Correspondence / x) 8'
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Plan Review #
Date 7 CITY OF TIGARD
OREGON
Solis Special Inspections
This form shall be signed by the Owner, Engineer or Architect of Record and returned to the Building Division prior to
issuance of the permit. Please note that a separate structural special inspection form may be required.
Project Address: I 5405 5 u Z,, Protect Name: LA
Architect of Record (Firm): I VA ( Phone:
Engineer of Record (Firm): I,. Phone:
Soils Engineer: ( Firm: Phone:
Lot: Subdivision:
The following special inspections shall be performed according to the State Building Code and City of Tigard's Municipal
Code Chapter 14.06.010 - 14.06.040:
❑ Engineered Grading ( >5,000 cubic yards) - U.B.C. 7014
Regular Grading - U.B.C. 7014
Compaction Reports (per ASTM standards listed in U.B.C. 7002)
Testing Agency: Ar P a a - 7 - Li 73 5.w_ Tech , ` .,. ' Po
Phone: ( 740O
❑ Other
The owner hereby agrees to employ the above soils engineer for the above -noted special inspections.
Signature of Owner
Print Name -►∎ W./ AA-A4- Phone No. (27 c - o
Firm 1::\ Le_ � ear l �� — � Date L 5
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13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772