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Permit ", ?' MASTER PERMIT CITY OF TIGARD '>it `: COMMUNITY DEVELOPMENT Permit #: MST2010 -00013 T(GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/17/2010 Parcel: 2S112CC22100 Jurisdiction: Tigard Site address: 15723 SW 81ST AVE Subdivision: GAGE FOREST Lot: 28 Project: Gage Forest Project Description: New SFR. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 940 sf Basement: 0 sf Left: 5 Parking Spaces: 2 Height: 25 Bathrooms: 3 Second: 1349 sf Garage: 403 sf Front: 15 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: sf Value: $250,118.78 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 0 Catch Basins: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0 Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 1 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum > =100K: 1 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less. 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr. 0 Ea add'I 500 sf: 4 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'I Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) TIMBERLAND HOMES INC TIMBERLAND HOMES INC 12670 SW 68TH AVE 12670 SW 68TH AVE STE 300 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503- 620 -8860 PHONE: 503- 620 -8860 FAX: 503 -598 -9081 Total Fees: $15,240.56 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -001 h OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: 0'_-1.4L4kJ Permittee Signature: . AlaildinQ'erit EC EI ��� � ,t� v��rz1' .di* itri.����yt`r'�+EtFFP�cfu�}. ui�Ai cl�ak l r�"`u a t � � Residential 1" N1 1,14 + + l � 't.0„yr FOR OF FIDE lu<SE "Ot�tLY s�+"�#' +' s �t vv 3. W City Of Tigard 6ard JAN 19 Rece ved Permit No ' 7 • � Date B�: ,Q'� . ` 13125 SW Hall Blvd., Tigard, OR 97223 CI Plan Rev tea a, a " Phone: 503.639.4171 Fax: 503.598.1960 CITY aateBp el NJ ) -j -4—fb Other Permit , , o{lay „(1 '`r'' '' 'f' Inspection Line: 503.639.4175 to Read} A ^ Juris. 0 See Page 2 for 1 'TIGARD p BUILDING 01VIS tified�Tvteth p� p-' I U� 1 I § Supplemental Information c• m� .r >' Internet: www.tigard- or.gov t TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLLNG ® New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. � 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi - family Number of bedrooms: 3 1 ❑ Master builder ❑ Other: Number of bathrooms: 2.5 I JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: /S S � 8/ - New dwelling area: aa-y7 square feet City /State /ZIP: Tigard, OR 97224 Garage /carport area: yo square feet Suite/bldg. /apt. no.: Project name: Gage Forest Covered porch area: 0 square feet Cross street/directions to job site: Hall to Langtree to 81st Deck area: 0 square feet Other structure area: 0 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Gage Forest Lot no.: 4 Pennit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all 1 equipment, materials, labor, overhead, and the profit for the I DESCRIPTION OF WORK work indicated on this application. Hew single family residence Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Timberland Homes, Inc. Type of construction: Address: 12670 SW 68 Ave, Suite 300 Occupancy groups: City/State /ZIP: Tigard, OR 97223 Existing: Phone: (503)620 -8860 Fax: (503)598 -9081 New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: Timberland Homes, Inc. All contractors and subcontractors are required to be Contact name: Maureen Denny licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 12670 SW 68 Ave, Suite 300 jurisdiction in which work is being performed. If the City /State /ZIP: Tigard, OR 97223 applicant is exempt from licensing, the following reasons apply: Phone: (503) 620-8860 Fax: : (503) 598-9081 E -mail: maureen @timberlandhomes.net CONTRACTOR Business name: Timberland Homes, Inc. BUILDING PERMIT FEES* Address: 12670 SW 68th Ave, Suite 300 (Please refer to fee schedule) City /State /ZIP: Tigard, OR 97223 Structural plan review fee (or deposit): Phone: (503) 620 -8860 Fax: (503) 598 -9081 FLS plan review fee (if applicable): CCB lic.: 141715 Total fees due upon application: Amount received: Authorized signature: i This permit application expires if a permit is not obtained Print name: Maureen Denny Date: 1 / 7 accepted as complete. / J /� O within 180 days after it has been acce , p Fee methodology set by Tri-County Building Industry Service Board. / I: \Building\Permits\BUP -RES PennitApp.doc 11/6/07 440- 4613T(11 /02/COM/WEB) .r 7 � ` `.. m. lit, r� IF,,QR OFF E .J E Lb . t . ! ectrll 1 Permit A p fl at ioI3 �� -,i , . N,H w E, ,... P.ecened T � . pity Permit No.: otg 00O0 ( I Date By: ll� i r of Ti gard � I 13125 SW Hall Blvd. Tigard, OR 97223 Plan Re‘. ie�.v w ..-- e 4 Phere: 503.639.4171 503.639.4171 Fax. 503.598.1960 Lare B Cther Pzrmu: x 1 ' 'pt � ' KD p Ins ection Line: 503.63: 4175 I Dar_ R acy: /Bv. ' . i E See Page 2 for ' ah -�kP Internet: wwnv.tigard- or.gov I Noutted'vlethod: �l I ❑GGGGGGGG7CAL:'Afur matron TYPE OF WORK PLAN REVIEW ® New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. . JOB SITE LNFORML4TION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: /1'7 S, J Q' / 3 100I-LP or more. occupancy. p Q ❑ Six or more residential units. ❑ Recreational vehicle parks. Cite /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous j g locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: Gage Forest ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Langtree Description 1 Qty. I Fee. 1 Total 1 ' New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Gage Forest Lot no.. 9- 1,000 sq. ft. or less t 145.15 /i/s7/c 4 Ea. add') 500 sq. ft. or portion S_ 33.40 la. W 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq- ft.) 75.00 ) 2 New Single Family residence Limited energy, multi - family 75.00 2 ' $ Y residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: Timberland Homes, Inc. 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 12670 SW 68 Ave #300 Over 1,000 amps or volts 454.65 2 City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or relocation Phone: (503)620 -8860 Fax: (503)598 -9081 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with . ® APPLICANT . ❑ CONTACT PERSON ' above service or feeder fee, 6.65 2 each branch circuit Business name: Timberland Homes, Inc. B. Fee for branch circuits Contact name: Maureen Denny ithout service or feeder fee, 46.85 2 Y first branch circuit Address: 12670 SW 68 Ave, Suite 300 Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Tigard, OR 97223 Each manufactured or modular 90.90 2 dwelling, service and /or feeder Phone: (503) 620 -8860 Fax: : (503) 598 -9081 Reconnect only 66.85 2 E -mail: maureen@timberlandhomes.net Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited- Business name: Lighthouse Electric energy panel, alteration, or Address: 27750 SW 95th Ave, Suite 109 extension. Describe: Page 2 2 City/State /ZIP: Wilsonville, OR 97070 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 582 - 9600 Fax: (503) 582 - 8484 Investigation per hour (1 hr min) 62.50 CCB Lic.: 154897 Electrical Lic.: 3 - 562C Suprv. Lic.: 2783S Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES . _ Suprv. Electrician signature, required: Subtotal: Print name: Mike Neel n Da Plan review (25% of permit fee): e ye/ a t l / iS • i State surcharge (12% of permit fee): Authorized signature: ic./ � TOTAL PERMIT FEE: /► This permit application expires if a permit is not obtained within 180 Print name: n,` 1 k Av g Date: days after it has been accepted as complete. s Number of inspections allowed per permit. 1:\ Building \ Permits \ELC - PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/VEB ; echanica Per mit A lication ' oK o>Hrlce u sk. ONLY r T Recived , iti City o Tigard e Rec L • • • tO a 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Other permit. a Phone: 503.639.41 Fax: 503.598.1960 DateBy: Inspection Line: 503.639.4175 Date Ready/By: See Page 2 for hIG \RU Internet: www.tieard - or.gov Notified/Method: Supplemental ln r '.. i . 0 r :fi' '', 4,�y e ,.: C �if ,.... E i *,y �tt•� �• . '_'41 tag ..., T-T1 7 t.. - % � S. f4...�'� � ..:4, .o-.r 1 -. ,.,... � 6 f k 0.d ."'i;7:7-1 • El New construction ❑ Addition/alteration/replacement Mechanical permit fees' are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: p mechanical materials. e. ui.ment, labor overhead, and .rofit. �. M' -4 _ _ '' . V :N r •l;l' r0 !."..7.0.e".:*, d I4l:W04, 4: �•, � „ rr� i' % � 37 v S e U } �7V k4 1�,�� ®1• and 2 - family dwelling ❑Commercial /izldustrial ❑Accessory building For special information use checklist ❑ Multi - family ❑ Description Qty. ❑ Master builder Other: p Ba. Total k ` j =� k' � .1,:;' 1 . s"rk.' . KeKest/ k cooho - /k � : �� ���' � h i'�i+� y" � Ids' =�•. - - Alr conditioning Job site address: / S7 L p- 3 S r- O ✓ Air con site plan show in; iiacement) 46.75 Furnace 100,000 BTU ducts/vents) 1 46.75 46.75 City/State/ZIP; Tigard, OR 97224 Furnace t00.000 + jjTU(ducta/ vents) � 54,91 Suite/bldg. /apt. no.: Project name: Gage Forest Heat .um. - 61.06 Cross street/directions to job site: Langtree Duct work � , py� H dronic hot waters stem MON 23.32 1 Residential boiler (radiator or b drooic) 23.32 Unit heaters (fuel -type, not electric), in -waU, in -duct sus.ended etc. 46.75 �.� Pluelvent for an of above 23 32 Subdivision: Gage Forest Lot no.:10 Other: IMEIFINII Tax map /parcel no.: �m Other fuel a i .tlaocee • 1 - - / : �' g' 1�'_ oF g ' `' .�,r`7 :;tBt B / r 41.. �W.rx . i f c. ; ;; - Water r 33 39 7"" `� Wat haute 23 32 Mini _ _ a ,, ,�{ ., .•,_ ... >s - Gas fire.l ce • New single family residence Flue vent for water heater or as z l 7 fi - .lace 23.32 66��J �O Lo; 1i :bter pas NI 23.32 Wood /.ellet stove 33.39 . Wood fire.lace/insert r 23.32 ,� ..,., i ' I ?Sti ;: Fi y ` a r .. w ',B. a Chimn /liner/flue/vent 23.32 Name: Timberland Homes, Inc. Environmental exhaust and ventilation Range hood /other kitchen Address: 12670 SW 68 Ave #300 e•uirtrent • 33.39 MEI Clothes d er exhaust 33.39 City /State/ZIP: Tigard, OR 97223 Single -duct exhaust (bathrooms, Phone: (503)620 F ax: ( 503)598.9081 toilet coin .artments, utili rooms . 23'32 Elag 23.32 rr 't ,c { Y A, _ F� fi C . ,_ .; -ti 6a ' rrq • - �„ • e, q R t ::,0S;;. , Atticicrawlslace fans r 4, ; . -Other: 23,32 Business name: Timberland Homes, Inc. Fuel .' . to _ Contact nerve: Maureen Denny $14.15 for first four. S4.03 for each additional Furnace, etc. i� Address: 12670 SW 68'" Ave h300 Gas heat .um. City /State /ZIP: Tigard, OR 97223 Wall /sus.ended /unit heater �- Phone: (503) 620 Fax: : (503) 598-9081 Water heater fire., lace 111.1 E - mail: maureen@timberlandbotnes.net Rang e M' � :, , < Z}5 . =)' !F� Barbecue � _ '' -�� �-•t Clothes d er ( as Business name: Central Air, nc Other: 1111111 L. Address: PO Box 433 � Subtotal _ CitylStatc✓ZIP: Clackamas, Q : 97015 Minimum permit fee (590.00) Phone: (503) 656 - 1908 I Fax: (503) 650 - 3898 Plan review (25% of permit fee) ., L ' - 1 CCB lic.: )78624 _ _ State surcharge (12% ofperrnit fee) TOTAL PERMIT FEE • k . t.; J V v L ` Ibis perm application expire, if a permit is not obtained tb o 150 Authorized signature: \ days after it has beet accepted as complete. Date. 1 / /) 1 • Fee methodology set by Try- County Building !Away Service Boa's Print name: Andrew Scheidt 6 `- `-)Iiilrll�jrl? P rrr�i � ti ©n r 3 . ` , ,,, N7 'mites -R . lr` fit a /jl e $7 ?% 1 1t rY £ w. - Ali'ding, Fixtures _ r . o F d � R F USE >r. t' ` *.',.j l'I R ecei\ed p ,�� .. it of � jga. P.'71'" n. f a2 0 .0 13 y:,- 'd ' " 13125 Sw Hall Blvd., T;gard, OR 97223 p Platt Re ,e . i,e,. > v AI; Phone: 503.639.4171 Fax: 503.598.1960 Date :By: Other ?omit `(o.: F Ready /By: H See B ;i: i Inspection Dat Read B ection Line: 503.639.4175 Page 2 for ' <1.; ;�.i ;{,;f$, Internet: www.tigard- or.gov Notified/Method: �'� Supplemental Information TYPE OF WORK FEE* SCHEDULE ® New construction ❑ Demolition For special information use checklist Description I Qty. 1 Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ® 1- and 2- family dwelling ❑ CommerciaUindustrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 .3 9q 6 ❑ Master builder ❑Other: Each additional bath/kitchen 45.00 Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: / c72.3 5 1-ti r / - r Catch basin or area drain 16.60 City / State/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60 Suite /bldg. /apt. no.: Project name: Gage Forest Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Hall to Langtree to 81st Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 445/ Water service (no. linear ft.: ) Page 2 ubdivision: Gage Forest Lot no. Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK preventer Page 2 1 1 - _�+ew single family residence t J g Y Backwater 16.60 Clothes washer 16.60 Dishwasher 16.60 ® PROPERTY OWNER Drinking fountain 16.60 ❑ TENANT Ejectors /sump 16.60 Name: Timberland Homes, Inc. Expansion tank 16.60 Address: 12670 SW 6$' Ave Fixture /sewer cap 16.60 City/State/ZIP: Tigard, OR 97223 Floor drain/floor sink/hub 16.60 Phone: (503)620 -8860 Fax: (503)598 -9081 Garbage disposal 16.60 ® APPLICANT Hose bib _ 16.60 0 PERSON Ice maker 16.60 Business name: Timberland Homes, Inc. - Interceptor /grease trap 16.60 Contact name: Maureen Denny Medical gas (value: $ ) Page 2 Address: 12670 SW 68 Ave, Suite 300 Primer 16.60 City/State /ZIP: Tigard, OR 97223 Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: (503) 620 -8860 I Fax: : (503) 598 -9081 I Tub /shower /shower pan 16.60 E -mail: maureen@Timberlandhomes.net Urinal 16.60 - CONTRACTOR Water closet 16.60 Business name: MEI Plumbing Water heater 16.60 Address: PO Box 207 Other: City /State /ZIP: Banks, OR 97106 Subtotal l..J� . Zu Minimum permit fee: $72.50 Phone: (503) 324 -0759 Fax: (503) 324 -0580 Residential back minimum permit fee: $36.25 CCB Lic.: 102535 Plumbing Lic. no.: 34 -276PB Plan review (25% of permit fee) Authorized signature: State surcharge (12% of permit fee) /�`� / - ^--t� �i TOTAL PERMIT FEE Print name: Kris Malmedal Dat r / l� / jJ This permit application expires if a permit is not obtained within / 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I.\ Building \Permits\PLMF- PermitApp.clot 12/27/06 440- 4616T(10 /02 /COM/WEB) Oregon Residential Specialty Code N1107.2 ( Vi/L1 - 2.61 , 0 -60 6/ :IIIGH- EFFICIE.N.CY I.NTERIOR LIGHTING .SYSTEMS Permit No.: MST2010 -00013 Jurisdiction: Tigard Site Address: 15723 SW 81st Subdivision/Lot #: Gage Forest 28 -and/or Map and Tax Lot #: By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. .(Oregon Residenti. Specialty : s N1107.2) Signature: Date: 91 • B v O It{1i . actor/Authorized Agent Print Name: Steven A Brown ORSC Section N1107.2. High- efficiency interior lighting systems. A minimum of fifty.(50) percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the _permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt. I:\ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08 Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, Steve Brown , am the_general contractor or the owner- builder at the following address: Site Address: 15723 SW 80 City: Tigard Permit #: MST2010 -00013 Subdivision/Lot #: Gage Forest 28 • and/or Map and Tax Lot #: To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes, the building official shall be notified in writing by the _general contractor that all moisture - sensitive wood framing members ed in construction have a moisture content of not more than 19 .percent weight, g' / framing members. Signature: 1 y Date: 11'1 •1 U - GetContr. 'e Owner- Builder .l: \Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08 STREET TREE CERTIFICATION I, S $ , Owner /Agent for �'�� � Q � (PLEASE PRINT) (PERMIT HOLDER) Do hereby certify that the following location meets City of Tigard and Washington County land use and development standards for street tree installation. ADDRESS: / S 72,2 ,5 &t.) 8� � � 5�2 � b SUBDIVISION: , � LOT: .0. SIGNATURE: - • DATE: p D N .�►" R/ AGENT) j RECEIVED BY: DATE: 1 (CITY OF TIGARD) l:\ Building \Forms \StreetTrecCertificate 01/19/07