13401 SW MOUNTAIN RIDGE COURT 13401 3W Mount;:,i r Ridc c: Ot. _
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CEPTiVICATE OF
����� TIFARD C rFnI Y VO/F RD ljr.cupniqcy
COMMUNITY DEVELOPMENT DEPARTU NT mom PC-RMIT #• • • • • . •
13126 SW HWI Did P.O.BOX 23307,n9mM,OrWl OM41504�75 7�11/— 'a
SITE ADDRESS. 13401 SW tIOUNTOIN RIDGE Ur PARLELS 29109AS-03200
SIJ13D?V 1 S 1 ON. . . . i THRi.0 MOUNTAIN ESTATE"Si ZONINSt R-7
ALOCH.. . . .. . . . . . . I LOT. . . . . . .. . . . . . . t25
CLAS3 OF WORK, iNEW
TYPE OF JJSE. . . I Sr-'
OCCUPANCY GRP. cR3
OCCUPlINCY LOADt325 4
TENANT NAME. - . 2
Remarks
Owner:
THE HOLLMAN COMPANY
7006 6W NYBERRY RD
;UALATTN OR 970Gi--'
691-2115
CONTRACTOR NO'r UN Fn.r
phollp #1
R%4 0. . a
occupanry olo
f the alve t'vf"%r4?Tlced building is hereby given, anti Ccov-tifi.es
the comp'liallco with the State Of r)v-eU()r' SP19c"Alty Godes for the yrol-Afl,
A I
qccupanc,y, rind use under rc
which tho refer pet-mi %I w S` i9sved.
V TRF Dr,.FIAPTMFN"r E lf[D-,I,-N* G INSPECTOR
P093T IN CONSPICUOUS PLACE'
LkSPELTIQ1!- tQCICP.
City of Tigard Buildinq Departeant
131.25 SN M:.11 Blvd. Tigard, Oregon_ 97223
Inspection Line (Rec-O-1?hone)• 639-:175 Business Phones 634-4171
� r
I
f
Pc,oti.ny Plbg. Underelab Mach. Rough-in Appr/Edwlk
Pound. Pl.bg. Top Out Gap Lina FINAL
Post/Ream Struct. San. Sawer Praminc
Fost/Beam ttech. Rain D.reln Inaul&tion -Plumb.
Plbg. underfloor Water Line Gyp. Be.. Hach
Date Requestert..-- �/ ! _Timms AnAele Adireeas_.1r L/`-,(.__.._-2-27274,1-1-11 Permit #:5d �
Builder:.-- -'G�--
THE POLLCI UNG OORRECPIPNS ARE REQUIRED:
CID
Inspectors.._
APPROVED _ DISAPPROVRD APPROVED ,UBJEi"I TO ABOVE k
t'nll For Rninep.
i
�,nsP$cxloh ip'1�S3
City of Tigard Building Departaint �
13125 BW Bell Blvd. Tigard, Oregon 97223
mope^ti.on Lire (Rec-O-Phone)y'S39,41775 Btaineso Phone: 639-4171
Inspection:
Tootinq Plbg. Un celab Hoch. Rough-in Appr/SduIk l
Found. Plbg. Top Out GAB Line FINAL:
Poet/Beare Struct. San. Sewer Framing -Bldg.
Post/Beam Hach. Rain Drain Insulation -Plamb.
Plbg. Underfloor ..Water Line uyp. ad. -Hoch.
Date Reyuest,od:� / -�/ _ — Time: AM PN
Address: L�Q --� Permit /:
Builder:__ /'/
THE }F`OLLAW�ING CORRECTIONS ARE RXQUIRED1 ,
Inspectorl� IP L.w _--_. Date:_
APPROVED DISAPPROVED APPROVED S"R.lECT TO ADOVE
Call Par Rolnep.
[liSPE�CTIO�I NO�Cg
City of Tigard Building Department
13125 FM Hall Blvd.. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-41.775 Ruslneen Phones 639-4171
Inspections
Foatiny Plbg. Undoralrb !loch. Rough-in Appy/Bdwlk
Freund. PIbg. Top Out Cas Line FINAL:
Post/Beam Struct.. San. Sewer Framing -Bldg.
Poset/Beam r,ach. Rain Drain Insulation -Plumb.
PUn. Under!'loor Water/Line Gyp. Bd. -Mech.
Date Reguoetede �`�` t!� — _�TimeT �� PN
Address: l• �/ rmlt Is `�L
Builders
TIIE FOLLOWING CORRECTIONS ARE RRQUIRED&
�A
Innl,ectars � •'�' DatA ..1. ztL (,__
APPROVED DIBAPPROVED APPROVED 9110JECT TO AROVE
Ca11 For Reinsp.
arr sis �r astir ssw ai w,w s
INSPECTION NOTICE
City of Tigard Building Department
P.O Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection ' �y 4�-"
Time A.M
Date Requested - {
Address _ / � /% - ` �^` _ Permit # �G°3 7
--
(�wner..-- — — Lot
Builder ----
Tha following Building Code deficiencies are required to be ::orrected: '
A S ZZ--
Presented to _ �_ Approved
Inspector / ❑ Disapproved
Date ` — --
CALL FOR REINSPECTION
[] YF$ 0 NO
sot• saf � wa +se ser ewr w �
INSPECT ION NOTICE
City of Tigard Building Department
13125 SII Nall Blvd. Tigard, Oregon 97223
inspection Line (Rec-O-Phone): 639-4175Business Phone: 639-41.71,
/�
Inspections L Lr
Footing 4�bn, Under blab Mech. Bough-in Appr/SdwiK
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Rech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Lino
Gyp. Bd. -Hoch.
Date Requested: / -[ Time: AliPN
Addrese:
Builders 04
THE FOLLOWING CORRECTIONS ARE REQUIRED:
F'�Iasi-� Arzv v/Q v
t �lLyu� P'v_a r c-rrt�— Izy..cr-
L7` '�✓tZM.4Car 21 [A.J4Ts'Q-- LA IS
_ 3200 ' —
r
Inspector: /. - -_e Date. L 7
APPROVED DISAPPNDVRD l APPROVED SUBJECT TO ABOVE
Cal! Reinsp.
I
f"�vEEM-t��7 NvAIc� t
City of Tigard Building Departsent
13125 BN Bali Blvd. Tiqard, Oregon 97223
Inspection Line (Ree-O-Phone): 639-4175 Huo ineae Phones 639-4171
i `,
Inspection:
Foot!.ng Plbq. UrAerslab Mwh,.Rough— Appr/Sdwlk
Pound. plby. Top Out Can Line PINALt
Post/Beam Struct. Sewer ``� 1Jtp� -Bldg.
Poet/Ream Mach. Rain Drsin C~ Insulation -Plumb.
Plbq. Underfloor Nater Line / Gyp. Bd. -Nech.
Date Requeeted:.�_����!�! TLaet AM�)�S / PM
Ad ireea 416AQ Permit #3 Q-
-3
-mv Pouxm O CORRRCTIONS MM REQUIREDi
Ll 4-V _ r ._. _ -'__Ls. —.�---
lnePector, �._L �-- Datat
APPP0vF.D DISAPPROVED 4-1► PP ROVED SUBJVCT To A--Bova
__call For Reinep.
aR Dior t� ver � v ..
r
I,-NSPE-MION NOTICA
City of Tigard Building DepartsJr.nt
13122 SM 9a)4 Blvd. Tigard, Oregon 97223
Inspectl,nn Line (Rec-O ones 639-4175 Business Phone: 639-4171
Inspections—___
Footing Pjpg. Underslah Mech. Rough-in Appx•/Sdwlk
Found. Plbg. 'fop out Cas Line FINALt
Poet/Beam Stccct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain InOUlatLOn -Plumb.
Plbg. Underfloor Water Line Gyp. Ed. -Meeh.
Timet __—AM _�PM
Addceae t_,_,� ) �1 Perron)i
C._
Builders y
THE FOLiOWINO CORRECTIONS ARS RRQUIRBDt !jl
i
Inspector-
11(
P
4'
f
r
APPROVED DI,APPROVED APPROVED SUPJRCT TO ABOVE
Call for Rainsp.
a.r elw ews ser aio
i
i
IN4 CPION Ncalgi t l
City of. Tigard Building Department 4
13125 SW Ball Sled. Tigard, OrevIon 97223
Inspection Line (Rec-O-Phone)t 639-4175 BunineeA Phone: 639-4171
Inspection^
Footing Plbg. Underelab Mach_ Rough-1n Appr/Sdwlk
Found. Plbq, Top Out'i Gas Line FINAL:
Poet/Beam Struct. Ran. Sewer Framing -Bldg.
Poet/Beam Mach. Pain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd. -Meeh.
Date Requeated:—I —2 '4 �— _Tisnat
AddreeesPermit
THE FOLLOWING CORRECTIONS ARR REQUIRED:
---- Datet -
APPROVED D1.:,APFIROVED APPRo-nD SUBJECT TO ABOVE --
_ Call For Reinsp.
INSPE�'TION NOr1cR
city of Tigard Building "Sport—t
13125 IM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-U-Phone)s 639-4175/Business Phones 639-4171
inspections_
Footing Plbg. Underelab Mach. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Lina FINAL:
Poet/Ream St:ruct. San. sewer Framing -Bldg.
Poet/Ream Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor: Mater Lint Gyp. Bd. -Mach.
Deta neersegtedtP .._. Times A►+`� 4
Addresas Ptnait fs
/
Builders
THE FOLIAMIMO COMMONS ARE REQUIPE12
Inspector: L Dates,
L-' APPROVED D'SAPPROVED APP!'.OVRD BUBJECT TO ABOVE
Call Yor ReLnep.
as t� aaa aas tata aar nal
I
i
zNs�t�4lL l!oT_?�&
City Of T lard Duil.ding Departaent
13125 Aft Hal. Blvd. Tigard, Oregon 7722.1
Inspection Line (Rec-O-Photte)t 639-4175 Business Phunet 639-4171
inepec�iont,__ _ �_'��
Footing t rPI-bg. Undersl b Mach. Rough-in Appr/Sdwlk
Found. rlbg. Top Out Cas Line FINALt
PORI/Beam Struct. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulation _Plumb.
Plbg. Underflror Water Line Gyp. Rd. -Mach.
Date Requested:____ �/fi7. Times AM PN
o
Permit U t
C 7'
Builder: —
THE FOLLOWING CNIP"CTIONS ARE REQUIRED:
i
Inspectortt Datet I,/
_Y APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
---.Call For Reinsp.
_IN Sia g,_r NST t S
ri.ty of Tigard Building DOP`r120e0"
13125 SM Ball Bled. Tigard, Otlagon 57223
Inspection Line (Rec-O-Phone): 639-4175 Busi.neer. Phone: 639-4171
Inspection:__—__----
Footing Plbg.
Underslab Mhch- Rough.-in Appr/Rdwlk
Found.
Plbg. Top Out Gas Line FINALs
"''''� Framing -Bldg.
Post/Beam Struct. C+�eD• s
.-Plumb.
Post/Ream Mach. In Drain
Insulation
plbg. Underfloor `tutor �s Gyp. Bd. -Koch.
UTimes _�. PK
Data Re, .,�.atsds _
--�� _rf
rmit 1:
Address:
, C 1
Builder:___ �r.L�.� +�---- �M
TBB FOLLOWING CORRECTIONS ARE REQUIRED:
--- _-- ........
Inspector:___, a -- —�-
l APPROVED �- DISAPPROVED APPROVED SUBJECT TO ABOVE
Cnll For. Reinsp
i
INSPECUON NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223 1
Phone 639-4175
Type of Inspection
Date Requested "�` ' y'� _. Time A.M. P.M.
Address ,/ �/���9�1.��� - Permit
Owner- __ _ Lot
Builder
The following Building Code deficiencies are r;rquired to he corrected:
¢ /G fi cKt �rr� r"U Slrab ®n l(?r�i:
( i3Astru 1jr- FAJ✓► _.��� —r o bc -t�t3.-ac. 1='► tet_u
TZF z.jn '1-n 1A4-A., :1('
>pi
Presented to -- ,))Approved
Inspector Disapproved
Date --
CALL, FOR REINSPECTION
❑ YES ❑ NO
INSPECTION NOTICE
Cite of Tigard Building Department
P.O. Box 2.3397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested 7 90 Time_ _ A.Nl.. —P.M.
Address 3'��� - ! ?� .` Permit
Owner Lot #_
Builder /v04n.'
The following Puilding Code deficiencies are required to be corrected:
C� �d=O" 4/7 5��ssEs-/t-'�i •�'ierrN 5 e f�:: T� /y Lo�'�c-n sSHy.:.''
/RiTO G/�fL G4lu'✓r�a _
/7S / l�O�'i��IC. lee YLx,4Y Azg-U%K C1S
J, C�G�sMi�ISnlCcs �v/rrt*7YC/
- - - 4 .fin��o tJ 4 -A-V 1€V
Presented to _ L_ Approved
Inspector � � Disapproved
Date --
. CALL FOR REINSPECTION
CJ YES ❑ NO
SEWER CONNECTION
C�l'f:MIT
CITYOFTIGARD I,r' .. . . SWR90-»0 368
�rtrOFn�im _hM r r �. . .
COMMUNITY DEVELOPMENT DEPARTMENT cHROM fit"aIM, r'ERM11 #. : MST`:a0 (r03f
t 3126 S W Hail Blvd. P.O.Banc 23367,T pud,a.00r,0722q- Q4+76 D.."a T k I xa" ll I~D i 10/05/90
a1 TES ADDRESS—. 1.3,601. 5W I10UNI'AIN RIDGE C1 PARCEL: 2S1.A`0D (%):3P.Q)0
t:'s l.1F+DIVT.S3IpN. . ,. . :
] HI r h1O1JNI'A1N ESTA'rE5 ZONINGa
B1. O C:F'.. . „ ., . . . ,. . ., I.»C; . . . . . . . . . . . . . :25
'T'NRNP NAME::. . . .,
0`:iA NCJ. . . . . . . . .. .. .42398 FIX'T'URE:. UNITS. . . :
C:I_faSS (IF WOF;'V— „ :NEW DWELLING (JNITS. . : 1.
TYPE OF I.)SE. . .. , . :SF NO. OF:' BUILDINGS-. 1
I NC)TALL. 1''if't•"::. . . .. : "L)SWR IMPERV SLJRFACE. . : :: -F
F Eel»S _.W.._._...»......_._.._..
THE. HOLLMAN COMPANY typt- �n1oL111t by date -rear: I-)
/006 SW NYBE'RRY RD PRM'T' $ .1500. 00
INSP $ :35. 00
1I.1ALATIN OR ':J 0(:,2 PAYId $ 1.53:";.00 JI-H 1.0/05/90
Pi1(:)11e #x 691 -2115
C ON'TRIACTOR NUI' ON FILE
V1hc)ne #e $ 1535,. 00 TOTAL
PPri
REQUIRED :INSPE C*TIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspec titan
of the Unified Sewage Agency. The permit expires 120 days from
the date issued. The total amount paid will be forfeited if the
oermit expires. The Agency does not guarantee the accuracy of the
sVe sewer laterals. If the sewer is not located at the measurement
given, the iistaller 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 in74��4
ateral. _ _.......
. �Q.G'
..._.._.........
_._
Ik.t P d H y '
C J. I fcaY :i1.1s>pec:ti.ran - 63`a 41.;5
j MAsTER PE:RMTT
CIIYOFTIFARD
PERMIT #. . . . . . » r 11ST'90.._(d 037
CITYOFTWARD G'RTIh. PERMIT N. : 11ST90•-•0037
COMMUNITY DEVELOPMENT IDEP"TMENT 0"GN DATE ISSUED: 10/05/90
13126 SW Hal 8W. P.O.Bow 23397,Toad.Oreq n 970 Mwi 405
7
11::: ADDRESS. .. , r 1.::340:1 EW 1110UNTAIN RIDGE CT FIARCEL.. 2S109AI:r03f'0G)
THREE: 1*,C)UNTAIN ESTATES 7_0111110
1..17 C:N.» » . . . . , , . .. . LOT. . » . . . . . . . . . . 525
. _........._.._. ._......_-,.__._._...__._...._._... BUILDING - ........ .__. .... _.. _...,._�....__._... ..........__.......__.....
C SSUE I DWELLING (.1N I TS 11 BASEMENT. . . . . . . . I® S f
t-1.AISS OF' WORK. S NEW I;EDRMS S i BATHS"3 GARAGE. . . . . . . . . . a 9x58 s f
IYF'E UF' L)SE. . . ISF F'i_OOR AREAS-_-- - REQUIRED SE:TRACKS......w.__._..... .._-
IYPE:: OF* CONST. :5N FTR1iT'. . . . 11.'70!5 ss f• I...EF=T» .. 55 ft R16HT. : 1.5 f
UCC:L)PANCY 0RP. IR3 SECOND s,f FRONT. I20 ft RE::AR. . :20 f
�3TORTES. . . . . . . I3 TIA.T.RD. . .. » I741 s:f RF.O1.1IRwD•-•-•••-••-._._..___.._.._....___...__........
I IE':.GH i.. . . . . . . . ..25 'f t: TOTAL.......... ••..336 78 1s f SMOKE. Dr TECTORS. I Y
1'I...OUR LOAD. . . » 540 p.,f VALUE. . . . . 1.864:.32 PARKING SPACES., 10
Rema-rlr.S I
PLUMBING
SI14KS .. . . » . M N . . : . F•LOOR DRAINS. . .. , -0 BACK1=1_OW PREVNTRS. . y 0
LAVATORIE:S. . . . . 16 WATER HEATERS. .. ,. :: .1. 'T'RAP'S. . . . . . . . . . . . . . ..H
1 (IFi/SHOWERS. . . . 14 LAUNDRY TRAYS.,. . . r 1. CATCH DOE;INS. . » . , „ ,. -.0
WATER CLOSETS. . 13 SEWER LINE (ft) . 50 GREASE TRAPS. . . » .. . 50
1)1SHWASHERS. . . . : 1 WATER LINE (ft) .. - :1.00 C)T'IIE'R FIXTURE--S. .. .. „ ,. rl�l
is ARPAGE DISP. . . 11 RA.T.N DRAIN (ft) . -.0
WASHING MACH. . . 91 <:ii I''AIN DRA:I:NS. . I 1
_._._�.___.._._..
MECHANICAL ._., ....__.._.._._..._. .._ . ...--_._.... .__..__...__. FEES
L1NTT HiRS. . 50 t--pe amcactnt; by date •rec:pt
/fa(IS / / VENTS . . . . . 10 P'AYM 9s J00. 00 ,TLH 09/1.8/90 20487.7
NOX TNPUT 10 BTU VENT F ANS. , r 6 BPRT 9• 650. 50
I URN ( 100K . . :W HOODS. . . . . . : 1 BP'LC' $ 422N 83 / !
F URN )=100K . . 51 WOO DSTOVE:S.. 5 0 P5PC 4: 32. 53
I':I...00R FURN. . . , 90 CLO DRYERS. -. 1. BP'LC $ 15. 00
10II_/CMP ( 3HP50 OTHE::R UNTTSr0 STDC $ 600.00
GAS OUTLETS11 SSDC $ 375. 00 ! /
OwrierI -----.._._. ._.._---- - . ...._..._........_..........................._.._.......__.. .. ",ARK $ 250.00
THE: HOLLMAN C(IMP'ANY MP RIT $ 1146, 50 / !
7006 SW NYBERRY RD MPL.L $ 1.1. 6 3 ! /
MFJPC 11 2. 33
UAI...AIIN OR 97062 r,PRT $ 1'77» ';i0
I'horte H5 691••-2115 P 5PC; $ 8. 88
111t.r•ar..tc:)•r;: -...._.--_....._.__....._........-. ........_......_................................_.... r'AYM $ 249i.-.. 70 J'LH 10/05/90
I i IC HOLI_MAN L:OMPANY
`006 SW NYBERRY RD
HJoLAT I H OR 97062
i h1 c)lle #1 691-21.15
i;wsa N. . I 1586 _.......................___.._..........._....._____._.__.____..___.._._.._ ._._.
1- 2592. '70 TOTAL..
This permit is issued subject to the requlations contained in the ----- REOUIRE:D INSPECTIONS -- -
Tigard Municipal Code. State of Ore. Specialty Codes and all other Foc:tt/fot.lrtd Inmp Mec:hartical Insp
applicable laws. All work will be done in accordance with approved Wt•r Prraot'ing Pant Plt.tmh Tap Ot.tt
plans. This permit will expire if work is not started within 190 Post/Beam Sti-Lict Framing Irtsp
days of issuance, or if work is suspended or more than I80 days. PO4st/Beam Mer_har, Fireplace Irtsp
/ 'ravel. D•rairt Gas; Li.rte It•tlsp
Permittee Sign<at:ctre5 / ! .. [ -V- F'] m/c►ndsl,ah Iricsp Inst.tl.,atir,rt Trtyla
P'LM/Underfloor Gyp Bc)ard Insp
1.s%ct a ti B y I _._ _._._._.....�__.........__ .._...__.... _..... ...___.__. _.. F"t ri g D r a i.t7 B s m't R a i.n dr a i n I n si p
(;al :l for :trtspectiort - 639-4175
cI'TY OF TIGARD - REC.E'.Ir---r (IF PAYMENT RECEIPT NO. 116
GHEU,'. AMOUNT a 4027,,7C
NAME. a HOLLMAN COMPANY CA%J AMl'.-)UNT 0.00
ADDRESS PAYMENT DATE 00
1 /05/9
SUBDIVISION
TUALATIN, OR 97062-, 11401 MOUNTAIN RIDGE:
FURF OSE OF PAYNETJAMOUNT PAID PLIPFOSE OF F",AYME.NT AMOUNT PAID
mliTio
g -ociz-5------—6-56 15(p ri-timb,ING PERM 177.50
HECHANICAL., PE 46.50 sn'. Dull-D t,",r::R
349- 46 SEWER USA 15,00.00
["It AN CHECf�'.' FE
SEWER INSPECT :!,5,0() STREET SDC C)(-)
PARKS SDC 250 Q0 STORM DRAIN SDC :375.
TOTAL AMOUNT PAID 4()'77
^.,1 TY OF TI(3(.,iPD WCUIPT OF PAYMENT RECEIVST NO. s90-204877
CHECK AMOUNT v 100.Qc)
NAME r. HOLLMAN COMPANY CASH AMOUNT t 0.00
ODDRESS a PAYMENT DATE 0911S/90
SUBDIVISION
F'l-IRPOSE OF PAYMENT AMu(JI4,r PAID F'ORPOOL. OF ):`#WMENl f`MOIJNT PAID
1 ,1..,'4N CHEa.,.'. F'L, 9---46F< 10(1.00
1 1 ".401 SW WJUNTAIN RIDGE CT
TOTAL AMOUNT PAID 1(10.00
CITY
OF ,T16;A:- RD 1312.SW.11104 WWI [��
COMMUNITY OEVEI OPMEfYT O�PgRTMENT (5W)63941171 PEd4T)'
OATI: L>SfFD
+JOB ADDRESS: �, '/ r _�c`.`_/?�I a f i fiLL4
j JI L L't- nX PIAP/Tlyr :,I S� - y f� 6-Mao
: 1i3: i�rr It:1r�r.�'��t7t• ,�sftr ` �.`2 LAM) USE:U
VAL TON: c
GWNER SF'FXvU1L 2ddr1 a
NAME: �`",t v « c '{c•L_ REISSUE OF:
LAST RUS: UW:
FWM PtAirr/
MUNE: SENSMVE LAND:
-- --
APPPOVAIS I2D�7IRED
Q]NIRACILIF2 PlANN M:
NAME: — ---
C IIJG NE3 RING_
ADMSS: )L)U&. t�ce I - 77 ETRE D-r-PT
EMNE: 2/!S I'rET6 RP
BT=ERS J3Ca4M: - - c s f� EjCP Ia4M: = `� MT/ :
J311; TAX: _
CALMAT1aNS-
NAME: TIS MIMS:
AU IZES: OEM-'
(1114ENIS:
AMOUM AMJW PD. ►i.. DOE
u c = 10-432 00 Building Permit Fees L c,S o :� 0 6SrJ .5 u
10-431 00 Plumbing Permit Foes S
10-43101 Iecbanical Permit Fees - a
10-230 Ol state BliMiny Tax (5%)
Building 3 2..5 3 ',�
Plumbing S, rJr
Mech a.33
10-433 00 P.Lans t3�edc Fee v c /p.�1 I;M 30, Y G
Build.irg -c,11, 3 y Lc`O.
f --t+�--
Plumbim
PSIe!.iz it Ci 3
: 44 30-•202 00 Six axvrer_ticn ($&U
30-444 00 Sewer L15Pec tiah , .3 3>
51-448 00 Street System Dev Q� (SDC) c
52 449 00 PMJM System Dev Ma> (PDC) s-V
31-450 00 Storm Dizinrage SySst Dev (9 (SSDC)
10-230 06 Fire
TOM
Imc_LivrA BY: c.. Date Pecei_ved:
-f'/3587P_WPF
GRAM GIEROSION CONTROL INFORMATION
(YFNI RAI_COfYF'RACTOR NAME:& ADDRESS: CASEFIL.E NO.:
----- �* r PERMIT NO.:
iL( "- -f'c APPUC NAME AND ADDRFS
EXCAVATION CONTRACTOR
��
,
NAME&ADDRESS:
OWNER NAIvfl ND ADDRES�
T'EL.EPI IONS NUM. EiRS: —
APPLICANT• c. �: ",6' c L(<U.G` PROPERTY DESCRIPTION:
OWNER; 1)t r t L) STREET ADDRESS AND CROSS STREET' ATED
GENERAL CONTRACTOR: S(��� _ s,1 c/
EXCAVATION CONTRACTOR:
S1TE/10B: l t i zL n ,f
LEGAL DESCRIPTION:
24 HR/AFTER HOURS EMERGENCY TAX LOT NO.:
CONTACT PERSPN,TITS E,TELFTXNE: 1 1/4 SECTION
= �,c-' I t t'L i x f' SITE SIZE,ACRES
,- — DISTURBED/WORK AREA,ACRES:_
LOCATION&ADDRESS WHERE SPOILS
LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAINS TO:(CIRCLE ONE)
(NOTE:PERivOT'i MAY AF REQUFRED) CATCH-BASIN DITCH PIPE CREEK
(CIRCLE ONE) PRIVATE PROPERTY
PUBLIC RIGHT OF WAY
EROSTONISEDIMENTATION CONTROL (ESC) MEAS MS
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 SEQUEI4CE OTHERi_ _
OTHER
PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK-.
EROSION CONTROL PIAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETF,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 WILLCONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE,
I
' NER SIGNATURE -��` //ltJ�/' 4PLICANT SICIRTATURF
OITICIAI,USE ONLY,
RECEIPT DATE ACCEI91:1)
1fI: NUMBER RECEIVED NY