Permit CITY OF TIGARD MASTER PERMIT
i COMMUNITY DEVELOPMENT Permit #: MST2009 -00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2009
Parcel: 2S112CC19400
Jurisdiction: Tigard
Site address: 15888 SW 81ST AVE
Subdivision: GAGE FOREST Lot: 1
Project: Gage Forest
Project Description: New SFR.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 973 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1349 sf Garage: 403 sf Front 15 Smoke
' Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $252,795.72 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: 0
Bckflw Prevntr: 0 •
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn > =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! 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)
JT ROTH CONSTRUCTION INC J T ROTH CONSTRUCTION
12600 SW 72ND AVE #200 12600 SW 72ND AVE #200
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: PHONE: 503- 639 -2639
FAX: 503- 624 -0239
Total Fees: $15,132.15
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 ar- set forth in OAR
952- 001 -0010 through OAR 952- 001 -0100. You may obtain a of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344
Issued By:
� ( 6 / (��fVl Permittee Signature: _ i _�
,\
Oregon Residential Specialty Code N1107.2
HIGH- EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: Nsr 0 7_ OW Jurisdiction: &F
Site Address: / CriK j , / e/ 5 7 A
Subdivision/Lot #:
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: ��` = Date: 3
Owner /General ontr. s Authorized Agent
Print Name: 4%'/Zr:,
2 � � ✓� /'�
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.
1:\ Building\ Forms\RES - HighEfficiencyLighting.doc 07/01/08
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
a 110 32i" ei
I, T, O7?Y Caw. .44/& , am the general contractor or the owner- builder
at the following address:
Site Address: /5 CIA/
City:
6"/CD
Permit #: /Sr co
Subdivision/Lot #: / � Jr Z
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: ��- _ ,, -; -/� - Date: /
General Contractor or Own uilder
0,Z$*/'tE /?E 7 c (74/ T/3/45/
19! E cilo-t / E,9i ✓J 4
(:\Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08
.
Building Permit Application RECEIVED
Residential o\l.
MAY 27 2009 F012 OFFICE 1,SF. \
City of Tigard Date/Sy: ST2�. cy11Gkl
- � y ��
y 1 • ( Permit No
• 13125 SW Hall Blvd., Tigard, OR 97223 a
l:. Phone: 503.639.4171 Fax: 503.598.1960 CITY �F TIGARD Pl an Revie /
Da teBy: 6 ` Other Permit: A a
I" I G n IZ D Inspection Line: 503.639.4175 BUILDING DIVISI Date ReadyBy: / 1�s: H See Page 2 for
Internet: www.tigard - or.gov Notifie.) ethod: '7 /y - r - Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
FI 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: $200,000
❑ Accessory building ❑ Multi- family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2.5
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 15888 SW 81". New dwelling area: 2,322 square feet
City/ State/ZIP: Tigard OR, 97223 Garage/carport area: 403 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: 5.3 square feet
Cross street/directions to job site: Hall/Langtree Deck area: 0 square feet
Other structure area: 0 square feet •
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Gage Forest I Lot no.: 01 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Construction of new single family residence Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: J.T. Roth Const. Inc. Type of construction:
Address: 12600 SW 72 Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone: (503)639 -2639 Fax: (503)624-0239 New:
❑ APPLICANT ® CONTACT PERSON NOTICE
Business name: J.T. Roth Const. Inc. All contractors and subcontractors are required to be
Contact name: David Jensen licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 12600 SW 72° 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) 806 -0602 Fax: : (503) 624-0239
E -mail: davidj @jtrothinc.com
CONTRACTOR
Business name: J.T. Roth Const. Inc. BUILDING PERMIT FEES*
Address: 12600 SW 72°d. (Please refer to fee schedule)
City/State/ZIP: Tigard OR, 97223 Structural plan review fee (or deposit):
Phone: (503) 639 -2639 I Fax: (503) 624-0239 FLS plan review fee (if applicable):
CCB lic.: 31700 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: David Jensen I Date: May 21, 2009 • Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Permits\BUP RES PermitApp.doc 11/6/07 440- 4613T(11 /02/COM/WEB)
Mechanical Permit Application roR OFFICE usr ONLY
City of Tigard Received Permit No.:
lig . • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G A It D Inspection Line: 503.639 Date Ready/By: tutu: g
Internet: www.ti ard -or. ov Supplemental See Page for
g g Notified/Method: Supplementel Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
® 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: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 53,800.00
1 -and 2-family dwelling CommerciaUindustrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® y g ❑ ❑ Accessory building
El Multi-family 0 Master builder ❑Other: For special information use checklist.
Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 15888 SW 81". Air conditioning or heat pump
(requires site plan showing placement) 1 14.00 ilk--
Cit Tigard OR 97223 Furnace 100,000 BTU (ducts/vents) 1 14.00 d k —
Furnace 100,000+ BTU (ducts/ventsL 17.90 t
Suite/bldg. /apt. no.: Project name: Gas heat pump - 14.00
Cross street/directions to job site: Hall/Langtree Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Gage Forest Lot no.: 01 Flue /vent for any of above 6.80
Other: I 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 1 10.00 1 O
Gas fireplace 1 10.00 le
HVAC installation of new single family resisdence Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
0 PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: J.T. Roth Coast. Inc. Environmental exhaust and ventilation
Address: Range hood/other kitchen
ddress: 12600 SW 72
equipment 1 10.00
City/State/ZIP: Tigard OR 97223 Clothes dryer exhaust I 10.00 to
Single -duct exhaust (bathrooms,
Phone: (503)639 -2639 Fax: (503)624-0239 toilet compartments, utility rooms) 6 6.80 A.
❑ APPLICANT ® CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: J.T. Roth Coast. Inc.
Fuel piping
Contact name: David Jensen $5.40 for first four; $1.00 for each additional
Address: 12600 SW 72 " ". Pomace, etc. I
Gas heat pump
City/ State/ZIP: Tigard OR 97223 Wall/suspended/unit heater _
Phone: (503) 806 -0602 Fax: : (503) 624 -0239 Water heater 1
Fireplace I
E -mail: davidj @jtrothinc.com Range
CONTRACTOR Barbecue
Business name: B &M Heating Clothes dryer (gas)
Other:
Address: PO Box 1111 MECHANICAL PERMIT FEES*
City/State/ZIP: Boring OR 97009 Subtotal 1 1. , (0
Phone: (503) 515 -5763 Fax: (503) 637 -5244 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 124757 U Z/ /ID State surcharge (12% of permit fee) 14, I - 7
TOTAL PERMIT FEE ► 34T `"
Authorized signature: This permit application expires if a permit is not obtained within 180
> days after it has been accepted as complete.
•
Print name: Bruce White I Date: "L/ /9 • Fee methodology set by Tri-County Building Industry Service Board
1:\ 13uildng\PemutsvMEC- Permitnpp.doc 01n9 /07 I •17T(t1rovCAM/WEB)
1 .
Plumbing Permit Application
Building Fixtures FOR OFFICE LSI ONLY
City of Tigard Received
Permit No.:
Il Date/By:
• 13125 SW Hall Blvd., Tigard, OR 97223 plan Review
C , Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
Inspection Line: 503.639.4175 B kris: ®Se Page 2 for
Internet: www.ti
T I G n R n and -or. o2/ Date Ready/By: Y g
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description I Qty. I 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 ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 1 399.00 3
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 15888 SW 81 ° . Catch basin or area drain 16.60 •
City/State/ZIP: Tigard OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Hall/Langtree
Manholes 16.60
- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 20) Page 2
Storm sewer (no. linear ft.: 20) Page 2
Subdivision: Gage Forest I Lot no.: 01 Water service (no. linear ft.: Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Plumbing of new single family resisdence Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: J.T. Roth Const. Inc. Expansion tank 16.60
Address: 12600 SW 72 Fixture /sewer cap 16.60
City/State/ZIP: Tigard OR 97223 Floor drain/floor sink/hub 16.60
Phone: (503)639 -2639 Fax: (503)624 -0239 Garbage disposal 16.60
❑ APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: J.T. Roth Const. Inc.
Interceptor /grease trap 16.60
Contact name: David Jensen Medical gas (value: $ ) Page 2
Address: 12600 SW 72 °d . Primer 16.60
City/State/ZIP: Tigard OR 97223 Roof drain (commercial) 16.60
Phone: (503) 806-0602 I Fax: : (503) 624-0239 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: davidj @jtrothinc.com Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Malmedal Enterprises Inc. Water heater 16.60
Address: PO Box 207 Other:
City/State /ZIP: Banks OR 97106 Subtotal
Minimum permit fee: $72.50
Phone: (503) 324-0759 Fax: (503) 324 -0580 Residential backflow minimum permit fee: $36.25
CCB Lie.: 102535 Plumbing Lic. no.: 34 -276PB Plan review (25% of permit fee)
State surcharge (12% of permit fee) 4 7 ,
Authorized signature: 4 , ' /ice TOTAL PERMIT FEE '
Print name: %Vfm Date: This permit application expires if a permit is not obtained within /ATM 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ auildiag\Permits \PLMF- rmnitApp.doc 12/27/06 440- 4616T(10ro2/c01wwm)
•
'Electrical Permit Application FOR OFFICE ESE ONI.Y
City of Tigard Received
Permit No.:
III Date/B :
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
I' I G It D Inspection Line: 503.639.4175 Date Ready/By: kris: Ell See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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.
1 - and 2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® y g ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ `A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: 15888 SW 81". I ° °I>P°rmore. Occupancy.
❑ 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: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: HalULangtree Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Gage Forest Lot no.: 01 1,000 sq. ft. or less I 145.15 (415 4
Tax map /parcel no.: Ea. add'I 500 sq. R or portion 4. 33.40 I'� --C)1
Limited energy, residential 1 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Wiring of new single family residence Limited energy, multi- family 7500 2
g g 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: J.T. Roth Const Inc 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 12600 SW 72nd _ 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)639 -2639 Fax: (503)624-0239 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: J.T. Roth Const. Inc. B. Fee for branch circuits
Contact name: David Jensen without service or feeder fee, 46.85 2
first branch circuit
Address: 12600 SW 72nd. 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) 639 -2639 Fax: : (503) 624 -0239 Reconnect only 66.85 2
E -mail: davidj@jtrothiuc.com Pump or irrigation circle 53.40 2
•
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Grizzly Electric Inc. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 8002 NE Hwy 99 PMB #248 extension. Describe: Page 2 2
City/State /ZIP: Vancouver WA 98665 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 909 -4080 Fax: (360) 694 -8939 Investigation per hour (1 hr min) 62.50
CCB Lic.: 186218 Electrical Lic.: 37446C Suprv. Lic.: 2643F Industrial plant per hour 73.75 _
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 2 7 , ,'-S
Plan review (25% of permit fee):
Print name: Ron Nelson 4, j2 Date: May 19, 2009 State surcharge (12% of permit fee): '33
I Authgrized signature' O. TOTAL PERMIT FEE: 3 ( 2 2
Th permit application expires if a permit is not obtained within 180
Print name: . • • , r �/� Date: days after it has been accepted as complete.
(� • Number of inspections allowed h CO ° ermit. LOCO_ V — T
1: \BuildinglPermilskELC- PermitAppdoc 5/23/06 440- 4615T(11 /OS /COM/WE6 '
cj.Q0 (#2-°-..-
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
® Audio and Stereo Systems*
❑ Burglar Alarm
® Garage Door Opener*
® Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
p Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
1:\ Building \Pennits\ELC - PermitApp.doc 03/23/06
ST 3 E CERTIFICATI•
d /rlS i./ , Owner/Agent for d. I /om' e i/te (PLEASE PRINT) (PERMIT HOLDER)
Do hereby certify that the following location meets
City of Tigard land use and development standards
for street tree installation.
ADDRESS: 5 .
SUBDIVISION: LOT:
1
SIGNATURE: � � � �' ��
DATE: /� 20 3 ,
(O[, D ER /AGENT)
RECEIVED BY: DATE:
(CITY OF TIGARD)
1:\ Building \ Forms \StrectIrecCcrtificate 01 /19/07