11546 SW LAKEVIEW TERRACE-1 -- 11546 SW LAKEVIEW TERR
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IN¢PX TION N01 q V
City of Tiga: d Building rpar-tment
13t25 SA Ball Blvd. Tiard, Orwynn 97223
Iieoection Line (Rec�-d�0e):_63,11--4175 euninene Phon r 639-417?
Inepect5.on-
footing Pit Undernlah Mach. Pough-in Alp Sd
Found. Plby. Top Out Gan Lino FI'N)L:
Poc+t/Ream Structs. San. Sewer Framing _R,,iy
Poet/Beam Mach. Rain Drain insulation -11umb,
' Plbg. Underfloor Nater Line Gyp. Bd. 4141ch
Data Raguentwds CIL— —,— `Time: — ,--AN ______PN
_.L =Y� -
Addrene•_ � t ���-�����_ Permit
Builder:—Oz
THE FOLLOWING CORRECTIONd ARE REQUIRED:
inspect
pt41�1C' Dater_
PPPAMD OIs"r APPROVF•l, SUBJECT TO ABUyE
-_Call inr Reinsp.
CITY CERTIFICATE OF
OF TION RD ( 44 OCCUPANCY
G(:!VI�lIIjNP�Y DEVEI_�PMENT 1 Cr' ij-i i gAMr PERMIT N. . . . . . . a M"'1114-02-49
SPARTMEN1'
13125 SV I W Blva. P.O.B-23397,bgart,C pW 97223 1")839.4176 \\
-- _ -`-- �---/ DATE I SSUEU t .111819A
.11E PDDRESS. . . e 11346 SW LAKEVIEW TERR
'.31-111D I V I S I UN. . t VILLAGE AT SUMMER LAKE PARK 3 PARCEL e 1 S 13;3DD-083NA
OLOCR. . . . . . . . . . ttONINGe R-4. 8
LL�Tr • • • • • s • . • • . . 1��G
CLASS OF WORK. tNEW____
TYPE OF USE. . . o RF
OCCUPANCY GRP. oR?
/.1L CUPANCY LOAD t 220 4
TENANT NAME. . . t
Remarks e
Owners ------•------2222__._._._ _________� .22.22_
f)UN MORISSET'TE BLDEn9, INC.
Fa O BUX 19521A
"L)RTLANU OR 97219
r"hOT19 *1 503-620--7538
1.:nntract or t
DON MORISSE:TTE BLGLRS, -INC.
'w SW BANDY FID
10210
LAKE OF3WFGD OR 970,35
1")h%-"@ #1 S01 -620-753(21
Reg #. . I 33'.,J3
Occupancy of the ;above referenced building is h@l-%tby given, and certiti ("., I
the compliance wilt, the Statr Of Oregon Specialty Codes for the y►•oup,
ciccupanc:y, and urv? tinder %oh1rh the referenced persalt was issued.
t:•IFt': DEPARI'MEN"i
BUILDING I CTOR
_ BU! D I Ne� .rFI C I PSL------
POST
._.POST IN CONSPICUOUS PLACE
s■ air � v w■ Bar Bart
�I�Ef"1.'IU O�TIGE
City of Tigard Bnil4ing DepartmI
133.15 Be Bell Blasi. Tigurd, Or'eganImapection Line (:'oc•-O-Phone, 639-4175 Ruainee: 6.19-4171
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Found. Plbg. 70P 'Out Gas Line FINAL#
Post/swam struct. San. Ower Fr-iming cc_�_�14-
lot/Rwarr MO01. Rain Drain Insulation -plumb.
P11-j. Under'loor Nater Lino Gyp. Bd. -Koch.
Dat.e Remieoted:_ / Times _PN
'0,4
Address:.. G �l 1c
Permit f i
Bulider: y�—_ ——
71M FOLLOWING CGRRECTIONS ARE P.BQUIRED+
t t"—
Inspector:� r� �— Date
APPROVED 01SAPPROM APPRMT% SUBJECT TO ABOVE
Call For Reinsp.
d
i
y
City of Tigard Building Dnpartment
13125 Sw Ball Blvd. Tigard, Ocego.n 977.23
Inspection Line (Rec-O•-Phone): 639-4175 Business Phone: 639-4171
In,ipection:.— -- --------- --
Footing Plbg. Underalab Mech. Rough-in lippr/adwlk
Found. Plbg. Top Out gas Line FINALi
Post/Beam struck. Ban. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plcunb.
Pl.bg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requested:_------
_�_. —___PM
Addrees: z1'-3-q � �_ 4C,� Permit f.?
THIO P41LLOWlNG CORRECT! I" *^"
Z4
Inspectors — Dates—
APPROVED — - DISRPPROVRD — APPROVED SURMICf TO ABOVE
i
----Cal l Pur Reinep. i,
es +tri' s� s, sel
iRtcTiott noTlcE -
City of Tigard Ruildinq nepert:aeut
13125 By Hell Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-o-Pho,e): 63f)-4175 Pusineee Phone: 639-4171
Inspection:_____
Footing Plbg. Underslab Mech. Rough-in <�pp /Sd-lk)
Found. Plbq. Top Gas Line FINAL:
Post/Beam Struct. 8rn. Bew['r Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plus_..
Plbg. Underfloor Nater Line Gyp. Bd. -Hoch.
Date Asqueelodt__�_ L _,1yA__ 4'imet PM
Address:_//5 izll__� Permit
Builder: �_��,
TIM POW- NO 1lORRECTION3 ARL+ REL' IRED:
-_ A
//. ,, -
�z J
Impactor:_Alc al. r4 _ Date:_
v_APPROVF,b DIBAPP' APPROVRD 6UBJRCT TO ARCArF
CRll For Neinep.
s WW es► W- wir ser ad
INSPECTION_NcYfICE `i�•' r
City of Tiga � Building p,.partmmt I
13!25 OW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O-Ph-ne): 639-4175 Busi-news Phone: 639-4171
Inspection:_ _.--�_-- - — --- -----
Footing Plbg. Undurslab Mach. !lough-:.n Appr/Sdtilk
Found. Plbg. Top Out Gas Line FINAL:
Pont/Beam Struc,.:. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line �yp�.--' --Koch.
Date Requested: Z- .- c� -C? L _Timer __AM PM
Aldress:._1;J'4 l� AD eZ7V f«,�. ___ permit #s,rfZJ O
Rulll.er: ri.srl.{L ;JJ St • 'r rte_.- _ ----
THE FOLLOWING ODRRECTION8 ARE REQUIRED:
Tn"ctors Dates) O ��
�&PPRC,VED __ D7aAPPRMD APPRMD SUWZCT TO ADM
Call For Mel.nsp.
ser n � � ,ter aiv +e. a1r
ZNBP)<CT3�1 ncrric� f'�
City of 719rrd Building Department
13125 811 Ball Blvd. Tigard, Oregon 97223
Inspect.on Line (Rec-O-Phone)t 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbg. Undar-slab �Meoh- Rough-in.` Appr/Sdw1k
Found. P.bg. Top Out Gas Line FINAL:
Post/Beam ltruct San. Sewer Framinq -Bldg.
Poet/Beam Mach. Rain Drain Insulatio -Plumb.
Plbq. Underfloor wi-low Tine nj Gyp. Bd. -Mach.
Date Requested:_=L �L/ - -� Timet -�LAM _-PM
Address: t• n!i/. Permit #s �} V
BuIIder:_
THE FOLLOWING CORRECTIONS ARE OLQUIRED:
__� ✓L�/TT„:LC �i`/ %�"�'T'.t//1��,—SCS—_.1z
Inspectors-•- — ----- Date:
�hPPROVED _ DISAPPROVED _ APPROVRD BUBJEC'r TO ABOVE
--_Call For Reinep.
elwjq WK ww'A asr erg
City of Tigard Btsklatng w)epartaent
13125 SN Nall Blvd. Tigard, Oregon 97223
Inapection Line (Roc-0-Phono)t 639-4175 Buninens Phcne: 639-417
t 1
Inspection:. -`.____.__�---
Footing Plbg. Underslab 114 Koch. Rough-in Appr/Sd•rlk
Found. Plbg. Top Out Cas Lina FINAL:
Post/Beam struck. Sar. sewer Framing -Bldg.
Moch. Rain Drain Insulation -Plumb.
Plb(S. Underfloor Water Line Gyp. Bd. -Koch.
Date Rocptested: ��- �Q
-- _ TlJOeI �- _AM __PM
Addreo&:__ 1.�L/l. �c'/'cl�..*�,� Permit 1�_ �O —OZyr>
Builder:—L2�22--
THY
--FO-OL--LOWIING C0Rg3CTjOMS ARE PFQUIREDt
Inspectors Dater
APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
l Call For Reinep.
�N¢PECTIOII i:^T'CE r 6i
City rr. tigard Building DoWactment
13125 Sw %all Blvd. Tigard,, Oregon 97223
Inspection Line (Rec-O-Phone: 639-4175 Business Phone: 639-41-7
Foo tIng PIbg. Underelab NKh. Rough-in Appr/Sdw!k
Pound. Plbg. Top Out Gas Lille FINAL:
Post/Ream Struct. San. Sewer Framing -Bldg.
Poet/Ream Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mach.
Date Requested: ' _Timet _ 2LAM PN
Addresel f .7 y� r— �"'(-E_. Permit #1
Builderl _41��1
THR MWA)WINO CORRECTIONS ARE REQUIREDI
cZ R 51 /, r- Ki mssLr,t 1 A1 LJ-7 c
. .LJ N1 :
Inepeotorl Dates ♦ 10 iv �_
APPROV20 DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
LF wa
INSPECTION NOTICE
City of Tigard Building Department
P O Box 23397 i'}I
Tigard, Oregon 97223
Phone: b39-4175
Type of Inspection . 4 . �
Date Requested Ti a A.M. P.M.
Address /` o– riwr�_� Permit #_- —
7wner —_ -- Lot #_
3uilder�w!
The following Building Code deficiencies are required to be corrected:
Presented to
Inspector
Disapproved
Date
CALL FOR REINSPECTION
C 1 YIS8 Lj NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23391
Tigard, Oregon 91223
Phone: 639-4175
/'�
Type of Inspection -�- ClL
Date Requested_=_ -,//j 7 �_ 1 ills A.M._— P.M.
Address ---� `�� /Z" Permit #!a
Owner _ Lot �#
Builder _ �� 1 --- -- — -- - ----The following Building Code deficiencies are required to be corrected:
r
Presented to (,i'
-- - } Approved
Inspector �" / i, _-- _ -_ Disapproved
----
Date
CALL FOR REINSPECTION
O YES 0 NO
INSPECTION NOTICE
City of Tigard Bi gilding Department
F.O. Box 23397
Tigard, Oregon 97223
Phone. 639-4175
Type of Inspection ��'T�
Date Requested .�' Tinge A.M._— P.M.
Address f Permit
Owner I — Lot #
Builder
f he following Buildinq Code deficiencies are required to be coorected-
r—
Presented to — _-- _ _ _-._ proved
Inspector __ ___ ❑ Disapproved
Date ----
CALL FOR REINSPECTION
f] YES 0 NO
I
WASHINGTON COUNTY INSPECTION CARD Project NO r
DEPARTMENT Of 'AND USE AND TRANSPORTAI ION PERMIT NO. � <
FOR INSPECTIONS (.AL..: 640-3561, 24 HOURS _
FOR INFORMATION CALL: 640-347OATL
I
ADDRESS
PERMITE[
DIRECTIONS PHONE NO.
('CCf10N5: RUCT MP UMB FJMECH nELECT
CALLED IN BY
E�-TAPPROVED.
REOUEL MD INSPECTION APPROVED -
HOWEVER NOTE: --
DNOT APPROVED:
REPAIR OR REPLACL ANI) RE-INSPECT: -
I STOP WORK UNTIL r� ______. -•--
INSPECTOR
L� ,e Lz e..g
.1 1
INSPECTION NOTICE
City of Tigard Building Department .`
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection Z Date Requested9e Requested —/h�9 Time A.M.---P.M.
Address Permit # 2� 0,11
Owner _---.-.------- Lot 4
Builder
The following Building Code deficiencies are required to he corrected:
el
Presented to JI—Approved
Inspector _ ❑ Disapproved
Date1���C�
CALL FOR REINSPECTION
C YES (-1 NO
CITYOFTIFARD SFwWF. R ER11 IFT,C;'T'.I1.',N
I'ERMI'T'
CrTY
COMM',INITY DEVELOPMENT DEPARTMENT TIMM
F'r:1M„ F'Ii::F�htl'T fit„ a MUT'3C�I- 0r!4'rj
13126 SW No!Blvd. P.O.Bow 23387,r9wd,Omppon 9W`NG"M41'6 DATE-- I S S�K D" 00/17/90
SITE nDDRLSS). . . : 11546 SW I AK VIF_W TERR PARCEL': I.S1:3:3DD-05300
St.)BDI:VISICTN. . . . « VILLAGE: AT SUMMERLAKF H3 7ONINCis
1•:+I...00K. . . . . . . „ . . « LOT. . . . . . . . . . . . . ..92
TENANT NAME. „ . . . «
(.)S)A NCI. . . „ ., .. „ . . . 142357 F'IXTURE: UNITS. . . I
CLASS OF' WORK. , . -NEW DWELLING UNITS. . « 1
'TYPE OF USF:.. . . . . ISF NO. OF” BUILDINGS11
I:NS)TALL 1YPE. . . . «NUSWR IMPERV SURF"ACE.. . «
RiA-f-ksl
Owrie-r: FEES
DON MORISSETTE ELDERS, INC;. type amoi.tM, by date rec-,p
P 0 BOX 19524 PRMT $ 1.500. 00
I:NSF' $ 35. 00 /
PORTLAND OR 97219 POYM $ 1.5315. 00 FILL 06/1.7/90
Pl-ic)1.1e 0.- 503-620-7538
Lcirltractor: ----__........_.._..._.._...._..._............_......_.__.........._.............
C.C. ITRACT'OR NOT UN VILE
F Iionr� ii , $ 1535. 00 TOTAL_
Reaq ii. . ..
------ _..___ REQUIRED INSPECTIONS _....._..._.._._..
This Applicant agrees to comply with all the rules and regulations ::)ewer Iiispectioi7
of the Unified Sewage Agency. The permit expires 128 days frim
the date issued. The total amount paid will be torfeited if the
permit empires. The Agency dues not guarantee the accuracy of the
side sewer laterals. If the sewei is not located at the measurement
given, the installer shall arospect 3 feet in all directions from
the distance given. If not so loc,ited, the ins alley sh purchase
a "Tap and Side Sewer" Permit and the Age
w 11 in 1 lateral.
F re r m i !:t e e S i g n a t 4c r e ........_....
_.._.. _.. ._._._._.__..._ _.......� _..__._......_..._..... _. _
l < ued Hy
CACI. fo-r inspec,tirari E,39-•4175
—
CITYOFTIFARDAll�l' MASTER E'E:R11I T
Y'r
Cf�Y�FT16i74R� G'E RMIT M. . . . . . . r MS t
COMMUNITY DEVELOPMENT DEPARTMENT t�RmYON PRIhI. E'ERMIT #. I MST90-- 0249'
13125 8W HeII BW& P.O.Baa 23397,Tied.Oregon 177F27 JW)4 g 175 D A T I_ ISSUED: 08/17/90
SITE ADDRESS. . . 1 11546; SW L.AKEVIEW TERR PARCEL: 1S1 33DD -05 300
SUBDIVISION. . . . 1 VII_I...ACaE Ai' SUMMERLAKE (4:3 ZONING:
BLOCK. . . . . . . . . . i LOT. . . . . . . . . . . . . 992
_....__�._._. BUIL.DING _..._...._....._._._........._. .._-._._._._.___...__._....-__._._....
RLISSUEI DWELLING UMITS: 1 BASEMENT. . . . . . . . :0 sf
CLASS OF WORK. -.NEW BE:DRMS:Al BATHS:3 OARAl3G:. . . . . » . . . . 1845 s f
TYPE OF USE. . .. .-SF FLOOR FARE:AS-._.-..-.._....__....._- RLQUIRED CiE:TBAC:FiS- --- ----
T'Y1=E ()F C0NF.3T. ::'5N F.I:RST. . . . 11162 s L E`F 1. . : 10 ft RIGHT. :."'5 1 1.
OCCUPANCY GRP . AR3 SECOND. . . 1:340 sf FRONT. :20 ft REAR. . s46 fi;
S'TORIES., » . .. „ „ .. 12 THIRD. . . . :10 <sf REOUIF:ED--
HEIGH'T'. ., ., » » . . . 120 ft T"OT()1. _-.._.._.-.-....;.2502 S SMOKE DETECTORS. 1Y
F'L00R I...()0D. . . . 140 psi- VA1-UE. . . 110,894 PARKING SPACES. . :0 it
F�e+marE%s:
PLUMPING .__._..._...._._._.._ ._.._.-_._ __ _...__._.____. _. ...._._......_..
::3INKS. . . . . . . . . . .. 1 1='LOOT'; DRAINS. . . . ..0 BACKFLOW PREVNTRS. . :0
LAVATORIES. . . . . :3 WATER VILATLRSr'. » » :1 'T'RAP'S. ., . . .. . „ . . . . . . . :0
TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. -0 CATCH BASINS. . . . . . .. :0
WATER CLOSETS. . :3 SEWER !..INE: (ft) . .N GREASE TRAPS. . . . . . . ..0
DISHWASHERS. . . . .. 1. WATER t_INI: (ft) . : 100 OTHER FIXTURES. . . . ., ."O
GARBAGE DISE'. . . 11 RAIN DRAIN (ft) . :0
WAST-ZING I*IACH. ., . :: 1 SF RAIN DRAINS'i. . : 1
_._....._.._.-_.._..____...__.
MECHANICAL _ _._._.._.._.__._..__.._....._. ..__._._._..._._. F"E.:E:ca
FUEL TYP'Lr_,...__.._._...._.._._____. UNIT H'TRS. . :O type amocint by crate r•ecpt
/GAS/ / / VENTS . . . . . 10 P'AYM $ 100. 00 J'LH 07/18/90 202888
MAX INPUT10 FTU VENT F AN1�. . :2 BP'RT $ 475. 51
FU R N ( 1001! . .. :H HOODS. . . » . . : I FPLC 9s 309. 08 /
1=URN )::-:.I WOK ;: .I. WOODSTOVE.S. :0 B5P'C• 1i 23.. 18
FLUOR F"URN. . . .. .0 CLO DRYERS. : I STDG s 600. 00
FOIL/C;hIE' < :iFil='::C3 OTHER UNIT S:0 SSDC $ 375. 0(11
GAS OUTLETS 1 '1 PARK !h+ 250. 00
Owner1 _..-,_._..___._..__._..____.._ _....__.._.....__._.-.___...-_-, MP'RT $ 34. 50
DON MORISSETTE: 1:+LDFRS, INC. MP'LC $ 8. 63
(:' O BOX 195)24 115P'C 'I: 1. 73
P'P'RT $ :1.40. 00
1-'UR'l __AMD OR 97219 P 5P'C $ 1. 00
Phone ii: 503•-620.•75:38 P'AYhI $ 2125. 22 PLL 08/17/90
l.
Ina a C:to
'r: ...___._.... ... .._ ._.._ ..._...._ ..._._ ._._-.......
D(JN M(:)Ft1S'"=.i'Tl'E: BUDERS, INC.
I O BOX 1,9524
I'ORTL.AND OR 97219
PI-lone N: :50:3••-020•-•7538
�zeq H. . 1 ;3`5533 _ ._...............�,_..___ __...__.___._..__..�______._....._...._....._.._.............
* 2225.22 TOTAL
This permit is issued subject to the regulations contained in the - - REOUIRE:D INSPECTIONS -
1igard Municipal Codt, State of ere. Specialty Codes and all other Foot/found Insp Mechanical. Insp
applicable laws. All work will be uone in accordance with approved Wt•r E'•roofirlq E m Phtniti Top Out
plans. This permit will eipire if work IS not Started within 180 Post/Foam 1:'it•rt.tc•t F-raming Insp
days of issuance, or if work is suspended for Bore than 0 ys. P'ost/Bream I'ler_han Fi. reep:lace Iiir;p
LCrawl. D•rai.n Gas Line 11iCsp
Permittee Si.griattt're: `� _. _.._ P'l.m/tetnds].ah Irissp IisLtla.t-J.ovi :1:n«sp
/fes
PLM/Unde-rfloor Gyp Board Irisp
.......__..... I: t r i g U r a i ri B s m' t; Pain B r a i.n Insp
Call fo-r i.rlrpect:iari 839-.4175
i kF
I
CTT'Y OF7 TIGJAR0 REC:EIF'7 OF PowMENT P.ECE"Ir'T rlo, a 1.70 ..207-E165,
DON h1(11`� TC SE TTF CHECK AMOUNT a strt+a:'>.ate:'
CASH AMOUNT
ADDRESS a P O PDX 195214 PAYMENT D►1TtE a (Q/1-7/191)
SUP-1) a
PORTLAND. OP, Q-721 c; V AT SUMME:RL_AF,:C' f#'?•
i"!..IRF•OSE OF i"AYMENT AM1,3UNT FIA 1 0 F•I..)PPOt7E OF' F•A MENT AMOUNT PAID
JFEE fr ', r F' 4%.5'.tea? Fl–UMR.tNG PERM
"'•cCHANICAL. PE :741 .5r1 f.7, HIJTI_Ti PER ."_i].
I–AN CHE(7FE 217. 71 ;' C.G.IE F USA I.!�a;!a,!.(K)
F.WE'R I N 7F'E SGT :5.010 STREET GDC
`30C: 25t:l.00 STORM DRAIN SLAC „17!", 00
i
1, OT 1157
I
I
To::r LOT —ot�t
Tf.+TAL AMOUNT fi'AID _ 366(.). 22
1,9A
I�
0FT16;A` �^+� It PLAN CHECK APP%IC�AT O
Cj1YPJ) , }�I �pexeo PLAN CHPERMIT
�� PERMIT 11 �'' . -�-
COMMUNITY DEVELOPMEtlT DEPARTMENT / DATE ISSUED - ��.�-_
��tos`w.FwarmPA- ur9r.��y..4o.�v°^srza.(sa't63"1
rs
iAX t'iAP/LOT �5/ - 1 Z)!2
JOO ADDRESS: LAND USE: _
-> t.OT:
ai1B: r � -� -` -
ALUAfi4 SPECIAL NOTES
OWNER ?2 1 n(1 f I u REISSUE OF:
HARE: YYl'D_ ISSN LAST REISSUE: _
ADORESS:
FLOOD PLAIN/
1 p g - _ SENSITIVE LAND: -
PHONE- �-lOc r APPROVALS RErUIREO
- PLANNING. -
OOtMACTOR ENGINEERIN";: -
NAME.: ------ - FIRE DEPT
ADDRESS: _ _ OWER:--------------------------
_ --
--- I1 EMS RE(�UIREO
PHONE: --- - ------ LIST/SIJOGUNTRACTORS: .
BUS TAX: _
ARgI/ENGINEER _ T1 A �, CALCULATIONS:
NAME: T21_�7 TRUSS DETAILS:
ADDRESS: PARKING PLAN:
_ -- LANDSCAPE PLAN:
OTHER:
P f 10NE: ____
N
DESCRIPTION - AMOUNT AMOUNT P0. BAL. DUE
PERMIT
M ACCT '
10-132 00 Building Pec mit Fees
�_
_ 10--431 OG Plumbirg Permit Fees 3,L =ySb
10-431 01 Mechanical Permit lees
1030 01 State Building Tax (SX)
Building _ 3• 8
Plumbing 7• u4 ✓ /7
Mech
10-433 00 Plans Check Fee
3 � Building -
III Plumbing
b Mech p---L- 3 -l/ —
�V, p 30-202 00
Sewer Connec.ti��n
30-444 00 Sewer Inspection
51-448 00 Street System Oev Char'T"e ( OC)
52-449 00 Parks cysl-em oev Charge (POC) -r
Sturm Drainage Syst Oev Chrg (SSOC)
31-450 00 _
10-230 09 'iRFO
10-230 OG washirtgton Cou(rty --
10-220 (X) Amart/Wedgewood
APPt-IC.ANT SIGNATURE
oat Received: ---
l:eceived Oy: _
'"ATY OF" TIGARD F'FCET.PT OF F"AYMENT REMPT NO. .9(1--20 686
CHED: AMOUNT c 14C).00
NAME t MOr-:I.S)E'TTE. DON HOMES CASH AMOUNT x 00
ADOPESS a BOX 1.95214 PAYMENT DATE
FIOPTI-4AND. OP '"07219— SUr4DIVISION
I-IJRF'QSE OF P"A (MENT AMOUNT PA I D OF' PAYMENT AMOUN T PA 11)
C'HEU FE 1110. (A.")
I J546 SW 1-4W.E.VIEW C7 .
PL(431-1 . #7—T7,P SW (-'W, I DGEV I EW CT .
TC-ITAL., AMOUNT !:'AID
�tAUINIa�.KV1IVIV LVI�t Kl�� tl�rt�i�l�i�+ � �u�,.
GENERAL CONTRACTOR NAME& ADDRESS: CASEFILE NO.,---
PERMIT
O.: --
PERMIT NO.:
�, , ►-,ti ` ' ( APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR
NAME& ADDRESS: I L- I71_L1 )1` I —_
ONTER NAME AND ADDRESS:
TELEPHONE NUMBERS:
APPLICANT' -,'x 1 '+ Y"1C 1�-tc='-"i'Tir �, �- PROPERTY DESCRIPTION:
OWNER• L- l, rl i 1 �'- .l �ZL 11+ 1�1= _ STREET AD RE
SS AND CROSS SIREET/LACATED
GFNI;RAL CONTRACT'OR:y _L1 '(i I 1 t f ,t �d� ` %h:-�.L��C L le-
EXCAVATION CONTRACTOR:,_, I
STIE/JOB. — LEGAL DESCRIPTION:
24 HR/AFI'ER HOURS EMERGENCY TAX LOT NO.:
CONTACT PERSON,MILE,TELEPHONE: 1/4 SECTION:
SITE SIZE,ACRES:
--- DISI-URBED/WORK AREA,AC;'ra_
LOCATION& ADDRESS WHERE SPOILS
LEAVING) SITE WII-L BE TAKEN SIZE RlJ1J01T DRAWS TO. (CIRCLE ONE)
(NOT-t,:pERMM MAY BF RFQUIRED) CATCH-BASIN DITCH PIPE CREEK
(CIRCLE ONE) PRIVATE PROPERTY_
-- (�JSIk RIGHT OF WAY
ERQSIQNIS EDIMENTAT_IQN C()NIR �E IMEASURES
MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS
DURING CONSTRUCTION: FOLLOWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZED CONSTRL' TION 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 SEQUENCE OILIER
OWER _
PLAN FOR EROSION CONTROL PREPARED AND SUBMITTED IN ACCORDANCE WITH`TECHNICAL GUIDANCE HANDBOOK-.
EROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY
►'HONE NUMBER, SCHEDULE,ISTAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MFAS(IRES,AND
APPLICABLE STANDARD NOTES.
1 HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE.
OWNER SIGNATURE APPLICANT SIGNATURE.
0M- CIAL USE ONLY.
RECEIPT DATE ACCEPTED
FILE NUMBER __ RECEIVED_ __ 4Y.-
-
' P.O.Box 19524
Portland,OR 97219
(503)244-9314
The Foundation For Affordable Homes
SC K�L9
20
PCwIJ # 13-�
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