11667 SW 129TH PLACE Uju'u
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IIEI(-,7 SW 1�9TH PLACE
4
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CER'TIT IC;ATf: UF
C;TY'OFTIGA;
C)C CUVANCY
(WYOFTI�ARD PERMIT M. . . . , . . o MQTryC". aFl3k1
COMMUNRY DEVELOPMENT DEPAiRT EM OREGON
13125 SWHWIBlvd. P.U.Box 23397.T43M,Orepon 97223 (503)(139.411; DATE ISSULDo 09/06/90
SITE ADDRESS— : 11667 SW 1.29TN PL PARCE.L& 13].33DD-•600
SUBDIVISION. . . . o VILLAGE AT SUMMERLAKI: PARK r' ZONINUs
BLOCK. . . . . . . . . . n LOT. . . . . . . . . . . . . ..45
CLASS ("r' WORK- o NEW
TYPE OF %j9E''. . . s S
OCCUPANCY GRP. E R3
OCCUPANCY LOADo220 •r
TENANT 1 AME:. . . o
Remarks t
Owners
DON `iORISSE TTE BLDERS, INC.
P !, BOX 17524
PORTLAND OR 97219
Phone ME 503-244-9314
Contractor E
DUN MORISSEITE RLDERS. INC.
P 0 80X 19524
PORTLAND OR 97219
Phone N o 50,3-620-7538
38
Ron ". . s 35533
Ocr_l.tpancy of the ab(�ve referenced building in hereby given, and cectifiee
the compliance with the State Of Oregon Specialty Codrs far than group,
rreupancy, and t.ttte under which the referenced permit W 9 itvaued
/ r
FIRE. DEPARTMENT' -s f3UILDI G I ECTOR
BUILDING OFFICIAL
POST IN CONSPICUOUS PLACE
1
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection r---i "i A
1
Date Requested Time A.M. P.M.
Address _�L Ca 7 `T_ �i �-J Permit #�l U-0230
Owner Lot
Builder
The fol.owing Building Code deficiencies are required to be corrected:
Presented to W-Approved
Inspector /' Disapproved
Date
CALL FOR REINSPECTION
O YES C7 NO
INSPECTION NOTICE
City of Tigard Building Departmer.t
P.O. Box 23397
Tigard, Oregon 97223
Phone. 639-4175
Type of Inspection
Date Requested Time. A.M. P.M.
Address Permit
Owner Loi
Builder
The following Building Code deficiencies are required to be corrected:
Presented to roved
Inspector 131upproved
Date
CALL FOR REDYWFCTION
F-1 YES
i
INSPECTION NOTICE
Citv of Tigard Building Department
P.O. Box 23397
Tigard, Or,�gon 97223
Phone: 620-4175
Type of Inspection Z__ ��'
Date Requested--_ "���J Time A.M.—_ P.M.
Address permit #Y,/—,,
Owner Lot #
Builder
The following Building Code de`iciencies are required to be corrected:
{
i � I
Presented to
_— pprovnd
Inspector —
[-1 Disapproved G
Date
-- C'W,J F'OR REI A ON
C7 YES 0 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 {�
Tigard. Oregon 97223
Phone: 339-4175
h.
Type of Inspection �✓� �� -- _
Date Requested__ a7_,OGTime .� A.M. P.M.
Address ._.__y z&P i'a 7 Permit # %li '�2�)3a
Owner_ Lot #
Builder _—_—_.—
The following Building Code deficiencies are required to be corrected:
f
Presented to —_.� J"pproved
Inspector _ [ V,'mpproved
Det•
CALL FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
City of Tigard Building Department
P.U. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection v f
Date Requested— Time A.M._ P.M.
Address Permit #
Owner_ _ Lot #
Builder
The following Building Code deficiencies are required to be corrected:
- - _
A —
Presented to ____ ❑Zapproved
ov
Inspector __
7
Date ----
CALLOhi l_R_� S . IOI�'
4 NO
INSPECTION NO T SCE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223 ✓'Jy
Phone: 639-4175
Type of Inspection -
r _
Date Requested '(` �/ Tin* .M. P.M.
Address Permit # 4z
Owner Lot #
Builder
The following Building Code iciencies ara equired to be corrected:
F
I
M
Ic0�=7� X�j
Prmnted to Approved
t'
Inspector C I Disapproved
Dots
CALL FOR REINSPECTION
0 YES 1-1 NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397 ;
Tigard, Oregon 97223
/Phone: 639-417
Type of Inspection r/1'w L- / ��SV i.AT[ o�✓_ _
Date Requested_ ZA a.90 rma_ A.M. P.M.
Address —//62(a 7 -7r/a Permit DD 30
Owner Lot #
Builder jjJ& 7�SC-,;:
The following Building Code deficiencies are required to be corrected:
Presented toApproved
Inspector I ❑ Disapproved
/ U
Date
CALL FOR REINSPECTION
Cl Yi• Cl NO
i
fi
INSPECTION NG FICE
City of Tigard Building Department
P,0, iiox 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection GGA
Date Requested _ Time A.M-tL'1Ak'&P.M,
Address i',L-7 �✓
Permit
Owner _—_- _ Let #
Builder !D vl 1
The following Building Code deficiencies are required to be corrected:
-- � cam. � (y^ ,.� �(�'�1✓I"�^L:w L
' r /
y
7
Presented to
Approved
Inspector -'G�� �^ ❑ Disapproved
Date.
CALL POR REINSPECTION
d YES [3To
INSPECTION NOTICE
City of Tigard Building Department x
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175 t
Type of inspection _ — -
Date Requested _ q Time A.M. P.M.
Address �� �� ,� J J Permit #
' #
Owner Lot✓ _
Builder
The following Building Code deficiencies are required to be corrected:
11_ — ----
`Lor ,
Presented to _ -- TApprowd
Inspector — ❑ 01upproved
Date --
CALL FOR REINSPECTION
[] YES ❑ NO
INSPECTION NOTICE
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 Z41 -7 42 e1' `"� Permit # Q
Owner 09 Lot #
i
Builder
The following Building Code deficiencies are required to be corrected:
r
Prosentwd to _ Appreved
Inspector
_ _ , Disapproved
Date
CALL FOR RFINSPFCTION
D YE8 0 NO
1.
Delete selected item
05MASTER PERMIT&a.& &A&A&&&&i&asaanaaaaaabaaaaaaaaa5aaaaaaaaaaaaaaa4
:MST90-0030: PROJECT:VILLAGE SUMLAKE #2 : STATUS:I : UPD:06/25/90: :MST: °
PERMITTEE:DON MORISSETTE BLDERS, INC. PRIM. . :MST90-0030:
SITE ADDRESS:11667 SW 179TH PL °
Oa CASE HISTORY Ad&h&&AAAAA&hh&&h&aSaha&Req/Sent3Schd/DueaEnd/Done&&ByaS`:ataaSG
A710 Post/Beam Inep 06/01/90 KS APP °
A715 Plm/undslab Insp 06/01/9) MS PASS
A/20 Mechanical Inep
A722 Plumb Top Out 06/21/90 MS FAIL °
A722 Plumb Top Out 07/17/90 MS PASS °
A725 Framing Inr:o 07/16/90 KS DIS °
A726 Framina <REINSP> 07/20/90 KS 779
A730 Fireplace Insp / / °
A735 Gas Lina Inap 06/22/90 KS AIS °
P.735 Gas Line Insp 09/27/90 KS APP °
A740 Insulation Inep 07/20/90 KS APF °
A745 Gyp Board Insp 07/25/90 KS APP °
A755 Rain drain Insp 05/25/90 MS APP °
A760 Water Line Inep 05/25/90 MS APP
A765 Appr/Sdwlk Inep 07/20/90 MM PASS °
3Abfihbhg&hS3hh6bA{�fifif�ahaAaAa&AhA�AS&5A&&aa&a`&aaAAhh&aASad&�aAAaaadA&4A&hAd&Aai
ti
INSPECTION NOTICE
City of T ,,,! F►nilding Department
'.O. t ux 23397
TigpM i.,dgon 972.23
Phone: 639-4175
Type of Inspection
Date Requested Time A.M.
P.M.
Address �f.�_c�Y� �� -- Permit
Owner _
Lot #__
Builder ^ —— - ---- -----
The following Building Code deficiencies are required to be corrected:
Presented to Approved —
Inspector i
n Disapproved
Date
CALL FOR REINSPECTION
❑ YEI 0 NO
INSPECTION NOTICE
City of Tigard Building Department"
P.O. Box 23397
gard, Oregon 97223
Phone: 639-4175
Type of Inspection
D* Reques-i Time A.M. P.M.
31)
Addiess Permit
Owner Lot
Builder
i The followin- Building Code deficiencies are required to be corrected?
Presented to Approved
Inspector DIsApproved
133te
CALL FOR REINSPECTION
0 YES El NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested—_ `� —5 Time�-A.M. P.M.
Address Permit
Owner — _ _ Lot # i
t
Builder
The following Building Code deficiencies are required to be corrected:
w
711 t
_ _ I
F
Presented to _ __ Approved
Inspector Disapproved
Date — _C
SCALL FOR RFINSPF,CIYON
❑ YES I 1 NO
INSPECTION NOTICE
City of Tigard Cuilding Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection 1507-;119
Date Requested. f- T
.1me-- A.M,5-�- � P.M.
Address --Z/ 4'-C- 7 Permit *'7401"56*
Ownp; Lot
Builder t-s-f 0 17 1 5 5 j 77-E,
Tha following Building Code deficiencies are required to be corrected:
Presented to ---- �Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
D YES F-1 No
CITY OF TIGAF;'I*.) RE("EIPT OF PAYMENT PECEIPT NO. 90-200 7 5
CHE(.-,K AMOUNT t '5270. 75
MOR ISSETI'E, DON CASH AMOUNT O. 00
PAYMENT DATE O!fi 15 90
St
S-18D TV I*S I LIN
PORTLAND. OR 97219- 11e36"% 5W 129TH Ft
PURPOSE OF PAYMENT Arl(--itJr,4T PAID PURPOSE 01: PAYNEINT AMOUNT FAID
BUILDING PER11 MST90-0070 460.50 FLUMP IN(i F:'[---PM 171-41 0
Pff'-,(',HANICAL PE 3-7. 50 ST. BUILD PER 31. 54
Fl..AN CHECV.:' FE 2.J. 71 SEWF-.P USA 1250. 00
,.+ 'AER INSPECT 00 'bTREET SVC 600.00
SDC 250. 00 C.-TORM DRAIN SDC 2!50. Oil
t'o,rAL. AMOUNT PAID 3270. 75
SEK.WER CONNECT10N
I-
.1.
CITYOFTIFARD :--R III 1T
COMMUNITY DEVELOPMENT DEPARTMENT WYOFT10 PERMIT #. . . . . . . . SWR90-0035
0119ft J
13125 SW HWI Blvd. P.O.Box 23397,T*M,Oregon 97223(503)6394175 ;777 PIRT.M., VAERMIT 0. - 11ST90-0030
L J'--4 an
SITE ADDRESS. . . : J-1667 SW 1.2971-1 I-L. I-1 A R C'E L-, 1.S 3 1)1) c':,0(a
'-')1.)B D 1:t I I S 11)N. . . . . VILLOGE AT SOPHIERILAKE PARK 2 Z 0 N'1 N G.
B L CK. . . . . . . . . . . LOT.. . . . . . . . . . . . . .
TENANT NAME. .
LJ S A N 0. . . . . . . . . . ..4 0 677 F'J X TO FN`c: L)N ITS
C L.AE313 OF WORK. NEW DWELLING (JN 1 T13. . . 1.
TYPE UF LJSE. . . . . ASF NO. OF:' BUILDINGS: 1
T.N ST A L.L T Y P'E. . . . .B 0 S W R .111 PER V S U R F A C I.:.'.
ni r.i-r I r.!:i
...........................I.—.1-1— F'EES
- - ,
VON HORISSE.TTE BLDE".RG, 1NC. type Anicit.kiit by date r e cp
il 0 BOX 19524 PRM $ 1.250. 00
1:Id E;I.., q> 35. CIO
PORTLAND OR 97219 V,0 y 11 1, 12 8,5. 0 0 11 1-4 05/13/90
6'h brie 0-. '.:503 244-9314
Car1t-(,ACt0-(—.
C.ONTRACTUR NOT ON
..............
$ 1.285. 00 'r oT A I-.
e Lj
REOL)IRED INSPECT"ONE;
This Applicant agrees to comply with all the rules and regulations sewe-f, 111spectiorl ............
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 accur,cy of the ...............
side sever 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 Agency will iistall a lateral.
Pertnit-tee G)1.qriatt.t-re-.
...............................
Ca1.1 f(:)r irispectiari 6:39 4 1.75
.............
C17YOF71FARD jk�� MASTER PERIrI I'r
CnYOFTMND F'E:RMIT tt. . . . . . . a II5'1'90•-0030
COMMUNITY DEVELOPMENT DEPARTMENT eiweooN
13125 SW FWI Bbd. P.U.Box 23347,Towd,Or"w 47223(503)838-4175 PRIM. P E R M I'T MST 9 0•_,0 0 3 0
k A:4--4'1 / I •rc^ c: rc r
S I T'E: ADDRESS- . :„ . : 11S67 SW 129TH F'L PARCEL: 1 S 133DD- 600
SUBDIVISION. . . .. '. VILLAGE: A'r SUMMERI_AKE PARK 2 'I,.ONINGa
FL.00�1. . . . . » » . . . a I_U 1 » % » . . . . . . . . . . ..45
REISSUES: DWELLING UNUS: 1 DASEME:N'T.. . . . . . . . a0 sf
CLASS CIF:' WORK. a NEW BE:DRMS z 4 BATHS a 3 GARAGE:. . . . . . . . . . .. 451. f
'TYPE OF USE. . . .-SF' FLOOR AREAS -_._.__._._.._.__.... REPUTRED SE ,rDACKS_-....... .........._.___......
'TYI'-'E OFF' CONST. -.5N F.-IRSI*. . . . a 7.050 sf LEF"T'. . a9 ft RIGF•11'. a 7 f t;
OCCUPANCY GRP. aR;:3 SECOND. . . .- 1398 s F'R0NT. ac'0 ft RE-AR. . a53 ft
STORIES. . . . . . . .0 THIRD. .. ., . ..0 sf F(E.QUIRED-•-•-----_._._._...._._._____..
HE::IGH'r. . . . . . . .. ..20 ft TO'T'AL_ :L'448 S SMOKE: DE.TE:CTORS. e Y
FLOOR LOAD. . . . a 40 IF s f VALUE.. . . . . 9>: 1.1.0':734 PARK INCi SPACE:S. . a 0
Remark.s a
PLUMBING ._....._.___...___«__._._.. __._____....._..__..._...__._.,,_..._. ....._..
SINKS. . . . . . . . . . .. J. F-LOOR DRAINS. . . . a0 BACKFLOW PREVNI*G a0
LAVAT'ORIES. . . . . a3 WATER HEATERS. . . : 1
TUB/SHOWERS. . . . t2 LAUNDRY 'TRAYS. . . -0 CATCH BASINS. . . . . . . g@
WATER CLOSE'T'S. . a 3 SE:WE R LINE (ft) . :0 GREASE: *TRAPS. . . . . . . 4,0
DIASHWASHE:'RS.. . , . I WATER LINE: (ft) . a 7.00 01'HE--R FIX'T'URES. . . . . a0
GARBAGE DISP. , ,. - .1 RAIN DRAIN (ft) . a0
WASHING I10CIA. . . : 1 SF' RAIN DRAINS. . -. 1
____..._._....._...._..._..._. MECHANICAL _._.__._....._.. . FEES
F"(JHL 'TYPES'-•-•--•••-.•••.--•--••- UNIT HTRS. . a0 type amount by date rec,pt
/GAS/ / / VEi;N'T'S . . . . . x 0 PAYM $ 100. 00 .FL.H 01/17/90 106917
I'IAX INPUT x 0 T+TII VENT F'ANS. . :3 PRMT $ 460. 50
F'URN < 100K . . c 0 HOODS. . . . . . : 1 PLCK $ 299. 33
TURN >--10F.)K . . a 1. WOODSTOVEe S. a0 5PC'T' 4 23.03
1=L.UOR F'URN. . . . :0 CLO DRYERS. a 1 S7'DC 11; 0100.1 00
UOIL/CI'IP ( 3HP-.0 OTHER UNIT'Sx0 SSDC `b 250. 00 /
OAS OU'T'LETS x 1 PARK $ 250.00
C)w rt e r a ..._.._..__.._......_._........._._. ._._.._..__._._.___... .. _..............._......... M I SC 1h 115.00
1)(314 MORIS`aE.rTE BL.DE:RS, INC. FF'RMT !E 117» 50
1.", 0 BOX 19524 1-11...(.;K 9. 38
` PC:'T $ 1.88
POR7'1 AND OR 97219 PRMT $ 132. 50
Pt)orie 01 50,4-244-9314 5PC7 'F 6. 63
Cai•it•r•acturs _..__._.__._......_.,.___._..____.._...__.._.._..,..___._.....__. PAY11 1,98x). 75 31...H 05/1.3/90
DON M(:IRISSE:T'T'E: EILDERS, INC:.
I' 0 DOX 1952.4
PORTLAND OR 97219
I'.*.,ticirie H a 50::3 244 9314
P685. 75 TOTAL_
This permit is issued subject to the rejulations contained in the REOUIRE:D ItISPECTIONS
Filard Municipal Code, State of Ore. Specialty Codes and all other Faot/fot.triri :Tri 7p Gyp Paard Irisp
applicable laws. All wor* will be done in accordance with approved Post/pea") Irie.p Rai.ri drain T.i7s'-p
plans. this permit will expire if work is not started within 1N F'1m/undlsl pb Irisp Water Lirie Irisp
days of issuance, or if work is su pended i r wore than 1N days. Mechanical romp Appr/Sdwlk Irisp
J F'ramiriy Irisp Fi.rial. Iiisper..ti.0i1
Permittee .ii. , riatt.trea - � f; ri.re l.see lw;
Uas Line Irisp
1.a;a;1.1 e d T?)'a _ ._..__.._.........�...__._......_..._.........._.__._.
1 ri s t.t I a t i ci ri I i•i s p
f. 1�pe�l:j.ctiiy .. 639-417S
f•
PLAN 64ECK APPISCATION
CITYOF TIRDGAA` arrrof ncw PLAN CHECK a /`"
� ; PERnIT It
COMMUNITY DEVELOPMENT OE P�A1G \RTW DATE ISSUED
t 7 t25 S.W.f l.�l Bbd_YA_Bnt ZSJ97.7tiq�'4�'4°^
{-� (ITS
YAX MAP/LOT ` 3 90
G•(r w L.7
J013 ADDRESS: LOT:: LAND USE
VALUATION: A 1 / / SPECIAL ROTES
OWNER ���� - 'REISSUE OF:
LAST REISSUE:
r?r FLOOD PLAIN/
ADDRESS: C1_ate-- -
t p - MO�— SENSITIVE LANG: — --
P110NE- APPROVALS REQUIRED
- PLANNING:
OONTRACTOR — ENGINEERING:
NAr1E: FIRE DEPT
ADDRESS: __— OTHER:
--
------------
ITEMS RgqUIRED
)11 E-. -- -- LIST/SUQOONTRACTORS:
GUS TAX:
ARCH/ENGINEER ^ A� CALCULATIONS: r —
NAt1E- TRUSS DETAILS:
ADDRESS: --- _ PARKING PLAN:
LANDSCAPE PLAN:
i�I 1nNF
9-3�4� — oWER:
DESCRIPTION
AMOUNT jvJOUNT PO. UAL. DUE
DESCR
PERMIT a ACCT 11
10-432 00 Building Permit Fees
-
10-431 00 Plumbing Permit Fees � •; u
10-431 01 Mechanical Permit fees
�- 10-230 01 State Quilding Tax 0%)L� �
Uuilding
Plumbing � -
nech /• 8 b' ,�/�
10-433 00 Plans Check Fee ✓ fbw
Plumbing
Mech
30-202 00 Sewer Connect""n 7
30-444 00 Sewer Inspection ,
5I-448 00 Street System Oev Charge (=DC) 1.1
�
52-449 00 Parks System Oev Charge (POC) -
31-050 00 StOrm Drainage Sy t Oev C'"9C)(^o$pC) _
10-230 09 TRFD
10-230 06 Washington County rice frlw(9`�7)
tO-220 00 Amart/Wedgewood
RCC 11 I .�.
r+PPLICANT SIGNMURE /
Received Uy:
UAte Received:
Ulm-WIN I
GRAI)INWEROSION CONTROL INFORMATIQN
GENERAL CONTRACTOR NAME&ADDRESS: CASEFILE NO.:_ _
PERMITNO.:3( 1(153q
J O Q03�j
_ APPLICANT tjAME AND AD RE • - n
EXCAVATION CONTRACTOR I-
NAME&ADDRESS:
�? - --
_) OWNER NAME AND ADDRESS:
--
TELEPHONE Nun- ERS: --
APPLICANT: II )n rfl PROPERTY DESCRIPTION:
OV1'NER: 1, Y4 J•Y STREET ADDRES$AND D CROSS STREF %L.00ATED
GENERAL CONTRACTOR:
EXCAVATION CONTRACTOR( ` —.�.
SIIF,/JOB:
LEGAL DESCRIPTION: lS ��-
24 FWAFIER HOURS EMERGENCY TAX LOT NO.: leC"Ca
CONTACT PERSQN, j7TLE,TELEPHONE: 1/4 SECTION: '7,F '/y 31:2>
Ll�•l-�f 3/4/ SITE SIZE,ACRES: t--6
-- DISTURBED/WORK AREA,ACRES:
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAINS TO:(CIRCLE ONE)
(NOTE:PERMITS MAY BE REQUIRED) tATC iF-B-ASIN DITCH PIPE CREEK
it 1 L�
(CIRCLE ONE) PRIVATE PROPERTY
C UBL C RIGHT 0 .
ERQSION/SEDIMENTATION CONTROL (E-SO 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 PERMANL FACILITIES
CONSTRUCTION SEQUENCE OTHER
OTHER
PLAN FOR EROSION CONTROL PREPARED AND Sl1BMTTTF;D 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 NITTES.
I HAVE READ AND WILL COMPLY WITH TIIE ABOVE AND WILL CONSTRl1CT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE C( 11 ON SI TI:.
J
\ .� _
OWNER SIGNATURE_ APPIJCARTSIGNATURE _
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
OFFICIAL USE ONLY.
RECEIPT DATE ACCEPTED
IT I NUMBER RECEIVED BY
WNRE
1 P.U.Box 19524
Portland,OR 97219
(503)244-9314
'rbe Foundation For Affordable Homes 1
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