8261 SW LANGTREE STREET-1 9261 SW [engtree
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INffl_"X ION NOTICE•
City of Tiga d Building+ Department
13125 SW Rall Blvd. Tier i, Orogon 977.23
Inspection Line (Rec-O-Phone): 639- 15 Business Phone: 639-4171
Inspections
Footing Plbg. Undoab sch. Kuvgh-i,1 CArpr/sdwl�,
'
Found. r1b9. Top Out Gan Line FINAL:
Post/Beam 9truct. San. !lower Framing -Bldg.
rust/Beam Hoch. Rain Drain :neulat•lon -Plumb.
Plt7. Underfloor Nater Lino Gyp. Bo Meeh.
Da .e Requested: _ s�- -----Time: �• AM PM
Permit 1:
�lddre�ie• I�--- -
/ r
BuiLler:
TRE FOLI.OMINO OORRRCTIONtt ARA REQUIRED:
L1 _Hot G2 � c S/e
Inspector: , 'J ` Date: Y L9
APPROVED DISAPPROVEO APPROVED SUBJECT To ABOVE
Call For Relnep.
CERTIFICATE OF
CITYOFTIGARD OCCUPANCY
COMMUNITY DEVELOPMENT DFPARTMENT CnYOFT4FARD I Pi--RMIT #. . . . . . . MF3T9@--0)08
i
13126 SW Hell Blvd, P.O.Box 23307,Tigard,Oregon 9WpW)0*4175 17
PAT-F !S89WE-19v 09�ylei?Y'91
I L A E)b R L Sbi. . . 1 8261 !-)W LANGTRE'E ST PAPCEL., 2S112CC--Ii000
ULAD I V 1 111014 LANu'rREE ESTATES ZONING% R-12
LOT. . . . . . . . . . . . . v42
(,LASS OF WORK. -NEW
FYPE OF' USE. . . g SF
OCCUPANCY GRP. cR3
OCCUPANCY LOAD I 220 4
W-INT NAME. . .
FITAN PROPERTIES
PO B')X C-635
t)LOHA ()R 97007
i"honp #x A455477
FITAN PROPS PTTES
�-40)14A OR 97007
1-111 viv 0: 6456477
14eq #.. . : 30556
fAceupallc:y of the ek,uyp rinfecenvpd building tv hereby given, and certifies
010 COMPIlanve with the State Of Oregon Specialty Codes fOt- the! grOtAp,
'Iccuponcy, and use -m0er which the re-fprenrerl pprmit was isnued.
FIRE OEE''AR"(ME N7 DU 11.1)1 NG INSPC�CTOR
POS)l IN CONSPICUOUG PLACE
T,��rrcrxc�_Ncrr;c�
City of '.igar:1 Building Department
13125 811 Bill Cad. Tigard, Oregon 97223
Inspection Lina (Rec-O-Phu e)s 639-41,75 Business Phone: 639-4171
Inspections __ ---
Footing Flbg. nderslab Mech. Rough--1,n Appr/Sdwlk
Pound. P1 9. Top Out Gas Line FINALI
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mach. Rain Drain Inau!ation
Plb. derfloor Water Lino Gyp. Bd
Date , quested: _� _.�—__Time: _ AMPM
! __i,�_. Permit I:1�1�/(�
Address:
Builders 7" ---
THE FOLLOWING C-ORREcTjoNs An REQUIRED:
17
.._.._._ _____-__- _
Inspector.s • --- ---_. Date. 7
APPROVED __ DISAPPROVED - — APPROVED SUBJECT TO ABOVE
Call For Rsinsp.
w w air w � nr ew w
�sPa�.�NOTzc
City of Tigard Building Department 1
13125 B1i Hell Bled. Tigard, Oregon 97223 1
Inspection Line (Ree-O-Phone)s 639-41.75 Business Phone: 6:9-41 I
iapact ion:___...
Rooting Plbg. Underelab Hoch. Rough-in �Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Ream Mach. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Rd. -Hoch.
Dnt, Req,:eated: r I Time: t PM
►.�•ireaa:_� i, _ ____ permit /j:
Buil.der:
THE FOLLOWING C,ORRECTTONS ARF REQUIRED:
44
Inspectors � � �.- / • � - Data: ` __ ` / �•�
APPROVED DISAPPROVED APPROVFD SUBJECT TO ABOVE
For Rainup.
::el ms mw mw ■a �. ew s m�1
��t9PRTTION NOTICE
City of Tigard Building Department
13125 871 Hall Blvd. Tigard,, Oregon 97223
Inspection Line (Rec-O-Phone': 639-4175 Business Phone: 639-4171
nepection:__— _---- ---
Footing Plbg. Underslab Mech. Rough-in 4ppr/Sdwlk
Found. Plbg. Top Out Can Line t":NAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Innvalation -Plumb.
Plbg. Underfloor Nater Line .yp. Rd. -Mach.
Date R//eqi:ested: C� / Time: -----AM QPM
71di�ress: cx Permit
Builder:_ '
THE FOLLOWING OORRErCIONS ARE REQUIRED:
Inspector: Dater-i�
VRROVF.D __ DISAPPROVED APPROVED SUBJECT TO ABOVE
:all For Reinsp.
a r swr +.r � sr sa v sda
ASPECT K NOTICE rj.
city of Tigard Building Der -tesent
13125 BN Ball Blvd. Tigard, Oregon 971 : (-..�
Irepecti.on Line (Rec-O!Phone): 639-4175 Bceineeb Phono: 63 -4173
Inspections__
Footing Lbg. Underalab Moc•h. Rough--in ]kppr/So.:lk
Found. Plbg. Top Out Cas Line FINAL:
Poet/Ream St"ct. San. Sewer Framing -Bldg.
Post/Beam Koch. Rain Drain Ineulnt�on -Plumb.
Plbq. Underfloor Nater Lire Gyp. Rd. -Koch.
Date Regvinsted:_ -45 �'r-0 I ----`Times _ AK
Address:_ e ,, e7Z Permit
Builder:
THE FOLLOWING CORRECTIONS ARK REQUIRF.Dz
Ole
1 n s pN,•t r: C.. /�"��. !ate-
-- Date:
APPROVED DISAPPROVED _ APPROVED SjjR.1RCT TO ARM
Call For Reinep.
a aONai a a w eFaMUMM MM
INSPECPIQiI_h'�CE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, orogon 97223
In9pection Line (Rec--O-Phone): 639-4175 Y Business Phone:`
Inspection:_
F
Footing Plb7. Underslab Mach. Rough-in ApFr/Bdwlk
Found. Top Out hoar Lina F1NRL:
Poet/Beam struct. o �` Fraaling -Bldg.
Post/Ream Mech. Rain Drain I�naulatlon -Plumb.
Plbg. Underfloor Mater Line Gyp. Bd. -Mach.
• _,_ _
Date Requested: T AM PM
Address:_ P
Builder:
.HE FOLLOWING CORRECTIONS APE REQUIRED:
Inspoctore `., _ Date:
_4&-_APPROVP.D DISAPPROVED APPROVED SUBJECT TO ASOM
_Call For Reinap.
w• +� aBI as rwr a� �► �
j,�l¢���q�1_NOTICE
City of Tigard Building Department
131
25 SU Ball Bled. Tigard, Oregon 97223
Inspection Line (Rec--O-Phone: 639-4375 Business Phcne: 639-4171
Inspection:
Footing Plbg, Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL:
Post/Roam Struct. San. Sower d Frtrning„� -Bldg.
Poet/Ream Mach. Rain Drain insulation -Plumb.
Plbq. Underfloor Water Line Gyp. ad. -Meeh.
Data Raquanted:-_ _ Time: AM PM
Address:_ ��/ �� Permit 1:.qz) -C)fC),i-
Builders-
THE FOLLOWING CORRECTIONS AREREQUIRED:
I
Inopectors
- Data: ./ Y
APPROVED _A DISAPPROVED hPPROVED SUBJECT TO ABOVE
Call For Reinsp.
ew � s� a� eat ear as
INSPEcTION_NOTICE /
City of. Tigard Building Department
131.25 Sit B&II Blvd. Tigard, Oreqon 97723 �
Inspection lA ne (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbq. Underelab Mach. Rough-in Appr/Sdwlk
i
Found. P1 ._Top Otlt Can Line FINALS
Poet./Roam St:ruct. Ban. Sewer Framing -Bldg.
Poet/Ream Mach. Rain Draia Insulation _Plua.�).
Plbg. Underfloor Nater .Line Gyp. Bd. -Mech.
Date Requested: / _—Time� AN _ PM
Address: ..,;) Permit #I Q�a
Builder: _
TMit FOLLOWING CORRECTIONS ARE REQUIRED:
-- -MOO wj1q Z< TSS T (1'.14--1 TV 5)a'/J"7 _
Inapector: �.� Dates 7
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
XNS 39T'ION�IOTICE /
City of Tigard Building Department ��
13125 Sw Hall Blvd. Tigard, Oregon 97223 /Inspection Line Line (Rec-O-Phone)t 639-4175 Business Phon i 39-4171
Inspections_ r
Footing Plbg. Underslabech. Rough-in Pppr/Sdwlk
Found. Plbg. Top Out ai LLT. FINALt
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Hoch. Rain Crain Insulation -Plumb.
Plbg. Underfloor Water Line�> Gyp. Bd. -Mach.
Date RequOLLed t_ -7 -� / Time: _k __.AX _r _(_PH
Addresst� !J i2(� Permit /t9y _1�__!
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector.t--
1
APPROVED -- DISAPPROVED APP'VWF..D SUBJECT TO ABM
Call l,ar Reinsp.
INSPECTION NOTICE
City of Tigard Building Departmer)e,
P.O. Box 23397 1-,'
Tigard, Oregon 97221
Phone: 639-4175
? 1�
Type of Inspection j A� 57 46—� –
Date Requested Time P.M.
Address Permit
Owner Lot
Builder
The follo,ving Building Code deficien4s are required to be corrected:
o U7
Presented to J4>rt}lproved
Inspector Di-approved
Date
CALL FOR REINSPECTION
L] YES FA NO
moilM
d Building
NOTICE
City of Tigard Department 1.
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Roc-O-Phony.,: 639-4175 Bus3nede Phone: 6 9-4171
Inspection:---.—_.� -- ------- --------------
Foot i:Ig Plbg. Ondazslah Mech. Rough-in Appr/Sdwlk
Foun.. Mg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Saw Framing -Bldc
Pnst/Bean Hoch. n ain Insulation -Plumb.
Ilbg. Underfloor we or Line Gyp. Bd. n/Meeh.
Date Requosted: -` _ _Time:
Address: �_Y o ��jPermit 1:
r,
Bu i bloc!
THE FOI.I.OWING CORRECTIONS LRE REQUIRED:
Tnspector: Dater
APPROVED DISAPPROVED _J APPROVED SUBJECT TO ABOVE
c�7
Call For Roinep.
lNSPSCTIGN_N(YPICE
CL.ty of Tigard Building Departaant
13125 an Ball Blvd. Tigard, Oregon 972231
Inspection Line ,nec-0-Phone): 639-4175 Busiiess Phone: 639-4171
Inspect ion s -- ----- ---— -------
looting 1 Plhg. Undarelah Mach. Rough-in Appr/Sdwlk
(Found�/ Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
P..st/Baam Mach. Rain Drain Lssulation -Plumb.
Plbg. Underfloor water Line Gyp. Bd. -Much.
Date Requesteds_ //` _-__-.Time: (�=AM rN
Addreses Parm lt
euildor: �-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
F
Vf
d
is
Inspectorsy_ ,� Dates" -�
�__APPROV=l) DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Rainep.
MASTER F-Lklylli'
CIIY®F TIGA RD PERMIT It. .. . .. . -- 111'.`3 1".-41 P IPA
WYOFTW
COMMUNITY DEVELOPMENT DEPARTMENT OR""
13125 SW Hall Blvd. P.O.Box 23397,71gaM,Oregon 97223(6031839411715 DATE ISSUED: 1.1/19/90
SW 1-fir '' IRLLH, 311 r,ARCEL: i,*!G11A.?L:(.1 - il("'
I..-ANG I R E E Z011II N6 r
L C)T
BUILDING
6)1,-*L,L.I N G IJ N I TS . 13 BASE 11 F -.0 3 Sf
N I%W BEDIRMS-3 PATHS)19 GOROGE. . .. . . . . . . . :530 5 Sf
FLOOR REQUIRED SF*TB0GKS----............--—--'-'-
F1 R F3 T „ . :70 IF. etf L E F*T. . z',5 2 ft 8:1131-17 :03 ft
98 S)" FR C.)N T . 1-3 Y ft REAR., W-) f t
THIRD. .. ., :0 1.f, ,f R E.0 U I R E D ..............
f t: T010 I ------ :48 :s f siioy,,r:- DE rc-J.TORS..
- 4(A f 9ALUPH". $ 7,570 PPRKING SPACES—
PLUMPING
P F 1.1)0 R DRAINS. . .. .0 RACK, -L(]W PRE:-VNTIRS.
.1
WAIJ -1E.11TERS.. . . I
L(WhIDIRY TRAYS. . 0 CATCH BASINS.
:J, 'iEWER L I NE (f 00 GREASE TRAPS. . . . . . .. :
-I X It.)F
W A Y'I!:.P L. I NF: (f t 0 0 0TH 7 R V F :fa., . ., 0
NI [*-;AIN DRAIN (ft) . : :10
:W F
3 �ATN DRAINS-
0 1111 Cl f.)L FEES
- UNIT HIRS.. . :0 type Anirjunt Liv d iA t-e pt;
PAYM $ 40.00 J L H 0.3 1.2 90 10777 C,
(.1 VI-:NT' F A 14 F,. . 0:1. PF`RT + 361. 00
HOODS. . . . . . .0 F(VILC, $ 40. Plo
WOODS T(WL'S. B51"Ic It 1.8. 0 r.,j
:LCI DRYERS. : I STDC $ 600. 00
C)IHER UNITS-. 1 >S D I" $ 21150. 00
GAS OLM-E1993 PARK 14 P-50. 00
......... 11 FIR T 1; 131.9.00
11 P L C $ 9. 7`3
PPR $ 132. 50
PAYI :1
0
1 F2 5 0 JL.H 06/28/90
PAYM 1/41.8. 88 JL..H 11./19!1.3R
1.708. 88 TOTAL
subject to the regulations contained in the REOUTRED ThI9!-IECJI0hIS
Mats of Ore. Specialty Codes and all other Fc)ot/f0Ltnd Insp PlII-11111111 TOP CWt
as All WorF kill be done in accordance with approved Wt-r Proc.)f ing llisni F ri ni j n q I n S D
:,P,mit will evvire if work is not started within 160 PI0Si;/B(-"kft1 I'I-is P F: i-r It,p:L a(:�(- T n s p
worl, is 5 fl, more th� 180 daY3 C-NAW1. Drain GAS Linf- Insri
r-11.ni/(.ind!-,1,ib Inisp lnsul.atior) 11-jrp
L,v_14___
P L.M/0 n d e r f I e c)r G y p P(.),A,r(I T n
U n
F:tnq V-rAin Prml t Rain cirain Ii-isp
...... ....... ...................... IlccAianirc%l Tnsp Water I-ine Intip
C:al *l. for ins pec tion -- 639-41. M
IN
m M�w -ALM-=
PLUMBINU PERMIT
C'TYOFTIGrARD mpo PERMIT N. . . . . . . : M ST9 00 10 1.1
cm
COMMUNITY DEVELOPMENT DEPARTMENT 01000N DAT11- ISSUrD: 11/19/90
13125 SW HWI Bbd. P.O.Box 23397,TWiud.OreWi 97223(603)8394176
SiTE AN)RI-11. . . 00. S I I T T -ITU
U 9 0
SUDDIVISION. . . . ZONTNGs
n
BLOCK. . . . . . . . . . .I .. . . . . . . . . . . . . a42
CLASS OF WOkK. . vNEW GARBAGE DISPOSAL5. . 10
TYPE OF USE.. . . . ISF WASHING MACH. . . . . . . I BACKFLOW PREVHIRS. . '.
OCCUPANCY ORP, . 1R3 FLOOR DRAINS. . . . . . . 10 TRAPS. . . . . . . . . . . . . . I
STORIES. . . . . . . . 12 WATER HEATERS. . . . . . 11 C A T CH HA' INS. . . . . . . I
F I XT U R E 8--- LAUNDRY TRAYS. . . . . . 10 3F RAIN DRAINS. . . .. . 9
SINKS. . . . . . . . . . :2 GREASE TRAPS. . . .
LAVOTORIES. . . . . :31 OTHER F1XTLJ1-'kES. 90
1*UB/SH0WERS. . . . I SEWER LINE (ft) . . . . 100
WATER CLOSETS. . s@ WATER LINE ( ft) . . . . :0 0
DISHWASHERS. . . . NIB RAIN DRAIN ( ft) . . . . c 10
Remarks I
OWNER i ['L E 5
'TITAN PROPERTIES I'll AY M $ 40.00 J 1 11 03/12/90 107776
PO BOX 6835 PPR 1 $
U I N.,C T, 40. OF)
Al 0HA Ok 9,7007 B5P(, $ 1
Phone Oc x,45!.5411 S T 1)cl, 600. 00
9SDU 11 250. 00
tore-----__...___.__.._._._.
PIUMbil-Ig ContraPARK $ 2510. 00
11PR 1 $ 39. 00
Names Smr-1 c 9. 7'SP1 5 P E, $ I
Addr e I
State PPR 1 1..�2. `.:;0
city.. -,—X
I p 1
_7
Reg oil . . . AdditiojiAl fees viot shown hpre. . .
PFUUIRED INSPECTIONS
This permit isiSSUpd subject tC) the raq
ulations contained in the Tigard ftrliCitlal F00t/fOUIIH Insp TT1%Ul0kti01_1 1115p
'A Wtr Proofiiiq Psm Oyp Board CuspCv.)de, State of Ofe. SperialtY CC)des and all
other applicAblo? laws. All work will be done Post/Beam Insp Rain drain Insp
in arcordance with appf-c)ved plans. This Crawl Drain Water Line Insp
permit will eXpiTe If W014', is not started VIlm/Lividsli-0 Insp oppr/Sdw1k. 1119r)
within 180 days of issk-kallce, or if work is P L M/U n d e r f I c)c)r MeChA)1iC-,1kl. Vinal.
r4uspevidpd fol, moyrp than IAH days. F*tj-jq Dr.R.JI-1 psmvt 1.1lumh Final
Mechanical Insp Puildiiig Final
Pli.imb Top Ot.tt Erosion Control
F* f'An1i.11q 11-ISP Wtr Proofing Beam
Vireplare 11.1sp P I m/Under f I nor
LILL Gas Livie Insp Add t t i onal.. . . . . .
t b o ttb Plumbing Contractor SignatLIVP
Call for inspec-f-.1ren 639-4175
1.cmtractAbr Notes i ...... —-------
CITY OF TIGARD — RECEIPT 011' PAYML:NT RECO I PT NO. r 91.1-206955
CHECK AMOUNT
TITAN PROPr-*.i0'IE5 CASH AMOUNT'
ADDRESS PAYMENT DATE
ALOHA. OR SUDD I V I S I ON
6261 GW LANGTREE
PURPOSE OF PAYMENT AMOUNT PAID PLlRPO7%E OF PAYMENT AMOUNT PAID
RLifT674(53PERM M5T9(p--01t,*s6_161_,()o
..umr,lNG` PFRM 132.5()
M('1-HANICAL PE 39.(10 ST. BUILL) rEr 26.63,
PLAN CHEC ',' FE 9. 75 STREET SDC 600.010
PARle,S SDG 250.00
rflTAL AMOUNT PAID
M PINK
SEWER CUNNECI'ION
1 11,
CI7YOFTIGARD DA 1. 1 J�1
l:
. .. . . . .. . 4 SWR90-0117
COMMUNrTY DEVELOPMENT DEPARTMENT MOM 0 01 08
SW LANGTRE4VI76 1) T E :I S S U L D.1"
13126 SW Heil Blvd. P.O.BOX 23397-TQwd,OW-
ST
ZON'ING:
1. E
SUkiDIVISION. I ANG'I'REL -42
Fil—OCK. . . . . . . .. LOT. .. . . . . . . . . . . . .
T'ENAN'T NAME. . . . . =
. . . . . . . . . . .41695
DWELLING UNI-T-S.
Cl.jjl.t; OF' WORK. . . :NEW
NO. OF' PU1.1 D1N6S"- I
J Y P E: OF USE. . . . . :SF SURF
DUSWR
e
FEES
type amc)uilt by date
1.1011 PROPERTIES) P.RM*I* :1,2 5 0.0 1,)
f:,o DOX 6835 5
0 0
f)I OJA() OR 9-7007
F,I.,(-
.)vie 0: 6455477
k'1c)j%jj'R0)CTOR NOT ON FILE
$ 12C'5.00 TOTAL
R 1:1 F.F.:.QU.TRLD INSPECTIONS
This Applicant agrees to —jm�ly with all the rules and regulations Sewer Jvispectic)rl
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 sever 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 PUTChaSe .........
a "Tap and Eide Sewer" Permit and the Agency will install a lateral. __.•__.
.......... ............ -----------
............
.............. ..
............. .................
Dy- ..................... .................. __._._.__._._.._._...»................._.._._._.
4i.75
CITYOFT167AFO
0 PLAN CHECK APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT (741% PLAN CHECK N 9 -,-3�/O-
13125 S W.Hall Blvd-P O,Boa 2 on 97,Tigard,Oreg972233,(SM)6;19-0175 1r
PERMIT # S p-
�, _��/o
(.V(,U DATE ISSUED
/,JOB t ItL:SS: L. � _�1 !� TAX MAP/LOT X51- /ol'�'L' l/UCSU
`;118: �A„Q X1..01 : - LAND USE: _
�VAL.UA(ION: _h, "70
OWNER ( - -_- SPEC AL NOTES (4
NAME: _ _ -�_-� _ REISSUE OF: U-UU 0 Ly
ADDRESS: ( _ _ C71, LAST REISSUE: _.
FLOOD PLAIN/
_ _ 0 SENSJIIVL LAND:
PI IONF _��¢1 D
APPROVALS REQUIRED
CONTRACTOR PLANNING:
NAME: ENGINEERING:
ADDRESS: _ U IRE DEPT
OTHER:
PHONE: J-uy - ITEMS REQUIRED
BUILDERS BOARD N: _ _- EXP DATE: _ LIST/SUBCOhTRACT'ORS:
BUS TAX:
ARCII/ENGINEER CALCULATIONS:
NAME : _. _ TRUSS DETAILS: _
ADDRESS: _ OTHER:
PHONE:
COMMENTS:
SUBCONTRACTORS: PLUMB: - � - MECH:
PL_RMIT N ACCT N DESCRIPTION AMOUNT AMOUNT PD. DAL. DUE
e N, 11 yc'_cVuy 10-432 (10 Building Permit Fees J(o/ .j / ,
.0-431 00 Plumbing Permit Fees /.42- o
10- 431 01 Mechanical Permit Fees 39 _
10-230 01 State Building Tax (5%)
Building off. u y
Plumbing
Mech
1U-433 00 Plans Check Fee 'S L�
Building
Plumbing
Mech
30-202 00 Sewer C%,nnec t i on (J
30-444 00 Sewer Ir.spectian
li!-448 00 Street System Dev Charge (SDC) _ L►_ V'
4--449 00 Parks System Dev Charge (PDC) _
j1-450 00 Storm Drainage Syst Dev Chrg (SSDC)
1:1--230 06 Fire
TOTAL L
l RE M
APP TCAN SIGNATURE lqly
Receivpd By: _ Date Received:
cn/3587P/18P / ""'
; VIN(;IENOSION CON'1'kQI, INFORMATION
GENERAL.CONTRACTOR NAME& ADDRESS: CASEFILE NO.:
PERMIT NO.:
A h,--fAPPLICANT NAME AND ADDRESS:
EXCAVATIONCONFRACFOR riTan1 r L,,r
NAME& ADDRESS: p Q'' Qux
_. _. OWNER NAME AND ADDRESS:
ITLEPHONE NU ABERS:
APPLICANT: L N PROPERTY DESCRIP'T10N:
OWNER;_ 1 1' STREET ADDRESS AND C SS STREET CATED
GIiNIRAI.CONTRACTOR: r •; I
EXCAVATIONCONTRACTOR:
f, 1-.��;
LEGAL DESCRIPTION:
24 HR/AF fL'R HOURS EMERGENCY TAX LOT NO.:
('O j-AC'PERSON,' '1"fLl:,'1'ELEI11 ION E: 1/4 SECTION:
SITE SIZE.ACRESL_
------- DISTURBL•D/WORK AREA,ACRES:
I OCATION&ADDRESS WIIERE SPOILS
LEAVING SITE WILL BE TAKEN SITE
I_B_VNOFF DRAINS TO:(CIRCLE ONE)
(NOl E I'l-RMI'lS MAY HE RE-QUIRIA)) (CATCI•_ II-BASIN DITCH PIPE CREEK
(CIRCLE ONE) PRjVATE PROPERTY
(—PUIl'RIGH 1 OF WAY
FRQSION/SEDIMENTATION CONTROL. (ESCI MEASURES
MINIMUM I:SC REQUIREMENTS MINIMUM ESC REQUIREMENTS
[WRING CONSTRIIC-11ON: FOLI OWING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STARR]ZED CONSTRU('CION EN'IRANCE REMOVE AND RESTORE TEMPORARY ESC
PERIMI'.'II?R RUNOFF C'ON'I k()I, FACILITIES
CLEARING AND GRADING k1 STRICIIONS CLEAN AND REMOVE ALL SILT AND DEBRIS
COVER PRACTICES ENSURE OPERATION OF PERMANT FACILITIES
CONST'RUCT'ION SEQUENCE OTHER
OTT II:R
PLAN FOR ER(,SIGN CONTROL PREPARED AND S(JBA1TTTED 1N ACCORDANCE WITH'TECHNICAL GUIDANCE HANDBOOK`.
EROSION CONTR')l.PIAN DRAWING AS RLQIIIRED.IIAS PLAN CONSTRUCTION NOTES COMPLETE.INCLUDING EMERGENCY
Pl1ONE NUMPER, SCIIP:Dl11.FJSTt.GING FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASORES,AND
APPI.ICABLE STANDARD NOTES.
I IIAVE READ AND WILL.COMPLY WTI-H THE ABOVE AND WILL CONSTRUCT AND MAINTAIN ESC MEASURES AS NECESSARY
TO CONTAIN SEDIMENT ON THE CONSTRUCTION SITE.
OWNERS AT'IIRF. APPLI A 'NATURE
OITICIAI,USE ONLY,
RECEIPT DATE ACCEPTED
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