Loading...
11675 SW TERRACE TRAILS DRIVE 1 1 1•� rn H I �) CTJ H C� b fl1 �- 116%5 SW TERRACE TRAILS DRIVE INGPECTIOii NOZ'ICS City of Tigard Building Dopartaent 13125 SN Ball Blvd. Tigard, or"on 97223 Inspectton Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspections Footing Plbg. Underslab :4ech. Rough-in Appr/Sdwlk Freund. Plbq. Top Out Gar Line FINAL- Post/Beam Struct. San. Sewer Framing -Bldg. Poet/Beam Mev.-h. Rain Drain Insulation -Plumb. Plby. Underflikor Water Line / Gyp. Rd. -Mach. Date Requested: / ,,/-C�� —'T Time? AM ___PN Address•. ���Cre �� ,�, e it Builder: -•--- THE FOLLOWING CORRECTIONS ARE REQUIRED: Inepector: - — Dates_ APPROVED DISAPPROVED APPROV'6D SUBJECT TO ABOVE Call for heinsp. ® MECHANICALL'. CITYOFTIVARD ClTYCFTNiARD PERMIT COMMUNITY DEVELOPMENT DEPARTMENT \� PERMIT #. . . . . . . : MEC91-02 16 13125 SW FWI BW. P.O.Box?3397.Tiprrd,Orpon 97223(603)639-4176 -- - -- a-A+1 11 D TE ISSUED: 11/19/31 SITE ADDRESC;. . . : 11675 SW TERRACE TRAILS DR PARCEL.: 2S103CD-04401 SUBDIVISION. . . . : ZONING- R-4. 5 BLOCK. LOT. . . . . . . . . . . . . . CLASS OF WORK. . :HUD FLOOR FURN. . . . : EVAP COOLERS: TYPE OF USE. . . . :SF UNIT HEATERS. . : VENT F=ANS. . . : OCCUPANCY GRF'. . :R3 VENTS W/O APDL: VENT SYSTEMS: STORIES. . . . . . . . :2 BOIL.ERS/COMPRESSORS HOODS. . . . . . . : FUEL TYPES-_.___..._____...- 0-3 HF'. . . . : DOMES. INCiN: /WOD/ / / -1`.; HP. . . , : COMML. INCIN: MOX INPUT: BTU 15-30 HP. . . . a REPAIR UNITS: F I RL DAMPERS?. . : .30--50 HP. • • • WOOD STOVE a. . : 1 GAS PRESSURE. . . t 50+ HP. , CLO DRYERS. . : Iy0. OF UNITS---------- AIR HANDLING UNITS OTHER UNITS. ,; F URN ( 100K BTU: (= 10000 c:f m : GAS OUTLETS. : FURN ) =100K BTU: > 10000 cf n: I emar4(s : NEW PELLET STOVE Owner: ____.________.______--------_.-______.__-- -____._.__._.__-______. FEES GARY SIEG type nmol-rnt by date recpt 11675 SW TERRACE TRAILS PRMT t 25. 00 JLH 11/19/91 - 5PCT ,b 1. 25 JL_H 11 /19/91 — TIGARD OR 97223 Phone #: honti^actor: CONTRACTOR NOT ON FILE (hone #r $ 26. 25 TOTAL. -------- REQUIRED INSPECTIONS ;his permit is issued sub,iect to the regulations contained in the Final Inspecti,)n Tinard Municipal Code, State of Ore. Specialty Codes and all other _ applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is P.t started ___ within l(W days of issuance, or if work is suspended for more tha- 190 days. _�-•--.______.... ___ _ �_�.__ —__ _ _. 1 el-m i t t e e Ls s i_ted By : _ ____—_— __..__.—_ ._.___ �.__-_ ______ ..__.._-- ----.--.-._._._.._.--_-____.._._ .... Call fur inspection - 639-4175 CITY OF TlBARD RECEIPT OF PAYMENT RECEIPT NO. a =1 i 19840 CHECF, AMOUNT 26. 25 NOME STEG, JUL.IE CASH AMOUNT (a. 00 PAYMENT DATE t 11 /19/'41 SUSD I V 143I ON PURPOSE OF PAYMENT AMOUNT PAID PURPOqE Or PAYMENT AMOUNT PA'i b 23. lAo ST. BUILD PER 1. 2 RITAL. MOUNT PAID 26 E5 CERTIFICATE OF' CITYOFTIFARDO.CUPANCY GIiXOFT16AID PERMIT M. . . . . . . a MST90 0085 COMMUNRY DEVELOPMENT D A MOCK 13125 SW FW I Blvd. P.O.Bax 23397,Thiard,Or+pon 't f 4175 1S 15 SUED: Oc '04/91 SITE ADDRESS. . . : 11675 GW TERRACE TRAILS DR PARCEL: 27103CD--@4401 SUBDIVISION. . . . t Z ON I NG3 a R-.4. 5 BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : --------------------- --------------------------------- CLASS OF WORK. a NEW TYPE OF USE.. . . :SE OCCUPANCY URP. :R3 OCCUPANCY ' .UAD z 220 4 TENANT NAME . . . c Pemarks: 15 ft sanitary -,ewer easealent on east aide of lot Ownerl GARY SIEB L0455 SW NURTH DAKOTA S1 03 TIGARD OR 97:=23 Phone M: 681-7300 Contralctore ----_,______-__-_-__-W_._-_--_-, CONTRACTOR NO'T' ON FILE 1 'honp N: Rwg #. . : Occupancy of the above referenced building is �hvreby given, and certifies the compliance with the State Of Oregon Specialty Codes for the group, nccup,inr.y, and use under which the referenced pernit was issued. ^FIRE: DEPARTMENT BUILDING IN ECTOR R Lqt C►IN 6. ,FICIAL POST IN CONSPICUOUS PLACE INSPECTION NOTIgE City of Tigard Building Depantivent 13125 SW Ball. Blvd. Tigard, Oregon 97223 Inspect.i.on Line (Fec-O-Phone): 639-4175 Business Phones 639-4171 Inspect i-on Tooting Plbg. Underslab Mech. Rough-in Appr/Sdwlk Round. Plbg. Top Out Gas Line BINALs Poet/Beam St-uct. San. Se"r Framinc Post/Beam Mech. Rain Drain Insulation -plumb, )) Plbg. Underfloor Water Lined Gyp. Bd. r M D&te Requested: L.LTimer �—,_.--AM pM Address- it fs �D �4/ r` Builder: � THE FOLLOWING ZCTIOINS ARE REQUIREDs Inspector: Date:_��yl DISAPPROVED L--��pyED SUBJECT To ABOVE Call For Reinap. ;NSPCTi00N N(Yr1cE City of Tigard Building Deksart:oent i 13125 SW Ball Blvd. Tigard, Oregon 97223 Inspection Line (Roc-O-Phone): 639_A1.75 Business Phone: 639-417 inspect i.on:__,_ - -- Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Struct, Ban. Bawer Framing �-Bldg_ Poet/Berm Moch. Rain Drain Insulation -plumb. Plbg. Underfloor Nater]Line Gyp. Bd. -Mech. Date Requesteds�Q �T�= AM c PM Address: / __ Permit •s_ A�l_ldors THE FOLLOWING ZRRECTJONS ARE REQUITSD 2 CU,k/L=/Z Inspectors Date:-1t� //� APPROVED D SAPPROVED APPROVED SUBJECT TO ABOVE v_ �--- Call For Reinsp. INSPECTION NOTICE City of Tigard Builciing Department P.O. Box 23397 'Tigard, Oregon 97223 Phone: 639-4175 Type of Inspectio / >.3. .� j. -- Date Requested % A.M. P.M. Address Z//11 - Permit # � &S� Owner --- --- --- - - Lot #-- Builder - Z _-_-�_-- — The following B 'ding Code deficiencies are required to be corrected: fts -- —�.--- Presented to - - __ -_ _ �Approved J Inspect.r �..A �v • v1 _—__ [J Disapproved Date ---- } '-7 �u ---- - CALL FOR REI '7:-."TO1' YES I 10 INSPECTION NOTICE Ju �� City of Tigard Building Department 0 P.O. Box 23397 `�.44, Tigard, Oregon 97223 7 Phone: 639-4175 Typo of Inspection �- J Date Requested ,/ Time ✓` A.M. P.M. Address Permit # O ` Owner Builder Lot -- The following Building Code defi,Iencies are required to be corrected: Presented to Approved ✓ Inspecto Date — __ � ❑ Disapproved CALL FOR REINSPF,CTIO,N' ❑ YES 0 NO INSPECTION NOTICE City of Tigard Building Department P.O, Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested —,Vf Time A.M. P.M. Address l-, 7St, '�/J e�� '%/ c iPermit #'�40 Owner _ Lot #_ Builder The following Building Code deficiencies are required to be corrected: C7 v- s�W C_� I f f"A-J Ptesented to rrfT'approved Inspector � [� Disapproved Date lu - r3—a0 CALL FOR REINSPECTION YES qK)yO ��. INSPECTION NOTICE l Ity of Tl�rd Building Department PP Box Tl rd, Oregonon 97 97223 , - Phone 639-4175 Type of14d"Date Red_ a�� .�_—_ Tim A.M. P.M. At '•ess / __ Permit Owner _ —._-- — Lot # Builder l— 4���J / / 0A/-= _ The following Building Code deficiencies are required to be corrected: Presented to — Approved inspector Disapproved Date CALL FOR REINSPECTION ❑ YES C7 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 , Phone: 639-4175 Type of Inspection Date Requcsted Time��L A.M. P.M. Address _ Z — Permit #4 Owner_A –_ --___-- _ Lot #_ Builder ----- The following A ilding Code deficiencies are required to be corrected: Presented to __ --------_-------- - --_ Approved Inspector _ --- — -- -- -_ ___ -- Disapproved Date ---- CALL FOR REINSPECTION O YES ONO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection _-- Date Requested _ e-1 7 Tim _ A.M. �_�P.M. Address U� a n �' Permit #__f� Owner Lot # The following tiding Code deficiencies are required to be corrected: !G'06'VL- i�v S c 4,1477 Al i u&t[1 /4.T"t'%Y [?r2.v S�- ��t��NU�/y iic/fc..�.�Tlyni ✓1l�c:s,.�rL �2.v',7 cam. s/ /iV 51221-4—' ` �;2.y �nL G�i� S�c'vz,icr.•- `1cT.:.d �S 5vAA77Jy LA--7T-7 ;5-4,j �2.s.�r7 C�tic�s✓��.�S. Preswited to _ Approved Inspector r blapproved Date CALL FOR REINSPECTION YES ❑ NO Nee a INSPECTION NOTICE Laity of Tigard Building Department P.O. Box 23397 Tigard. Oregon 97223 Phone: 639-4175 Type of Inspection - Date Requested jc5/9—? Time A.M..c P.M. Address .1 60 ZS- 7--'90.y4,-:. -rl7-,-" Permit #1V'CICl85 Owner _ __ Lot # _ Builder _51E �1The following Building Code deficiencies are required to be corrected: t•+�s/� sr�ir 7 �%7is. �Z �E/yNr iyu% Zi ,�:irGc=F--o 1- L6rZ .Sal.V �Lau�Z t?k 7Z� ��✓Sc!_l-A is -- — Presented to 14-Approved Inspector lJ Disapproved Date 5 �� CALL FOR REINSPECTION YES 0 NO INSPECTION NOTICE City of Tiga:d Building Department P.O Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection __�� CMZ �G�� •��1 .i��Jdi l�/ g� Date Requested - l' ` ')5w- A.M.-P.M Address - r �si1e�,� D Permit #_6?0 Owner Lot # Builder The following Buildirti, Code deficiencies are required to he corrected: -0�-y-100Y --. Arncl- Presented to Approved -'-- 040---- Inspector _- '04 Disapproved Date CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE City of Tigard Building Department P.0 Box 23397 Tigard, Oregon 97223 Phone: 639-4175 r Type of Inspection - Date Requested, �� TimeA.M. P.M. __ p Address ��✓ '�7+� ' I''d -- — Permit Owner Lot Builder The following Building Code, deficiencies are required to he corrected: o Presented to _ ❑ Approved Inspector proved Date - CALL FOR REINSPECTION ❑ YES ❑ NO INSPECTION NOTICE �r r City of Tigard Building Department / P_O. Box 23397 4 /� Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection �— —+ -- -�D `✓� �� �� ��� / Date Requested 7 '5i9& _ Ti A.M. P.M. Address �. 7 Permit # Owner _ _ Lot # Builder 17 The following Building Code deficiencies are required to be corrected: i Presented to [r] Approved f Inspector __ - .�_ __,. l_J Disapproved Date ---- _ CALL FOR REINSPECTION ❑ YES 1__1 NO INSPECTION NOTICE City of Tigard Building Department t P.O. Box 23397 Tigard, Oregon 97223 G Phone: 639-4175 Type of Inspection ----------- Date Requested _ —7 Tim A.M. P.M. Address . Permit Owner ------ - —- ---- — Lot #_� Builder 41 --__-- —The following Building Code deficiencies are required to be corrected: 1 ►rte: Presented to _ _ ------ -v ----- Approved Inspector _ - - Disapproved Date — CALL FOR REINSPECTION ❑ YES ❑ NO CITYOFTIGA MASTER r'E. . ✓ ; RDcTnroF nrm4� I-��:F;I�]:'r it. . . . . . : M y'T'9 0....0085 COMMUNITY DEVELOPMENT DEPARTMENT 02240+ PRIM. PERMIT ii. a IrISI'90•-•0085 3,z5 sw iii Blvd r.0.Box 23327,riper :)upon u� ,(g03y6;9 A)`S DATE ISSUED: 03/16/`�0 F'ARCELa 2S103CD--04401 SITE' ADDRE::SS. . . a 11E,75 SW TERRACE'. TRA1L.ti DR ZONING: R••-4. i SUBDIVIS]:ON. . . . RI_OCK. . . . . . . . . . a L.O . . • • . . " . • . . . .BUILDING ___._..___._.__._..____._.._._.._.._._._.__.._._ ......_........... ... RE,.�SUEa c DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 s'f (:;LASS OF WORM.. :NF:W BEDRMSa3 BATHSa3 GARAGE. . . . . . . . . . 9418 > T'YP'E:: OF USE. . . :c>F F'L00F< AREAS­­­­.....­ REOUIRED SE:TRACKS._.__._.._..__._..... TYPE: OF C'ONST. :5N FIRST. . . . -. 1165 s I_EFT. . :24 ft RIGHT. a15 f•t; OCCUPANCY GRP. ".R3 SECOND. . . :825 s F'RON'T. a65 ft, REAR. . a99 ft STORIES . 0 T . EIIRD. . . . :0 <._>f RE0UI �' S -.._._.._._.._..__.._.__...____..._._. -20 ft TOTAL.-••••__..____.: 1390 s-f SMOKE:: DETECTORS- --Y FIEIGH'r. . . . . . . . FLOOR LOAD­ - - :40 ps•;f V()L..LJE. . . . . $a 921.84 PARKING SPACE:S. . :0 Remarks: 15 ft sanitary newer easement on east; side of lot SINKS. . . . . . . . . .. .. FL.00R DRAINS. . . . .0 BACKFLOW P'RE:VNTr-;f:s. . :0 LAVATORIES. . . .. . .-5 WATER HEATERS. . . -. 1-00 TRAP'S. . . . . . . . . „ .. . 'T'UB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . : 1 CATCH WATER CLOSETS. . 13 SEWER L.INE (ft) . :0 GREASE TRAP:) ,. ., . . :0 DISHWASHE:RS. . . . 91 WATER L.INE. (ft) . : 1.00 (aTHER FIXTURES. . . . . :0 GARBAGE DISP. . . al. RAIN DRAIN (ft) . .-.O WASHING MACH. . . : 1 SF RAIN DRAINS. . a1 FEES FUEL TYPES–­­­­­­­ UNIT HTRS. . aH type amount by date ^eCpt /UPS/ / / VENTS . . . . . ..0 P'AYM $ 1.00.00 J1.1-1 02/27/90 1 0190 7 MAX INP'U'T•:0 Ji'l'l.) VENT FANS. . :3 PRM'T $ 412. 00 F URN < 100K — : 1. HOODS. . . . . . : I P'L_CK $ 267. 80 TURN )=1001( . . :0 WOODSTOVES. :O 5P'CT $ 20. 60 FLOOR FURN. . . . :0 CI_C.) DRYERS. : 1 STDG $ 600. 00 BOIL./CMP < 3HP:0 OTHER UNITS:O SSDC $ 250. 00 ! GAS OUTLETS: 1. PARI( 1; 250.. 00 Owner: __.__..._.. _.._._.._._._._..._._._.......__.__. P'RMT $ 36. 00 ! GARY SIEG P1 $ 13. 00 :10455 SW NORTH DAKOTA ST 143 5PC'T $ 1. 80 P'RMT $ 1.62. 50 T IGARD OR ri 7223 =,P'CT $ 8. 1.3 Phone ii: 681•-•7300 P'AYM $ 1017. 83 JL..H 03/16/90 Contract0•r: * OWNER/CONTRACTOR Rerl N. . : OWNER $ 2017. 83 TOTgL This permit is issued subject to the regulations contained in the - ~ - -- REQUIRED INSPECTIONS Tigard Municipal Code, State of Ore, Specialty Codes and all other FoOt/foUnd Insp Fireplace applicable laws. All work will be done in accordance with approved Post/Beam Insp Gas Line Insp plans. This permit will elpire if worV• is not started within 169 Crawl Drain lrlsl.11at:ian Insp days of issuance, or if work is suspended for more thin 189 days. P'lm/Undslab Insp Gyp Board Insp PI.-M/Llnde•rfl.00r Rain drain Insp F'prmittee Si.gl•laturea _..... L1. ...__ .0 ......_......_.._...__._ Mechanical Insp Water Line Insp PlUmb 'mop 01-tt Appr/Sdwlk. Insp I:sst.led By: F'"•raminq Insp Mechanical F"i.nal. Call for inspeetion 639-41.75 SEWER CONNECTION CtNOFTIGARD jiFIERM I I COMMUNITY DEVELOPMENT DEPARTMENT mom -[..R I T #. . . . . . . .. SWR90--0093 mom 13125 SW HWI Blvd. P.O.Box 23397,Tlg&M,Oregon 97, r 175 1�:R I'MM" PERMIT ii. : MS790 0085 t'g W?9f DATE ISSUED: 03/16/90 SITE ADDRESS. . . : 11675 SW TERRACE TRAILS DR Pl()RCEI--. 2SI03CD-0440]. SUBDivisrON. . . . c. ZONING: R-4. 5 BLOCK. . . . . . . . . . : 1_07.. . . . . . . . . . . . . . TENANT NAME. . . . . : USA NO. . . . . . . . . . c40617 FIXTURE UNITS. . . .- CLASS OF WORK. . . vNEW DWELLING UNITS. . : 1 TYPE OF USE. . . . . ISF NO. OF BUILDINGSil INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . : Isf Pernarkse 15 ft sartita-ry s;pwe-(, easement: c)ri east siide of Int Owrier: FEES ('.-;ARY SIEG type anlot.trit by date f, c,r)t: 1.0435 SW NORTH DAKOTA 13T 03 V,R M T $ 1.250. 00 INSr) $ 35. 00 TIGARD OR 97223 F.,A Y M $ 1285. 00 JLH 03/16/90 Hiorie it: 681-7300 Cc)iity,actar.- OWNER/CONT RACT OR 1.285.00 TOTAL M41"Ir R REQUIRE,I) TNI-3VILCTIONS This Applicant agrees to comoly with all the rules and regulations Sewer Inspecti(iii ............................. 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 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 locrted, the installer shall purchase a "Tap and Side Sewer" Permit and the Ajetlgy will install a lateral. ........ .................. ............ ......... .............................. 1 3 s u P d V! ............... ............ Ca-11 fci-r Inspectiori 639--4175 Cj l' OF T I GAR'D - RECE I F'T OF PAYMENT RK NO I 0010"?BE+8 CHECK. AMOUNT : 3'1Ow".f`3;_ NAP IE 1 JUI_I E 5 I EG C.:ASH AMOUNT : .CIO iiDDRESS1 10455 SW PI. Or"Ak OTA #3 PAYMENT DATE 1 03-•16--911 T I oARC!, OR =7"':'' &LOCI'-NO!A17DRe 4 1167`,'! 5W TEPPAI:E TF4, PURP0SE OF PAYMENT AMOUNT PAID PURPOSE Or PAYMENT _---- AMOUNT-f•olb 61J I L O I NG PERMIT (90-0085r r ---,_412.00 PLUMPING-PERMIT 162.`,U P'IECHAP111;AL PERMIT 5T'A1'L BUILD PERMIT TAx i`y'1.) T•(J.57, '•'LAI,l CHECIt FEE 116.80 SEWER USA (950-00fi') 1,250.00 .AEWFF INSPECION 'a.00 GTPFE;T '501 600.00 F- w:l:5 SYSTEM DEVELOPMENT FH 250,00 5T ORM DRAIN SVC 250.00 j .I I t tl TOTAL. AIiOI NJ' PMC) P � CRY OF T167ARDanoFncaIw Pt.AN piLCK APPLICATION COMMUNITY DEVELOPMENT DEPARTMEN/�, / PLAN CHECK N ��: 13125 S.W.1/41&•d-P.O.80K 23397,Tigard•Oregon 9rM.(W!)W941PERMI T N M DATE ISSUED _ -4 JOB ADDRESS: /I G 7 5 S w TC,E'RACE 7,iC4 i[ S D/c_ TAX MAP/LOT 1-�/-3 SUB: _ LOT: LAND USL: ^ VAI_UAfION: _. OWNER SPECIAL NOTES NAME: �_� reg ���[�_ q, Si a cy - REISSUE OF: ADDRESS: _(O yS� S c.i No�tti /��i��7Ya `* 3 LAST REISSUE: FLOOD PLAIN/ SENSITIVE LAND: PHONE: r�39-/2 2s fzr._, �9-/ " 730 ,t �/G 3 w� _ APPROVALS REQUIRED CONTRACTOR PLANNING: , NAME: _ S L C F �r 4n� w/f� fLt, r /l�'�'w J' ') ENGINEERING: ADDRESS: FIRE DEPT OTHER: PHONE: ITFMS REQUIRED RUILDERS BOARD N: EXP DATE: _ LIST/SUBCONTRACTORS: ^ BUS TAX: _ nl>CN/ENGINEER CALCULATIONS: NAME: ".4 Cox[) e/2 vpjCi,f7"Sk- TRUSS DETAILS: ADDRESS: _ OT1iER: PHONE.: COMMENTS: — SUBCONTRACTOPS: PLUMB: Sr`C/_ MECH:x PERMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. bUE /rL2j Qu•1,'0 f 5 10-432 00 Building Permit Fees /1 10-431 00 Plumbing Permit Fees /G2,5o 10-431 01 Mechanical Permit Fees 10-230 01 State Building Tax (5%) 3U S3 j 5-.3 Building Plumbi:ig Mech / . Y'V � 10-433 00 Plans Check Fee Building .;1 ev v _ Plumbing Mech 2 y-Li «A y�J,3 30-202 00 Sewer Connection / 2 SV 30-444 00 Sewer Inspection 51--448 QO '>treet System Dew Charge (SDC) 52-449 00 Parks System Dew Charge (PDC) - 2 ju _ S 31-450 00 Storm Drainage Syst Dew Chrg (SSDC) 10-230 06 Fire TOTAL j Off. REC N APPLICANT SIGNATURE Received By: _ - ---- Date Received. -- -__ cn/3587P/18P y » niNGll RO�iON CONTR )i, INF RMA'1'1 GENERAL CONTRACTOR NAME&c ADDRESS: ( CASEFILE NO..`__ PERMIT NO.: _ - APPLICANT NAME AND ADDRESS: EXCAVATION CONTRACTOR NAME&ADDRESS: OWNER NAME AND ADDRESS: TELEPHONE NUMBERS: APPLICANT' c: 3 z 5 �� w�'' ,;c'c x ��: k PROPERTY DESCRIPTION: OWNER .,> '�•- e _ STREET ADDRESS AND CROSS STREET/IACATED GENERAL CONTRACTOR: H(r r riv nn i 1•'. EXCAVATION CONTRACIOR:' c , ss ins f� T��r tiK_ — SITE/JOB: ___ _ LEGAL.DESCRIPTION: 24 HR/AFTER FOURS EMERGENCY TAX LOI'NO.: CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTIONS _ SITE SIZE,ACRES: DISTURBED/WORK AREA,ACRES: LOCATION& ADDRESS WHERE SPOILS LEAVING SITE AR1.L BE TAKEN SITE kUNOFF DRAINS TO:(CIRCLE ONE) (NOTE:PERMITS MAY BE REQUIRED) t. CATCHBASINDITCH PIPE CREEK (CIRCLE ONE),PRIVATE PROPERTY PUBLIC RIGHT OF WAY ERASION/SEDIMENTATIQNCONTFZ�_(,ESC)MEASURES MINIMUM ESC REQUIREMENTS MINIMUM ESC REQUIREMENTS DURING CONSTRUCTION: FOLLOWING CONSTRUCTION: SEDII mwATION FACILITIES STABILIZE EXPOSED SURFACE. STABI"IZED CONSTRUCTION ENTRANCE REMOVE AND RESTORE TEMPORARY FSC PERIMETER RUNOFF CONTROL FACILITIES CLEARING AND GRADING RESTRICTIONS CLEAN AND REMOVE ALL SILT AND DEBRIS COVER PRACT'ICE'S ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OTHER _„_.. OTHER PIAN FOR EROSION CONTROL PREPARED AND SUBMTITED 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 NOTES. I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAINTAIN E.SC MEASURES AS NECESSARY TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE. OWNERAGNATURF APPLICANT SIGNATURE OFFICIAL USE ONLY. RECEIPT DATE ACCEPTED FEE NUMBER_ - RECEIVED BY Permit No: — /�: Address: --- --- ---- -------- -- (N '• .�z Issued by:_ Date:____ ____ — - STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued. Licensed Architect and Engineer applicants, exempt from registration under CRS 701.010(7), need not submit this staternent. This statement will be filed with the permit. Fill in the applicable blanks, and initial box 1 and either box 2A or 2B: 1. I own, reside in, or will reside in the completed structure. — - M , contractor is 2. A. C._J y general -_- - , Contractor registration number I will instruct my general contractor that all subcontractors who work on the structure must be registered vvith the Construction Contractors Board. OR B. EZ"": I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor. I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. Signature of Permit Applicant Date CONSTRUCTION CONTRACTORS BOARD 0244J 10124189 WHITE COPY T-O ISSUING AGENCY PERMIT FILE PINK COPY TO APPLICANT r, F I I1` CITY OF TIGARD - RECEIPT OF P'AY'MENT RCC NOt 00107507 GHECv. ACIOUN T : 100.00 �Ji+MF: GARY SIEG CASH AMOUNT : .00 I fA'lVP':SS.- 10455 5W NORTH D40TA 11' FAYMENf DATE 02--27.-Q0 TIGARD, OR 97/22" BLOCK NO/ADDPt 116771 GW TEPRACE TRAILS (t PURPOSE OF: 'PAYMENT AMOUNT PAID PORPOISE OF PAYMENT AMOUNT F'44)11 FLAN CNEC.k FEE (2-64Pi) �--~`I00,.(jp k J' 1 I 1� 1 I I jmi:,L AMOUNT F;4if? I i �