGINO FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND APPLICABLE STANDARD N(1TFS. I HAVE READ AND WILL COMPLY wail THE ABOVE AND WILL CONSTRU(:T AND MAINTAIN ESC MEASURES AS NECESSARY TO CONTAIN SEDIMENT ON THE CONSTRUCT ION SITE. Ile- (`WNFR S ATTIRE l APPLI AN NAI'URE • • • • • s • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • OII�ICIAL USE ONI Y, R FCF.I I'T DATF ACCEPTED IT I: NI)MITI:R RI;CEIV1.1) BY