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10620 SW SUMMER LAKE DRIVE ,a I AC 91 I tiurnyIIf I .o CERTIFICATE: OV C17YOFTIFARD OCCUPANCY Cf V-0F!F ► :;.RMI T M. . . . . . . a M6 1 9".4-0.3 Q)'� COMMUNITY DEVELOPMENT DEPkI11MR4T oaahoN 13125SWN IIBNd. P.O.Box 233fl7,Tiw(d,Oregon 97223(W3)&A4176 DATE IgSUFDa 11/29/90 !31: 1L ADDRESS— . 10620 SW SUMMERLAKL. DR PORC[.La 1S133AD---0;`8(M SUBDIVISION. . . . a AMAPT SUMMERLAKE: IONINC?a R--7 BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . 92 CLASS OF WORK. aNE.W TYPE OF U1W*. . . a SF OCCUPANCY ORP. aR3 OCCUPANC) LOADa118 4 TENANT MAME. . . a Ren►atr1,s a 11wnera ---......—...—....----..- - ODELL CONST P O IROX 230273 T IGARD OR 97e 23 Phone Ma Contrsctora __..__._.._.._...__ ,._._.�__._. _....__._..._... JEFF DI DELL CONSTRUCTION P O PDX 230273 1 MARY) DR 97223 Pho nn! 14c 5036206732 Req N. . : 53603 Occupancy of the above referenced building its hei,eby gimen, and r.ert;ifte the compliance with the StAte Of Oregon Specialty Codes for the group, occupancya and use under which the referenced permit was issued. FIRE DEPARTMENT UILDIN["t3PEC1'OR I1..01Nt!' Cl F'F ICIAL ���__ POST IN CONSPICUOUS PLACE I Miles n jP6PECTION NOTICE City of Tigard Bnllding Department 13125 B11 Ball Blvd. Tigard, Oregon 97223 inspection Line (Rec-O-Phone): 63' -4175 Business Phone: 639-4171 Inspecti.on: _�— Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top tart ban Lina FINAL: Poet/Beam Struct. San. Sewer Frnmi.nq ��Hldy Post/Beam Mach. Rain Drain Insulation -Plumb. Plhg. Underfloor Nater Line Gyp. Bd. -Mech. Date Requenteds T1Mt AM PM Address& i! #f BuildersI��O THE FOLLOWING CORRECTJONS ARE REQUIRED: Dates APPROVED DISAPPROVED APPTIAMD SUBJECT TO ABOVE _ Call For Reinep. INSPECT70I1 i(OTiC9 City of Tigard Building DepartAan: 13125 SN Ball Blvd. Tigard, Oregon 97723 Inspection Line (Rec-O-Phone), a9-4175 Rusineos Phone: 639-4171 i nspect ion Footing Plbg. Under lab Mech. Rough-inppr/Sdwlk , Found. Pl.bg. Top Out Gan Line FINAL: Poet/Be,m Struct. San. Sewer Framing -Bldg. Post/Beam Meeh. Rain Drain Insulation -Plumb. Plbg. Underflonr Nater L�1M Gyp. Bd. -Hoch. Date Requested:_ �� c-T/ `'ril) —_Time: ......M PH AdJross:___, Builders T11M FOLLOWING CORRECTIONS ARE REQUIREDt i I.ispect f G � Date: PPROVRD DISAPP VMD APPROVED SUBJECT TO ABOVE Call For Reinsp. iNSPBCTIOIJ NOTICE City of Tigard Building Departntent 13125 S11 Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-o-Phone)t 639-4175 Business Phones 639-4171 I.iepections __�,— -_--- --- - - -- Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk Found, Plbg. Top Out Gas Line FINAL: poet/Boom Struct. San. Sewer Framing -Bldg. Poet/Beam Mach. Rain Drain Insulation -Plumb. Plbg. Underfloor / Water Line Gyp. Bd. -lh•1 Date Pgquestedt 1�- �l� Timet PH Address:_ -s s�-+s -�s��J-�. �Jy Permit �t el,4 L7 3 6 I Ruildart -- THE FOLLOWING WRRBCTIONS ARE REQUIRSDt tnspcctort-____ Datet %k PROVB:+ DIBAPPROVFD APPROM BO&IM ft ABM Call For Neinap. 1NI;PECTI011 NOT �" '� ►-�/ amity af. Tigard Building Department 13125 SM Ball, Blvd. Tigard, Oregon 9722.3 Inspection Line (Rec-O-Phone): 639--4175 Business Phone: 639-4171 Inspection.- Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Cas Line FINAL: Poet/Beam Struct. San. Sewer Framing -Bldg. Poet/Beam Mech. Hain Drain insulation -Plumb. ` Plbg. Underfloor Water Line Gyp. Bd. -Hoch. Date Date Requested: / - T��1 Gryl ------ Address:- Address:__� _ Y'_z72_-v-7kojj:�11�Q Permit I i Builder: 1 r Oma" _ THE FOLLOWING l'ORREr,TIONS AAF, R'�QUIRED: Inspector:-��`,� _. Dater APPROVED DISAPPROVED APPROVED SU!ITWC'T M AWWR 1 __Call War Poinap. INSPECTION NUTIC� /) City of Tigard Bailding DerartmPnt 131.15 811 Ball Blvd. Tigard, oregon 97223 pection Line (Roc.-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: _ Footing Plbg. Underelab Mech. Rouqh-in i Appr/8dwlk Found. Plhg. Top Out Gas Lino FINAL: Poet/Bova Struct. San. Soaor Framing -.Bldg. Post/Beam Hoch. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mach. Date RegnJ/eetod:,_ - /T l L) Time: AM PM Addreaa: 11)4p z.��'iLir.Cat/C�k__ Permit Builders TMT FOLLOWING CORRECTIONS ARR REQUIRED: Inspect-ors� "1 V lJ ��.lti�_` _ Date: I- Q 10 APPROVED - VISAPPROVRD Jl APPROVED SIIBIRCP TO ABOVE _ __Call For"__--Rainap. iNsp w-UM AMA City of Tigakd Buildiaq Department 13125 BN Ball Blvd. Tigard, Oreqon 572.'3 Inapect .on Line (Rec--O-•Phone): 639•-4175 Business Phone: 639-4171 Inepection•_,�___, __ —_'- -s---- Footing Plbg. Underalab Mech. Rough-in / A( ppr/Sdwlk 1 Found. Plbg. Top Out Gan Line FINAL: Poet/Ream Struct. San. Sewer Framing -Bldg. Past/Beam Mech. Rain brain Insulation -Plumb. Plbg. Underfloor Nater Line Gyp. Rd. -Mech. Date Requested l` �G �._-Tim' - _P.K PM Address: Builder: —- THE FOLLONINO COPwIC1'IONS ARE REQUIR fZ46+ ` Llbi►i� • i.s!1 1 I � -: (l 4 I L l��Y lG_ 1 TLl:.1 Dates inspector:_ --- ',' __APPROVED DISAPPROVE)) APPROVED SUBJErT TO ABOVE -_4__Call For. Reinsp. i INSPECTION NOTICE City of Tigard Building Department P.0 Box 23397 Tigard, Oregon 97223 Phone: 61'-9-4175 Type of Inspection — Date Requested �� 17+�D Time __ A.M.—.-P.M. Address �(,�. �� _ �-�'��li.�t�ll�-- Permit Owner Lot Builder The following Building Code deficiencies are required to be corrected: Presented to Inspector -- ---...-- __.__.._-- [� Disapproved Date — CALL FOR REINSPECTION Cl YES 0 NO w INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 9722.3 Phone: 639-4175 Type of Inspection Date Requested Time l.�P.M. Address ' Permit #1�1%��� (:caner Lot *,=q. BuilderL(,Z-- The following Buildinq Code deficiencies are required to be corrected: �Pres - ---- ------- Presented ented to _- --_ _ _. .-----C/Approved Insp(-cinr ��� U Disapproved Date -- CALL FOR REINSPECTION FI YES U No INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection 'u ---�i�i�'C- —f-l��¢�- i✓`ei- Date Requested a Time A.M._._._ ___P.M. Address ,u LL y� 7 �� �. Permit Owner_ -- —.—_ Lot #-- -------- Builder The following Buildinq Code deficiencies are required to he corrected' Presented to --------- -------------..-_. --- __-- P pproved Inspector —_ __- _ � I Disapproved bate CALL FOR REINSPECI:ION Cl YES 11 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 839-4175 Tyue of Inspection Date Requested U Time_ P.M. Address _! _�.. Permit Owner _ Lot #_ Builder ---�_-- The following Building Code deficiencies are required to be corrected: Presented to — _ - 17" Approved Irspector — Disapproved Date CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City of Tigard B.:itding Department P.O. Box 23397 Tigard, Oregon 97223 Phone 639-4175 Type of Inspection Date Requested ` Time A.M. ^. P.M. Address Permit # '4 � Owner _ __ Lot #__ Builder . E ---- ----- ---�—�-- ----- i he following Building Code deficiencies are required to be corrected: Presented to _ _ _-- -- -_ ,/��Approvetl Inspector ------_--_-_.— Disapproved Date C LL FOR REINSPEC77ON ❑ YES 0 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 p Phone: 639-4175 Type of Inspections ,/ O' � � L�r�•�s. X16. _• _. _ Date Requested -7- U Time---- A.M.---P.M. Addre.s _�L T Q -_..x�,s-�-�-<<-� Permit Owner -- - --_---.__--- Lot #— — Builder G 'e't C The following Building Code deficiencies are required to be zorrected: vresented to _ —__- _ . --_— �'t Approved Insneclor , o�� --------------_ _-..� Disapproved Dare _— -- CALL FOP REINSPECTION n YES I>> NO I w nw INSPECTION NOTICE City of Tigard Building Department P O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection _ De Requested r�_ `�� A :,(( Time 11-� A.M. P.M. a,vn( - ----�►E Lot #_� Builder � The following Building Code deficiencies are required to be corrected: Presented to u Approved Inspector /-' ---------- _ Disapproved Date CALL FOR REINSPECTION ❑ YES I] NO itniiiiiiii } 0 INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Z/ Tigard, Oregon 97223 C Phone: 639-4175 X Type of Inspection SiXg 4c Date Requested / Time __ A.W � M. Address Permit 3C%7 Owner_ _ Lot BuilderThe following Buildin(g/Code deficiencies are required to be corrected: 40, 6 s1.7 At OQ Presente.; to �� Approved Y" Inspector , Disapproved Date J9 - d �� CALL FOR REINSPECTION iK YES ❑ NO INSPECTICN NOT'.:E X, City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone. 639-4175 Type of Inspection _ r Date Request��e��d_// nme/— L_ M•-- P.M. Address —L G.L40.� Permit Owner-------- -- - — Lot #-- -- Builder ----- The following Building Code deficiencies are required to be corrected: Presented to — -- -- ----- Approved Inspector - 40 . Disapproved Date CALL FOR REINSPECTION ❑ YES 0 NO tUIMUNIM INSPECTION NOTICE City of Tigard Building Department / P.O. Box 23397 Tigard, Oregon 97223 µ' Phone: 639-4175 Type of Inspection Date Requested___�. _ Tim& — P.M. Address _ � Permit # 0-03y?_ Owner r Lot # �� Build ;:;4, ,=The following Building Code deficiencies 4req to be corrected: Presented to [ Approved Inspector _ f Disapproved Date CALL FOR REINSPECTION 0 YES ❑ No C'TY"OF TIVA RD MASTER PERMIT cnioFTWARD PERMIT C COMMUNITY DEVELOPMENT DEPARTMENT oweooN PRIM. PERMIT it. :; MST90­0307 13126 SW ISO 8% P.O.Box 23397,Tigard,Oregon 97,=(603)6119-4175 001E. ISSUED. wl & HODRLis. . . u 1Wu(._,U bW :)Ul,h11t:J&.AKE Dk PnRCELc ISI33AV-02800 3UBDIVISION. . . . i: AMART SU111111ERLAKE Z 0 N I N(3y- R Ill, Orr.". LOT. . . . . . . . . . . . . 22 BUILDING KE ISSUEs DWELLING UMITSil BASEMENT. . . . . . . . 10 sf (J..0S3 OF:' WORK. cNEW BEDRMS 13 BATHS 12 GARAGE. . . . . . . . . . 1399 s,f f Yl::'E OF USE. . . -SF FLOOR REQUIRED SETBACKS–------­ FY P E OF C,0 N S'T. »5N F'IRST. . . . - 1.1'.,38 sf LEFT . . -.5 ft R I C3H 1'. -.5 ft 0CCUPANCY GRP. c R3 SECOND. . . ..0 S f F'R 0 N 7'. 12 0 ft REAR. . a35 f t `3TORIES. . . . . . . gi THIRD. . . . :0 sf REQUIRED-------------------- !JF-­IGHT. _ . .. .. . . P18 ft TOTAL..----- -- : 1158 sf SMOKE DETECTORS. iY CLOOK LOAD. . . . :40 psf VALUE. . . . . $n 62290 PARKING GPACES. . :O Remark so ----------------------------- ---- PLUMBING SINKS. . . . . . » „ . . it FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :0 LAVA'T'ORIES. . .. . . 0 WATER HEATERS— il TRAPS. . . .. . . . » . . . .. . . c 0 TUB/SHOWERS. . . . 12 LAUNDRY TRAYS. . . i0 CATCH BASINS. . . .. ., ,. » K WATER CLOSETS. . :2 SEWER LINE (ft) . c0 GREASE 'TRAPS. . . . . . . 10 DISHWASHERS. . . . it WATER LINE (ft) . PIMO OTHER FIXTURFES. .. .. . .. -C4 GARBAGE DISP. . . it RAIN DRAIN (ft) , I@ WASHING MACH. . » at SP RAIN DRAINS- 91. I-------------- MECHANICAL -------------- ---------------- FEES ------------- - PUEL TYPES----------- UNIT HTRS. . :0 type Amount by date r,e c,o I /GAS/ VENTS . . . . . cO PAYM $ 100. 00 JLH 09/11/90 20462/ MAX INF UT':0 BTU VENTFANS. . 9 1. BPRT $ 322. 00 I URN ( 1010K - .- I HOODS. . . . . . c 1. BPLC 1- 209. 30 KURN >=100K . . :0 WOODSTOVES. gO B5PC $ 1.6. 1.0 I'LOOR FURN. . . . ..0 CLO DRYERS. -. I STDG $ 600. 00 iiOJJ_/CMP < 3Hr'.,:0 0 TH E R UNI TS P.0 SSDC $ 375. 00 GAS OUTLETS-. 1 PARK $ 250. 00 Aner : ---------------------------------- MPLIC $ 7. 50 ODELL CONST MPRT $ 30. 00 BOX 230273 M5PC $ 1. 50 PPPT 17. 50 i 1.GARD OR 9722.3 1"-15PC 115. 88 Phone Ni PAYM 1834. 78 PL.L. 09/14/90 Lontractors IFF'F O" DELL CONSTRUCTION 0 0 BOX 230273 fl(30RD OR 97223 Ohone #.- 5036206732 53603 1.'•:. 34. 78 TOTAL This permit is issued moat to he regulations contained in the REQUIRET) INSPECTIONS 'iqard Municipal Code, State of Ore. Specialty Codes and ail other Foot/found Inspi Fireplace Insl:) Applicable laws. All work will be done in accordance with approved Post/Beam StrUCt Gas Line Insp clans. This permit will expire if work is not started within 188 Post/Beam Meehan Insulation Insp days of issuance, or if work is suspended for e than 18 d Crawl Drain Gyp Board Insp FILM/Underfloor Rain drain Insp Peprnittee Sj.qnAtu-ve.-_,. ......... Mechanical Insp Water Line Insp Plumb Top Out Appr/Sdwlk Insp 19 si U e d D r.7-(,a m j.ni;! Tnsp Mechanical F i n 1. Call for inspection — 639-4175 SEWER CONNECTION / CITY OF TIGA RDF'E:RMI'T CIfYOF11671Rp E E_I.III T N. . . . . . . a SWR 90 0 3.)/ COMMUNITY DEVELOPMENT DEPARTMENT PRIM. F'I:::RMIT N. : MST 90 030' 13126 BW FWI Blvd. P.O.Bax 23307,Tipnd.OmgDn 970M 460) 176 DATE 09/1.4/90 T'T'I. --ID;)IyF::Sa 3,. . , : 1.H(:20 SW iUMME:RLOKE: DE 1='Afif.;Fl_.: 1Si1:3:3AD- fdr?E117N D1)]:t)'1:;310N. . . . .. AMORT SUMMERLAKL ZONING: R-7 I:11...00:1',. .. . . . . .. . . . a LOT*. . .. . . . . . . . . . . :2 T ENAN'T NAME'. . . . . : USO NO. . . . . . . . . . :4E378 FIXTURE: UNITS. . . : CA.-ASS OF:' WURK. . . :NE'W DWELLING UNIT'13. . - I TYPE OF' USE". :SF' NO. OF' BUILDINGS: 1 INSTALL TYf-,E. . . . ..BUSWR IIIF'ERV f;URFACE. a16f F;C."III a•rk.s: C)Wr)E;+-r. FEES - .___..._.._.�_...._....__......... ODE1..L CONST type amoulyt by (iate -rer T)t; 1' 0 BOX 2 30273 F'RMT $ 1500.00 / ! INS V' 9, 35. 00 T IGraRD OR 97'P_ ?;3 I"'(.)Y19 9+ J.'',-J35. 00 E'I._L 09/14/90 f:'1')C)rI e 0: C C.)17 t•r a c t o•r a ,)E F'F O' DELI._ CONSTRUCTION 0 PDX 230273 TJW: RD C.1R 97223 _..._..___..__.__..........._...._...__.._._.___._.__...._..___._»_ ._._........._..... 1=11.1orle t!. f.5036206732 ISY5. 00 TOTAL Rap 0.. . :: 53603 _._..__.._. RF.::1:lUIRE'D INSPECTIONS --- - This Applicant agrees to comply with all the rules and requ)ations Sewer frispection of the Unified Sewage Agency. The permit expires 12B 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 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 wi all a ate F'e•rmittee Si i.rlrlatt.lrCa: _ X S>'51.1('CI By Ca:l.I for inspectic)n 639-4:1 75 "31TY OF TIGARD --- RECEIPT OF PAYMENT RECEIPT NO. :90 -204780 C H f,-'G P:' AMOUNT c 7.369. 78 NAME a WELL. JEFF R. CASH AMOUNT a 0.CIO ADDRESS a I 060C) SW SUMMERLAK'.E DR. PAYMENT DATE-" 09/t4/90 SUDD I V 1.0)1 ON T I GAf 9, OR 9 7223 -- 1()6 StJMMR.LP-,,'. DEQ'. l"URPOSE OF POYMENT AMOUNT PA I L) F'I.)Rr-'DSE OF PAYMENT AMOUNT P(A I D AJILDINCS PERM MST90-0:7,cI7 7-2-2.CIO PLUMBING PERM llf'.CHANICAL_ PE 110.00 ST. BUILD PER — 23. 4EJ c" i)N CHED,' f:`E 116.80 SEWER USA 9 1).151 7, 1500.CIO '.A-'0JER INSPECT 15.00 STREET �iDC 600.60 F oRVS SDC 21110.CIO STORM DRAIN SDG 5. ot) F41ART SUMMER LOT #2 TCITt'-it. AMOUNT PAID -- 37-69. 78 � 13125 SW FkA af'Dlcc/ISD-T #CITOF T16A RD r ,n, (5W)639AIII Pflofu if .51 COMMUNITY DEVELOPMENT DEPARTMENT DATE T:Z JFD f -M--V JOB ADDROSS: lo c,-z6 SYMtj orY/e/u Uy _ rAx mAP/wr /s/- -?3Ad -2God :AJB: _ 10r: r11rm IUF.: VA1 WZZON: lG k OWNER -- v—— SPEQAL NOTES NAME: REISSUE Or: ADDRESS: o 1.77 3 LAST REISSUE: i7G4g n LO/L FI1 M PLAIN/ SFNSIT1W. LNm: — _ I7IONE: �Ys AI'I42I7VALs zt�llED NAME: �r2 ,•rs 7- FrrOtNIIRrNc: — ADDRESS: _ T k x �3r-'X73 ---- - -_ 7RE DEPT 4? 2 z? _ CGIM: BILI T)ERS "M 1: ! , LC ,� i'vP DATE: /1 — Lrsr/ 1= TAX: _ 11WILE IGINF-M C1U 11IATIOWS: -- NAME: _ Zl->tLc_ C ti�?; _ 11WS DETAILS: -- ADORES;: --- On=: _-- - -- P110NE: —G�By-$/'j —" 0101ENrS: C PERMIT # AC-T AMOUN17 AMMYr PD. BAL. DUE Lu - ,7 10-,432 00 Building Permit Fees 3"),2, -- __ -32 7- 10-433- 10-431- 00 Plumbing Permit Fees 1111 ,50 _/l 7 -- — 10-431 Ol Mechanical Permit Fees JL). c v -_ 30 10-230 Ol State Building Tax (5%) 3, Wilding 16- 16 Plumbing S .bf b Medi / 5 6- 10-433 00 Plam Check Fee �i Building -----,� c�, M leis' �.137� PlumbingMedi - 30-•202 00 Sewer Oa ion _67 L) 15-7d 30-444 00 Sewer 7nspecticn 3-3- 51-448 00 Street `yst-,em Dev Chang- (SDC) 52--449 00 Parks System Dev Charge (PDC) _ �� L)_ 31-450 00 Storm Drainage- Syst Dev Cit 3 (S,�C) 10-230 06 rirx- APPLI ICTIATURE Received By: _ Date Received: -- ef/3587P.WPF 1 CITY OF TIGARD — RECEIPT OF PAYMENT RF-CEip'r No. i90-204627 CHEGl< AMOUNT e 1c:►q.00 NAME a ODE LL.9 JEFF CASH i IOUNT c 0.0o ADORESS a lAYMENT DATE 09/ 11/90 SUBDIVISION TIGARD, OR 9 7x"_'2:!, PURPOSE Or- PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID ['Lo-'iN CHECK FE 9--23R 100.00 AMART SUMMERLAI,:t VOTAL. AMOUNT PAID 00.f)(7) GRADING(EROSION CONTROL INFORMATION GENERAL CONTRACTOR NAME&ADDRESS: CASEFILE NO.: pTjCZL �, FERMI 1'NO.: I i.,i,li) 2 ——1 —.— APPLICANT NAME AND ADDRESS: EXCAVATION CONTRACTOR 3 NAME& ADDRESS: OWNER NAME AND ADDRESS: TL'LEPHONE NUMBERS: d-- 1 2 z z APPLICANT: oS�I �l 5 � PROPERTY DESCRIPTION: OWNER- ��Dt�4 � ILo•( ��5-"� STREETADDRESS AND CROSS STREET/LOCATED GENERAL.CONTRACTOR:_c,-q >: /�•r'°��T "`.> ' `-ik' EXCAVATION CON-IRACTOR:�! SITE/JOB: LEGAL_DESCRIPTION: 24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: l-�,� 'fix CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION: .�c r �ttit �.1�c Leb /��y SITE SIZE,ACRES: DISTURBED/WORK AREA,ACRFS: LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WTLL.BE TAKEN SITE RUNOFF DRAINS TO:(CIRCLE ONE) (NOTE:PERMTI'S MAY BE REQUIRED) CATCH-BASIN DITCH PIPE "REEK t LL�i�:, c �aar�nr cLe — (C'RCLE ONE) PRIVATE PROPERTY PUBLIC RIGHT OF WAY ERQSION/SEDIMENTATIQll_C;)NJFRQL (ESC) MEASURES MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS DL JRING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDIMENTATION FACILITIt.S STABILIZE EXPOSED SURFACE STABILIZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY FSC 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 SUBMLTTED IN ACCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK-. EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLA14 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 CONSTRUCI'AND MAINTAIN ESC MEASURES AS NECESSARY TOC T N SF-DIMF.M'ON THE CONSTRUCTION SJTE. G'�1MFR SIGNATURE APPUCANT SIGNATURE )II I('IAL USE ONLY. RECEIPT DATE ACCEPTED FEE NUMBER RECEIVED BY