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Permit
'' ' CITY OF TIGARD MASTER PERMIT v f COMMUNITY DEVELOPMENT Permit #: MST2009 -00229 , ,TI G 1;1RID 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/23/2010 r Parcel: 2S 104 B B 12600 Jurisdiction: Tigard Site address: 14043 SW WALNUT CREEK WAY - Subdivision: Lot: y3 Project: Walnut Creek Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 942 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 27 Bathrooms: 3 Second: 1262 sf Garage: 435 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $243,512.95 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 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: 0 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: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum > =100K: 0 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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) MATRIX DEVELOPMENT CORP MATRIX DEVELOPMENT 1 MST Ersn Cntrl 503 - 681 -4444 12755 SW 69TH AVE #100 CORPORATION TIGARD, OR 97223 12755 SW 69TH AVE #100 TIGARD, OR 97224 PHONE: 503 - 620 -8080 PHONE: 503 - 620 -8080 FAX: 503- 598 -8900 Total Fees: $11,480.29 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. A • ' : • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 -0010 through • • R 9 -0$1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 11/ r ( ' �\ Issued !; : L1 .y Permittee Signature: • • - Building Permit Application Residential FOR OFFICE USE ONLY D City of Tigard RECEIVED Received DateB : 9 Q O' ./ Permit No.: ,040 _ r • Er 13125 S \\/ Hall l3lvd.. Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.19 Plan Review .�W L DateB : � n n -O ' Other Permit: I o 9- 1 TIGARD Inspection Line: 503.639.4175 L 0 9 2009 Date ReadyBy: ® See Page 2 for Internet: \rww.tigat_tl- or.gov Notified/Method: iv iii - ) Supplemental Information CITY OF TIGARD - TYPE O lb1 NG DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING ® New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest ❑ Addition /alteration /replacement ❑ Other: dollar) of all equipment, materials, labor, overhead, and CATEGORY OF CONSTRUCTION the profit for the work indicated on this application. Valuation: $ 33257413 : 8 ' 1— 24 '512 . ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi - family Number of bedrooms: 3 ® Master builder ❑ Other: Number of bathrooms: 3 JOB SITE INFORMATION AND LOCATION Total number of floors: 2 Job site address: 14043 SW' Walnut Creek Way New dwelling area: 2,204 square feet City /State /ZIP: Tigard, OR 97223 Garage /carport area: 435 square feet Suite /bldg. /apt. no.: Project name: Walnut Creek Covered porch area: 7_8 square feet 942_ Cross street/directions to job site: Barrows & Walnut Deck area: C-, square feet ti Z Other structure area: � / '9 square feet `� REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Walnut Creel: Lot no.: 043 Permit fees* are based on the value of the work Tax map /parcel no.: 2S1041313 12600 performed. Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and DESCRIPTION OF WORK the profit for the work indicated on this application. • 0 1 t� , 4 _ i Valuation: $ �/�� Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Legend !Ionics Type of construction: Address: 12755 SW 69' Avenue, Suite #100 Occupancy groups: City /State /ZIP: Portland, OR 97223 Existing: Phone: (503) 620 -808(1 Fax: (503) 598 -8900 New: ® APPLICANT ❑ CONTACT PERSON NOTICE Business name: Legend I lames All contractors and subcontractors are required to be Contact name: Steve Lucas licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 12755 SW 69' Avenue, Suite #100 jurisdiction in which work is being performed. If the City /State /ZIP: Portland, OR 97223 applicant is exempt from licensing, the following reasons apply: y: Phone: (503) 620 -808(1 Fax: : (503) 598 -8900 E - mail: slucas @legendhomes.com CONTRACTOR Business name: Legend I lames BUILDING PERMIT FEES* Address: 12755 SW 69" Avenue, Suite #100 (Please refer to fee schedule) Structural plan review fee (or deposit): City/State/ZIP: Portland, OR 97223 Phone: (503) 620 -8080 V a,1 Fax: (503) 598 -8900 FLS plan review fee (if applicable): \ Total fees due upon application: CCBlic.:SjlktK3 65 -7 Amount received: Authorized signature: ,, This permit application expires if a permit is not obtained //��lILL.. -- within 180 days after it has been accepted as complete. Print name: Steve Lucas Date: 12/08/09 * Fee methodology set by Tri- County Building Industry Service Board. I: \Building \Permits \BUP -RES PermitApp.doc 11/6/07 440- 4613T(I1/02 /COM/WEB) Electrical Permit Application RECEIVE r FOR OFFICE USE ONLY Received City of 1/1. `J ar b DEC 09 ��? DateB : q t� l �J/ �I' . r'IDi " 13125 SW flail I31vd., Tigard, OR 97223 Tigard, Plan Review 5 vb 59 • Phonc: 503.639 4 171 Fax: 503.598.1960 Date /By: Other Permit: TI GARD Inspection Line: 503.639.4175 CITY OFTIGAR 1 ► a.te ReadyBy: lurk: 65 See Page 2 for Internet: ww\e .ti eard- or,aov BUILDING DIVI$I '..tified/Method: Supplemental Information TYPE OF WO 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. ❑ Demi>1i ❑ 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 ® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ® Master builder ❑ Other: ❑Fire pump. ❑ Installation of75 JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", 100HP or more. occupancy. Job no.: Job site address: 14043 SW Walnut Creek Way ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: Walnut Creek ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street /directions to job site: Barrows & Walnut Description 1 Qty. 1 Fee. 1 Total 1 New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Walnut Creels Lot no.:043 1,000 sq. ft. or less 1 168.54 168.54 4 Ea. add'I 500 sq. ft. or portion 4 33.92 135.68 1 Tax map /parcel no.: 2S10413I3 12600 Limited energy, residential 1 67.84 67.84 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 67.84 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: Legend Domes 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: 12755 SW 69 Avenue, Suite #100 Over 1,000 amps or volts 552.26 2 City /State /ZIP: Portland, OR 97223 Temporary services or feeders installation, alteration, and /or relocation Phone: (503)620 -8080 Fax: (503)598 -8900 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is 201 amps to 400 amps 125.08 2 not intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670, and 401 amps to 599 amps 168.54 2 701 Branch circuits - new, alteration, or extension, per panel A. Fee for branch circuits with Owner signature: Date: above service or feeder fee, ® APPLICANT ❑CONTACT PERSON each branch circuit 7.42 2 B. Fee for branch circuits Business name: Legend I lames without service or feeder fee, 56.18 2 first branch circuit Contact name: Steve Lucas Each add'I branch circuit 7.42 2 Address: 12755 SW 69 Avenue, Suite #100 Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 City /State /ZIP: Portland, OR 97223 dwelling, service and /or feeder Reconnect only 67.84 2 Phone: (503) 620 -8080 Fax: : (503) 598 -8900 Pump or irrigation circle 67.84 2 E -mail: shicas@legendhomes.com legendhomcs.com Sign or outline lighting 67.84 _ 2 CONTRACTOR Signal circuit(s) or limited - Business name: Garner Electric extension. panel, alteration, or extension. Describe: Page 2 2 Address: 2920 SE Brookwood Avenue #A Each additional inspection over allowable in any of the above City/State/ZIP: I lillsboro, OR 97123 Per inspection 66.25 Investigation per hour (1 hr min) 66.25 Phonc: (503) 648 -4552 Fax: (503) 642 -7925 Industrial plant per hour 78.18 CCI3 I,ic.: 121 159 Electrical 1 , -305C Suprv. Lic.: 3707 -5 ELECTRICAL PERMIT FEES Subtotal: 372.06 Suprv. Electrician signature. rcquir Plan review (25% of permit fee): Print name: Chuck Gamer 4 " /. .' 1 • /08/09 State surcharge (12 %ofpermit fee): 44.65 TOTAL PERMIT FEE: .6 L. 7 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: Number of inspections allowed per permit. t\ Building \I'an nits \ELC- I'ermitApp.doc 03/23,06 Mechanical Permit A licatio AT, CEIVED Received FOR OFFICE USE ONLY City of 1'It a Date/By: O Permit No.: r ff-up 19 13125 S%\' I kill Blvd., Tigard, OR 97223 Plan Review Phone: 503.639 .1171 Fax: 503.598.1960 DEC 0 9 200' Date/BOther Permit:cy ` , v~ Inspection Line: 503.639.4175 Date Ready/By: luris: 0 See Page 2 for Internet: \\\\x\.ti,ard-oraov ARD Notified/Method: Supplemental Information CIT -f .y OF j I TYPE OF W ING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ® New collSI ucti0n ❑ Addition/al teration/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: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ® I- and 2-flimil+' d\+~clling E] Commercial/industrial E] Accessory building For special information use checklist. El I\-lulu-family ❑ Master builder El Other: Description Qty. Ea. Total .1013 SITE INFORMATION AND LOCATION Heating/cooling Job site address: 14043 SW Walnut Creel: Way Air conditioning _ (requires site plan showing placement) 46.75 Cit)r'St;ue%%IP: "I'ig,ard, OR 97223 Furnace 100,000 BTU (ducts/vents) 1 46.75 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 Suitc/bldg./apt. no.: Prgjcct name: Walnut Creek Heat um 61.06 Cross street/directions to job site: Barrows & Walnut Duct work 23.32 H dronic hot waters stem 23.32 _ Residential boiler (radiator or h dronic 23.32 Unit heaters (fuel-type, not electric), in-wall, in-duct, suspended, etc. 46.75 Subdivision: Walnut Crccl: Lot no.: 043 Flue/vent for an of above 23.32 Other: 23.32 Tax nulp/parcel no.: 2S10411313 12601) Other fuel appliances DIiSCRIPTION OF WORK Water heater 1 23.32 23.32 Gas fireplace 1 33.39 33.39 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/ pellet stove 33.39 Wood fire lace/insert 23.32 El TENANT Chimney/liner/flue/vent 23.32 ® I'ROPGIt"I'1' O\1'\1:12 Other: 23.32 Name: Legend Ilomes Environmental exhaust and ventilation Range hood/other Adchcss: 127.5.5 511' (9i1' ;wcnuc, Suite #1(111 kitchen equipment 1 33.39 33.39 City/State//"Ill: Portland, OR 97223 Clothes dryer exhaust 1 33.39 33.39 - Single-duct exhaust (bathrooms, Phone: (.503)620-80811 Fax: (503)589-8900 toilet compartments, utility rooms 5 23.32 116.60 © APPLICANT ❑ CONTACT PERSON Attic/crawls ace fans 23.32 Other: 23.32 Business name: Legend Ilomes Fuel piping Contact name: Steve Lucas $14.15 for first four; $4.03 for each additional Address: 127SS SW 69'1' Avenue, Suite #1011 Furnace, etc. I Gas heat um Cit+/State/LIk': Portland, OR 97223 Wall/suspended/unit heater Phone: (503) 620-8080 Fax:: (503) 598-8900 Water heater 1 Fireplace 1 E-mail: slucas'a Iegendhontes.cont Range 1 14.15 CONTRACTOR Barbecue Clothes dryer (gas) Business nnmc: "1'ri County I'cmp Control Other: Address: 13150 Clackamas River Drive MECHANICAL PERMIT FEES* Cit+/S(ate/ZlP: Oregon City, OR 97045 Subtotal 360 , ~ Minimum permit fee ($90.00) Phone. 1503) 557-2200 Fax: (503) 557-0919 Plan review (25% of permit fee) CC 13 I ic.: 73623 State surcharge (12% of permit fee) fp, t 2 TOTAL PERMIT FEE Authorized Signature: This permit application expires ifs permit is not obtained within 180 days after it has been accepted as complete. Print name: Steac Lucas Date: 12/08/09 ' Fee methodology set by Tri-County Building Industry Service Board I'.\B,61duy. I'einm>>ILC-1'ci riil,\pp dot 01/1`/07 440-4617T(I1/02/COM/WEB) ' Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City Ot Tigard RECEIVE t Received Permit No.: n /� Q M 111 'r 13125 Ste' I tall 13Ivd., Tigard, OR 97223 Date /By: � ✓ ./ j (�(' co g .9 I Phone: 503.639.4171 Fax: 503.598.1960 Plan Review 9 009 Date/By: Other Permit No.: At) ■ 116 y o TIGARD Inspection Linn. 503.639.4175 DEC 0 Date Ready/By: luris: 0 See Page 2 for Internet: www.tigard or.gov Notified /Method: Supplemental Information PITY OF TIGARD TYPE OF WORK UIIILDING DIVISION FEE* SCHEDULE ® New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 ® I- and 2- lamily dwelling ❑ Commercial /industrial SFR (2) bath 437.78 111 Accessory building ❑ Multi - family SFR (3) bath 1 500.32 500.32 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 .1013 SITE INFORMATION AND LOCATION Site utilities Job site address: 14043 SW Walnut Creek \Vay Catch basin or area drain 18.76 City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76 Suite /bldg. /apt. no.: Project name: \Valnut Creek Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 50.03 Cross street /directions to job site: Barrows & Walnut Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Walnut Creek Lot no.: 043 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: 2511141313 12600 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ® PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Legend Ironies Fixture /sewer cap 25.02 Address: 12755 SW 69' Avenue, Suite #100 Floor drain/floor sink/hub 25.02 City /State /ZIP: Portland, OR 97223 Garbage disposal 25.02 Phone: (503)620 - 808(1 Fax: (503)598 -8900 Hose bib 25.02 Ice maker 12.51 ® :U'I'I.ICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Legend 1 1 om es Medical gas (value: $ ) Page 2 Contact name: Steve 1.11cas Primer 12.51 Address: 12755 SW 69' Avenue, Suite #100 Roof drain (commercial) 12.51 City/State/ZIP: Portland, OR 97223 Sink/basin/lavatory 25.02 Solar units (potable water) 62.54 Phone: (503) 620- 8(180 Fax: : (5113) 598 -8900 Tub /shower /shower pan 12.51 E-mail: slucas a Iegendhomcs.com Urinal 25.02 CONTRACTOR Water closet 25.02 Business name: Wolcott Plumbing Water heater 37.52 Add 1075 W. 11istoric Columbia River Ilwy Water Piping/DWV 56.29 Other: 25.02 City/State/ZIP: Troutdale, OR 97060 Subtotal 500.32 Minimum permit fee: $72.50 CCI3 Lic.: 1122211 Plumbing Lic. no.: 26 -824PB Plan review (25% of permit fee) .� //- State surcharge (12% of permit fee) 60.04 1 Authorized signature: ' / -</ .t.,1( / -(�^ l TOTAL PERMIT FEE �� This permit application expires if a permit is not obtained within Print name Gloria Hawes Date: 12/08/09 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. • Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: Jurisdiction: 01 -- Co 2-7 9 // Site Address: /fie if 3 S &) r 'u aJ.gy Subdivision/Lot #: e r L - �,U �cr /,»a -7 e i��-e l� 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 Residential Specialty Code N1107.2) Signature: rkh ` " / Date: 7/, /� j r n 'O. = eneral C l`ttractor/ • u horized Agent / Print Name: C�d ) (0 ' 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: \Buildingw orms \RES- HighEfficiencyLighting.doc 07/01108 Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, c ij f!v t'U / G , am the general contractor or the owner- builder at the following address: Site Address: y / ` ScA) tO i-e- v c -7 L N2 0.1C. rr� /9 City: 1 Permit #: Subdivision/Lot #: (A.; 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 used in construction have a moisture content of not more than 19 percent by dry weight of dry framing members. Signature: — .4 1 1? /'i Date: ontt etor'nre - =Builder I: \Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08 •• . PERMIT NO. e9/ 00 „Z CleanWater Services 0„,. (•,,mmi,r„e „r is ch ar. LOT cj EROSION CONTROL INSPECTION REPORT DATE /fi / & INSPECTOR y SUBDIVISION / /./ 4,o.,r7 f O WN ER/PERMITEE r �„,../ ( / � , . 147 SITE ADDRtESSVaA1 i.� -.��,� /�. .�, i . .r r%/� c —� .. �,. ja ,nf f h `7J` A y rr v }� ..� y♦ t.„ FINAL ,.L 114 EcTioN • • THIS SITE MEETS THE POST - CONSTRUCTION EROSION CONTROL REQUIREMENTS SET FORTH IN CLEAN WATER SERVICES RESOLUTION AND ORDER NOTE: IF POST - CONSTRUCTION EROSION CONTROL MEASURES ARE STILL BEING EMPLOYED ON THIS SIT�VZOEET6RUTERI�Aj ©R AN APPROVED FINAL INSPECTION, THE MEASURE(S) MUST REMAIN IN PLACE UNTIL LANDSCAPING IS COMPLETE OR PERMANENT GROUND COVER IS ESTABLISHED. A COPY OF THE FINAL EROSION REPORT MUST)BE FORWARDED TO_THE'NE�W ONIVNER TIME NEW OWNER ASSUMES' THE RESPONSIBILITY FOR MAIN REPAIR AND REMOVAL. OTHER THANK YOU FOR YOUR COOPERATION! INSPECTOR • PHONE ��) -74: ,..",r Ni t1/71- c■ STREET TREE CERTIFICATION ,.z...... I , . -'v a L LAM- 7 1A0 , Own %.Agent for , /� , (PLEASE PRINT) _L, j 1 (PERMIT _HOLDER) (_ - ' a p ry Do hereby certify that the f rotation meets City of Tigard gland u`s'e a rd�'developrnent standards , for street tree lnstall t h I? -- I to , - -/ ADDRESS: /40 Li Z �� ey2 L0 1 I SS20`7- 0bZ2q SUBDIVISION: L j gu., LOT: 43 SIGNATURE: '_ re iC %► - DATE: q/1 i CO •i?NER , 'E1 .) RECEIVED BY: DATE: (CITY OF TIGA RD) I:A Building \ Forms \StreetTreeCertificate 01/19/07