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9403 SW 74TH AVENUE-1 f i I i 9403 SW 74TH AVENUE - CERTIFICATE OF CITYOFTIFARD OCCUPANCY rCMffAO F 7 WA R D COMMUNITY DEVELOPMENT DEPARTMENT onoom I PERMIT #. . . . . . . .. MST90-0a"04 13126 SW Hall Blvd. P.O.B.M97,Tjq&M,Orog.9=16MI obo.41175 D A E 10_;L I F D surr ADDRESS— : 9403 !:)W 74TH AVE PARCEL: 1sI'72rD8-.,I P-20 ':iIJBI)I V 16 1 ON. . . . r PqRTITION PLAT 1990-8 ZONING. SLOCt'. . . . . . . . . . LOT. . . . . . . . . . . . . :3 CLASS OF WORK. :NEW TYPE OF USE. . . s 6F OCCUPANCY GRP, :R3 OCCUPANCY LOAD: 1113 4 TENANT NAME. . . R 0 m fi r k Owner: r-E-*RNW130D DEV. INC 81!50 SW MAV'LELEOF ST PljRTL.PND OR 97223 Phone 01 2'44--1,?33 Contractors FERNWOOD DEVELOPMENT, INC;. 3150 514 MAPLEI-EAF sT 11�10RTI-ANI) OR 970:133 Phone #r E'44-12'33 Reg 4t. . o 49276 0CL.'ktr-'AT)1:'y Of thp at)oVe V-p . fet-enced building is hereby given, and c.,ertifies the c.ompliancq with the St.,,Ato Of Or"Non Gpe(---.jAjty Codes for the group, ()CL.111,ar�C�yj arid use tinder which the referenced permit wml, iosued. FIRE DrPARTMENT SULL.DING INSPECTOR BU . 1 NG 0 IF�iAl_ PO'sf IN CONSPICUOUS P1,q(-E INSPECTION.NOT:CR City of Tigard Building Department 131.25 SN Hall Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 63a-4375 euainees ?hone: 639-4171 Inspection: Footing P1.bg. Underelab Mech. Rough-in Appr/Sdwlk Ft^.nd. Plbg. Top Out Gae Line ANAL: Poet/Beam Struct. San. Sewer Framing -Bldg. Post/Beam Much. Rain Drain Ireulation -plumb. P1bq. Underfloor Water Line Gyp. Bd. -Mach. Datta Roquested: /2' Time: AM X PN 1 7 A!ldroeei 'rte-���F'i�� �.i i 5� Permit #t2-t7 Hnilder: THIS FOLT,OWING CORRECTIONS ARE REQUIREDs i f Date, APPROVED DISAPPROVED APPHOVF:D RUB.1=G'f TO ABOVE call For Rainsp. v �1 OF WM INSPECTION NOTICE City of Tigard Building Department 13125 SA Ball Bled. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 619-4175 Business Phone: 639-4171 i Inspection:_,—_—�—� --------- - ------ Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Llne YINAL: Poet/Beam Struct. San. Sewer Framing iA `\ -Dldq. Post/Beam Mech. Rain Drain Insulation -plumb. Plbg. Underfloor Wa'.e:- Line Gyp. Bd. /-Mach. — Date Requested:. _PH AcSdreset G -7 Permit is Builders ' THE FOLLOWING CORRECTIONS ARE REQUIRED: Mat r CA t.� i Inspector: Date: -- ----- _ APPROVED DIPAP^pnVED _._.._. APPROVED SUBJECT TO ABOVE --call For Reinep. x I' mSPEGTION NOWT-CE City of Tigard Building Departam.t 13.125 Sit Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phones 639 4175 Business Phone: 639-4171 Inspection:_ '— Footing Plbq. Underel.ab Mach. Rough-in Appr/Sdw1k Found. Plbg. Top Out Gas Line FINAL: Poet/Beam Struct. San. Sewer Framing -Bldg. Poet/Beam Mech. Rain Drain Insulation -Plumb. Pibg. Underfloor Water LLae Gyp. Bd. -Mesh. Date Eequesteds_ �1 T(Jyi:es _PM , THE FOLLOWING CORRECTIONS+ ARE REQUIRED: L A. boo za vel f;mrzz1N_ rY ! � /�+I Su M�►r�_, _� k9E'T�I�- �.y��4cTf o.�► �.� Q!'AT�. .t ok✓_L'�L.y7-r17 ,4��. inspectors— i __ Dates-A�[ --�--- PPPROVED <__L 41SAPPROVED APPROVED 9"WNCT TD ABOVN —� `'Z'NT7-For Reinsp. INSPE'T10N NOT7cE City of Tigard Building Department 13125 9W Ball BLE]_ Tigard, Oregon 97223 Inspection Line (Rec-O-Pho : 639-4175 Buniness Phone: 639-4171 IInspection: - _ Footing Plbg. derslab Mech. Rough-in Appr/Sdw1k Found. Plbg. lop Out Gas Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldg. Poet/Beam Mach. Rain Drain Insulati,n -Plumb. Plby. Under.flrjor Nater Line Gyp. Bd. -Koch. Dater Requesttldt �' Timet 1111 PM Address: Permit it Builder: THE FOLLOWING CORRECTIONS ARE REQUIRED, i 1 _ _,� Ca _ Ct• F � II U�SI0 �,15 Wkl� u< 'J1 �✓ln✓.�, 2 J Lo _�- Inspector,, Date:__, APPROVED ISAPPROVED APPROVED SUBJECT TO ABOVE ulI /or Reinsp. IN'�PECT GN NOTIt� �Y•� city of Tigard Buildinq Department 1312S Sit Ball Blvd_ Tigard, ora+gon 97223 Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171. Inspection: _—,— Footing Plbg. Unders].ab Hoch. Rough-in Appr/Sdwlk Found. Plbg. Top out Cas Line FINAL: Poet/Beam Strutt. San. Sewer Framing -Bldg. poet./Beam Koch. Rain Drain Tnsulation -Plumb. Plbg. Underfloor Water Tine Gyp. Bd. -Hoch. Date Requesteds . Time: _--AM PN Address: Z1 Permit Builder.sTHE FOLEAriING CORRECTIONS ARE REQUIR-E,—_D: I , Inepsc:.ors � / �� -------------- Dates .-_�� l APPAOVED OlsAPPROVRD -_ xrrROVF.D SUBJECT TO ABOVE Call For ReinsP. jNSPRCTjO 1MN<YCICE City of Tigard Building Depart- ent 1.3125 Sit Ball Blvd. Tigard, Oregon 97 �. > Inspection Line (Rec--O-Phope): 639-4175 Busineas P s -4171 Inspection: -T_ „ aA� Tooting PI1?j- nderslab Mach. Rgu =in Appr/Sdwlk Found. Plbp. Top Outne FINAL& Poet/Beam Struct. San. Sewer Framing -Bldg. Post/Ream Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line G Gyp. Bd. -Hoch. Date Requested: / rG T.ime: _ A AH __PH Address: '/ Gam' t f/ �-� Permit Builder: THE FOLLOWINS CORRECTIONS ARE REQUIRED: v54fZANCt.:. (,C) 7cy6Z.�/i�CZ- 0 Z AJS ��i fJ fZ.11l /� ►�Z'_ _i:.a c-,r c.T t�l���i S-'-'T"C> -t�c'�i L aj E� --B AiL'l�Lerp E GT � & Inspectors � Oates / ._ APPROVID DISAPPROVED APPROVED SUBJECT TO ABOVE mor MLnsp. INSPECTION NOTYCF / 7_ City -if Tigard Buildia9 DeP.ArtAbent 13125 SN Ball Blvd• Tigard,. ore9on 97223 Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 639-4171 Inspection:_.__— 9 �- -~ Footin Plbq. Under.slab roch. Rough-in Apl)r/Sdwlk P To Out Gas Lino FINAL: Found. Plbq. �) Framing -Bldg. Past/Beam Strutt. ��an. Sewer/ Post/Beam Mech. Rain Drain Inau)ation -Plumb. Plbg Underfloor Nater Line . GYP. Bd. -Mach. Date Pogue ated:_ - l�i'o� Addreset Builder: THE FOLLOWING CORRECTIONS AAS RSQUIRED: —_ oe Datet tnspsctort A_ _ APPROVED DIDAPPROVED APPROVED SUBJECT To ABOVE Call For Reinsp. R INSPECTION NOTICE city of Tigard Bui.tding Department 13125 ON Hall Blvd. Tigard, oregon 97223 Inspection Line (Roc-o-Phone): 639-•4175 Business Phone: 639-41 Inspections ---------- Footing Plbg. Underslab Mech. Rough-in Appr/sdwlk Found. Plbg. Top Out Gas Line FINAL: Poet/Beam Struct. San. Sewer Framing -Bldg. Poet/seam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor "star Lln* Gyp. ed. --Koch. Date Requested: Z3 D �Z a _Timet X_� — PK Address: i��! O S[✓ i Y �� Permit #t 3uilder:— �%Zi�G<..Y�C�y TliE FOLLOWING cORRECPIONS ARE RBQUIREDt Inspector: / Date:_ ��� PROVED 77RAi'PROV1Sb APPROVED SUBJECT TO ABOVE call For Reinap. INSPECTION NOTICE City of 7.igard Buildrig Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection �� — Date Requested ,,,/D s Time A.M. P.M. Address �' G�,2. G/� Permit # — — Owner --____ Lot # Builder �A"azg;�� The following Building Code deficiencies are required to be corrected: Presented to _ -----V l\pprovod Inspector U Disapproved Date _—_ _ ----.--------- CALL FOR REINSPECTION ❑ YE• ❑ NO Willi" INSPECTION NOTICE City of Tigard Building Department P.O Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested l r� Time A.M. P.M. Address 1C 7, '� Permit Owner _ Lot # Builder The following Building Code deficiencies are required to be, corrected: o r' _ _ a I 0 1 i Presented to - -- �_J Approved Inspector C_J Disapproved Date CALL, FOR REINSPECTION YES 11 NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard. Oregon 97223 Phone: 639-4175 ' Type of Inspection " Ly �' '�77 Date Requested L___� �D — Time A.M._._ P.M. ^vI Address y b 3 i — — Permit C-Nner __ Lot # BuilderThe following Building Code deficiencies are required to be corrected: Presented to .' A roved _ _ T I pP _ — Inspector '�" / _� Disapproved Date - CALL FOR REINSPECTION ❑ YEE ❑ NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 l Tigard, Oregon 97223 /1 Phone 663�39-4175 T,pe of Inspection Id .,/,A,1� 'z //�/ Date Requested ���� l!d _ Time A.M. P.M. Address _ /� �/ % r� —_ Permit #�� Owner ^- Lot BuilderThe foilowinq Building Code deficiencies are required to�be corrected: Presented to pproved Inspector Disapproved Date CALL FOR REINSPECTION ❑ YE! ONO CITY O T1GA� MA'a"fE»!� PERMIT CFTIYOFTIWARD F•RIrIIT b. . . . . . . : MST90-••0204 COMMUNITY DEVELOPMENT EEPARTMENT oesoloa PRIM. PERMIT N. : MST90•-0204 13125 SW 14WI Blvd. P.O.Box 23397,Tigsdr Orepor+97223(603)639-4175 DATE ISSUED: 06/26/90 ADDRE.SiS— . :: :)493 SW 741'1-1 AVE. PARCEL: iS125DID -4300 5UBDIVISION. . . . :, BOULEVARD HEIGHTS i ZONING: CAL1)CK. . . . . . . . .. . a LUTYYYY . n . nrn . nn :l8l BU114 14G -� _.._. ...m._.._..._....__r._ _.._..m_.._..m m__._... RE:I:.SUEaMST`0-••0203 DWELLING UNITS: 1 BASEMC'N'T Y . Y Y Y :0 sf CLASS OF WORI`,. :NE::W BEDRMS:.3 BATF(S:2 GARAGE . . . . . . . . . ..400 sf 'T'YPE OF USE. . .. :Sl:: FLOOR REQUIRED TYPE'. OF CONST. :;511 FIRST. . . . : 1620 sf LEFT. . *.28 ft RIGHT. .—J.5 f(: O(.:C'JPANCY GRP. :R:i SE:COND. . . :(d sf FRONT. -2 8 ft REAR. . :2 ft ST C)RIES. . . . . . . rr1. THIRD. . . . : 1620 sf REQUIRFiD_.._._..__.__.....m__.........mm__...._...._... HE::1:GH'T.. . . . . . . . : 18 ft TOTAL._.-.._.-... :0 sf SMOKE. DETECTORS. :Y FLOOR L.OAD. . . . 940 psf VAL.UL. . . . . $: 75240 1JARKIN(i SI!ACE.S. . :O rtryma•rks: m.._.._m._......____..__..___.._..__m._......_.m._ .._._._._.__..__ PLUMBING SINK'S.. . . . . . . . . . 91 FLOOR DRAINS. . . . :0 BA(,K1=LOW PREVNThS:sr. . :0 LAVATORIES. . . . Y :2 WATER HEATERS.. . . : 1 'TRAPS. . . . „ . . . . n n .. , n :0 Tl.1B/SH0WERS. Y . . :2 LAUNDRY TRAYS. . . '0 CATCH WATER CLOSET S. . a c! SEWER LINE. (ft) . :0 GREASE~ TRAPS.. . .r n . . . :0 1)ISI•(WASHE»RS. . . . : 1 WAT•! R LINE:: (ft) ., - 1.00 OTHER FIXTURE»a. . , . . -0 GARBAGE. DISP. . . : 1 RAIN DRAIN (ft) . a0 WASHING MACH. . . 1. Sf:' RAI14 DRAINS. . " J. m.m._...._...m. «.____ .. MECHANICAL.. ._........._..._..._.,._ ._.__.._.._. _ ._..._......_m.mm_...___.... FEES ............._..........._...._ FUEL UNIT HTRS. . :O type amoulIt by date .1,e 13 t; /GAS/ / / VENTS . . . . . :0 PAYM $ 40. 00 JLIA 06/05/90 20:1375 MAX INPUT:A B'T'U VENT FANS. . :3 1:1PRT $ 361. 00 TURN ( LOOK . . : :I. HOODS. . . . . . : L BPLC $ 40. 00 / 1 1=URN ):-1.00K . . :4I W(.ODSTOVES. :0 B5PC $ 18. 0`:, FLOOR F URN. . . . :0 CLE) DRYE»RS. : :t 0PLC $ :15. 00 BOIL/CMF < 31-IE':0 0THE»R UIII T'S-.0 SPDC 4 600. 00 GAS OUTLETS: 1 SSDC $ 250. 00 (')wrier: _.___.._.........._..__.._.._.._...._....._.....____...._._...._.._.__.-__..... PARK $ "-30. 00 1-1.RNWOOD DEV. INC: MPit'T' 16 36. 00 131.";0 SW M0F'1.+'A..E0F ST MPLC 9> `3. 00 Ir15F'C <g 1. 80 i,(JRTLAND OR 9122::3 RT 4 1.1 7 , `O Pi-ic:►r1e N: 244--1233 C'5PI, $ 5. 88 ("'ol-Itrar_tc)r: m......................._.._.............._...._._.....__......_.._.._.......,._. I-$AY11 $ 1664.23 JL.H 06/(26/90 WI4--IAM GODWIN I:A-RNWUOD DEV. LN(.: PO BOX 231207 TIGARD OR 97223-0000 Piic)rie N9 503-•244 123;.3 ReqN. . : 492/6 _m._.._..m_.._.__...m.._.m_..m_..m....._...__..__.__m_...m..___.._... $ 1704. 23 rr)TAL This persit is issued subject to the regulations contained in the -- -- - REOUIRE:D INSPECTIONS - - Tigard Municipal Code, State of Ore. Specialty Codes and all other F:ooi-/found Iiisp Plumb 'rap Out applicable laws. All Mark will be done in accordance with approved W1 P,c) Ming t4sm Framing Insp plans. This pereit will expire if work is not started within 180 r'os,t 'Beam Insp F'irep'lace ir1Gl:1 days of is>uance, or if work is suspended LOT more than 180 days. Cr,+w 1 D•ra i.rl Gas L J.rie 1:11,(1 c'1m/Mids1a.h Ir1sp Irlsulati.orl I1-1::p C'ernlittee± Si.gnatt.l r. `�Jy,�,�( _ ..,,,.� P!mM/(widenfluor• Gyp Bcaard Iy1sp • r trlq Drain Bsmr t Ra:i.1s drain Insp I%s u e d By:: _. ._..-_.m...._._.__...__.__..__..._.......__.-._. M e c h a m ix a 1 I n s p Water L.i n e I n s p La:l .1 for i rlsper-t Curl 639-41i5 SEWER CONNECTION CITYOF ��ERMI•r TIFAPD C1IYOFTg61QW T••-E:RM I T #. . . . . . . » SWR90 0219 COMMUN TY DEVELOPMENT DEPARTMENT ommoa+ FRIM. I:IERMIT 14. . 11,3190 (%204 13125 SW Hall Blvd. 0.0.Box 23397,llpaud,orpon 97,2z DATE ISSUED: 06/2f:,/90 `:)403 t3W 74TH AVE FIARCE;L.: 15125DB 430L� CaUecl)IV].C> fIJI�I. . . . » 140Ul_E:VARD F•IE16FITS ZONING:: BLOCK. . . . . . . . . . .. I O1.. . . . , ., . ,. . , ., . . . 1t3 TENANT NAME:.. UiA NO. . . . , . » . „ - +:luc 7 FIXTURE UNITS. - - -- CLASS OF' WCFiI'.. „ ., HE WTYPIE OF' U DWELLING UNITS. . : 1 c.:r"_. . . ::!. . �F NO. OF BUILD:I:NGS e 1 INSTALL T�C,E. .. „ ,. ,:I:+USWR I MPIE:RV SURFACE. » :S f R a FEES 1=E::RNW0O!? DE:V„ INC type amouilt by date -rec:pt 13:150 15'41 MAF'LE::LE AI" ST f:1RMT s 1250.00 INSF, : 5. 00 V,C)RTI...AWD OR 972 213 1='AY11 1285.00 JLH 06/26/90 I'I-tcxl7e #; 244 12:3;3 (-ca rt t:•r a c::t co•r » ........._. ......._...,__ ,...— _,._ _—._......_. ....._.._ CONTRACTOR NOT U14 FILE: I'1101-1e #a 1.213",. 00 TOTAL -- - REQUIRED INSF'E:C:TION£3 ___..._...._.. This Applicant agrees to comply with all the rules and regulations 1iiwF••r :Trtcypcect1011 of the Unified Sewage Agency. The permit expires 120 days from date issued. The total amount paid will be forfeited 1f the _..........__._. rmit 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 w,___..„.„,_,_____.._..._._ ___ .. _.._,w._..____.._ _. . _____.•_ a "Tap and Side Sewer” Permit and the Agency will install a lateral. „_,__.__,_,_,___•_„_,_.,..___,_...__.._ _.___._�_ _.____.._ .. .. __......_......_._ ..__ w..__._ _... ..__............... __.. _...__ ....._..__._ qt-riit'.t.1VE? : T4;w u e d B Y» ........ .........................I.__._-..____..._...__............_...._..._w. ._ _. __.......__—___....._.._._..._.__....._._ Call fo-r i.rtsper.t:ir.)r1 C,9-4.l'75 "IT,e OF F--'E('—'-ElPT OF PAYMENT RECEIPT NO. o 901-202046 CHECK', AMOUNT a 2949..2- NAME rERI'414001) DEVEA OPMENT CASH AMOUNT ADOPESS PAYMENT DA",E 06126/q, - SUBD 1")I S j ON PORTLAND. OR 972,23— 94C)7- SM 7471-4 AVE PURF:0SE OF PAYMENT AMOUNT PAID PURFOSE 01- PAYMENT AMOUNT PAID II Ftl MS BUILDING P—'E- 7,7. ---iF r 1.Nic; P' M 11 *7.or() MECHANID"l.. F1'�. 36. ST. BUILD PEP 5. FLAN CHU.'Jk FE 4.t)Q SEWER USA 1'250. (H) SEMER I NSPECT Q STPEET SDC ';.A-'Q. ;)0 I PAT;: S 9DC S'Trpm OPAIN Go( '25)'). 6C) 949 '2"A TOIAL AMOUIAT PAID � tition Plat No . THE NORTH ONE-HALF OF LOT 18, TRACT 1 , 'BOULEVARD HEIGHTS' , LOCATED IN THE SOUT14SAST 1/4 OF SECTION 25, TOWNSHIP 1 SOUTH, RANGE 1 WEFT, CITY OF TIGARD, WASHINGTON COUNTY, OREGON. MARCH 14 , 1990 SURVEYOR'S CERTIFICATE I , THOMAS L . AMBERG, BEING FIRST DULY SWORN, HEREBY, DEPOSE AND SAY THAT I HAVE CORRECTLY SURVEY' ' AND MARKED WITH PROPER MONUMENTS, THE LAND REPRESENTu. ON THE ATTACHED MINOR PARTITION MAP, THE BOUNDARIES BEING DESCRIBED AS FOLLOWS: A TRACT OF LAND IN THE SOUTHEAST 1/4 OF SECTION 25, TOW14SHIP 1 SOUTH, RANGE 1 WEST, WILLAMETTE MERIDIAN, CITY OF TIGARD, WASHINGTON COUNTY, OREGON, BEING MORE PARTICULARLY DESC141SED AS FOLLOWS: BEGINNING AT A 3/4 INCH IRON PIPE AT THE NORTHWEST CORNER OF LOT 18, TRACT 1 , 'BOULEVARD HEIGHTS' , AND RUNNING THENCE SOUTH 89" 19'42" EAST ALONG THF NORTH LINE THEREOF, A DISTANCE OF 304.93 FEET TO THE WEST RIGHT-OF-WAY OF S.W. 74T11 AVENUE; THENCE SOUTH 00'33'30" WEST ALONG SAID RIGHT- OF-WAY, A DISTANCE OF 105.91 FEET TO THE SOUTHEAST CORNER OF THE NORTH ONE HALF OF SAID LOT 18; THENCE NORTH 89 19' 19" WEST, ALONG THE SOUTH LINE OF THE NORTH ONE HALF OF SAID LOT 18, A DISTANCE OF 304 .92 FEET TO THE WEST LINE OF SAID LOT 18; THENCE NORTH 00"33' 11 " EAST ALONG SAID WEST LINE 105.88 FEET TO THE POINT OF BEGINNING.* CONTAINING ^ 1413 ACRES, MORE. OR LESS. �FEYCEPT 4 PO(TION DEDICATED FOP RIGHT - 01 Y PURPOSES RECORDED IN DOCUMENT NO. yn-! JL5_2._ 47;,� SUBSCRIBED AND SWORN TO BEFORE ME THIS 1V�� DAY OF."1����___._ 1990. DEDICATION KNOWN ALL PEOPLE BY THESE PRESENTS THAT JERRY E. AND MILDRED RUCKER, ARE THE OWNERS OF THE LAND REPRESENTED ON T14E ANNEXED MAP, AND MORE PARTICULARLY DESCRIBED IN THE ACCOMPANYING SURVEYOR'S CERTIFICATE, AND HAVE CAUSED THE SAME TO BE PARTITIONED AND SURVEYED INTO PARCELS AS SHOWN ON THE ANNEXED MAP THERE ARE 40 WATEP RIGHT APPURTENANT TO THIS PROPERTY. E. RUCKER MILDRED RUCKER *AND DO HEREBY DEDICATE THE EASEMENT AS SHOWN HEREON TO THE PUBLIC. ACKNOWLEDGEMENT STATE OF OREGON SS COUNTY OF WASHINGTON ���� KNOWN A L THESE PEOPLE BY THESE. PRESENTS, ON THIS_.Y�"-DAY. OF__ � _—__1990, BEFORE ME A NOTARY PUBLIC IN AND FOR SAID STATE AND COUNTY, PERSONALLY APPEARED JERRY E. AND MILDRED RUCKER, TO ME KNOWN TO BE THE PERSONS NAMED IN ANO WHO EXECUTED THE SAME FREELY AND VOLUNTARILY. 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DUE yt v 0;104 10-432 00 Building Permit Few 10-431 00 Plumbing Permit Fees 1fl 7�_ T 3 U _ 10-4.31 01 Medlanical Permit Fees 10-230 01 State Building Tax (5t) BuildingT Plumbing ,'5-y � 10-433 00 Plam- check Fee,, ��A 6-� _ Building --/u /• �, Plumbing Mr�d� i"'.c' � ✓ .5 64,/?40 --02'1 30-202 00 Sc%A--r 170nnection 30-444 00 Suer Inspecti.an 51-448 00 Street c)+St M De'v Charge (SDC) y G fl 52--449 00 Parks System Dev Charge (PDC) 4' -2 5 a _31-A50 00 Storm Drainage.'- Syst Uev Chrg (SSDC) &g5 0 30-230 06 Fire _ IWA1. ^ 9 3 w� f A TUCWr STGIIARM :deceived By: --- Date Fteaeived: of/3587P.WPF GRADING/EROSION CONTROL INFORMATION GENECASEFILE NO., RAL CONTRACTOR NAME&ADDRESS: PERMIT NO.: 11 � r J APPLICANT NAME AND ADDRESS: EXCAVATION CONTRACTOR ` NAME&ADDRESS: - SL OWNE l I1A.tiMvtiEl AND �ADDRESS: 1S > _ TELEPHOAt" ERS: DESCRIPTION' APPLICANT: PROPERTY OWNER' Li STREET ADDRESS AND CROSS STREET/LOCATED GENERAL CONTRACTOR: EXCAVATION CO AC'�PR SFTE/JOB_ �'_' LEGAL DESCRIPTION: 24 HR/ATrER HOURS EMER< PNCY TAX LOT NO.: CONTACT PERSON,TITLE,TELEPHONE: 1/4 SECTION' JL-eft ` _ C'r-r ) ,,�f-,c x II v SITE SIZE, ACRES: ,/ -- L,) ern - I ` . — 1 -3 1 _> ,r / -I / 'h k, DISTURBED/WORK AREA,ACRES: LOCATION&ADDRESS WHERE SPOILS LEAVING SITE WILL BE TAKEN SITE RUNOFF DRAIN : (CIRCLE ONE) (NOTE:PEItMrrS MAY RE REQUIRED) CATCH-BASIL DITCH PIPE CREEK C { L r/ t (CIRCLE ONE),jlBLyATEPII:OPERTl' PUBLIC RIGHT OF WAY E?S10N/Sr;QlMENTA•I'IO,N CONTROL (ESC) 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 SIL1'AND DEBRIS COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES CONSTRUCTION SEQUENCE OTHER OTHER _— PLAN FOR EROSION CONTROL PREPARED AND SUFiMITI'ED IN ACCORDANCE WFT'H"TECHNICAL GUIDANCE HANDBOOK". EROSION CONTROL PLAN DRAWING,AS REQ)IIRF.D,HAS PLAN CONSTRUCTION NOTES COMPLETE,INCLUDING EMERGENCY PHONE NUMBER, SCHEDULE/STAGING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND AITLICABLE STANDARD NOTES. I HAVE READ AND WILL COMPLY WITH THE ABOVE AND WILL CONSTRUCT AND MAIM' 1N ESC MEASURES AS NECESSARY TO CONTAIN SEDIMENTON THE CONSTRUCTION STI E. I OWNER S GNATURF APPL.ICA SIGN/ .HRE OFFICIAL USE ONLY RECEIPT DATE ACCEPTED FEE NUMBER RECEIVED _� BY —