Report (54) STREET TREE
TIGARDI
CERTIFICA TION
I, Vowner/agent gc( �� >g for
(PLEASE PRINT) (PERMIT HOLDER)
do hereby cert that the following location meets
City of Tigard land use and development standards
for street tree installation and is consistent r✓ PIM
��
with the approved site plan. , �n t � l s
FPP,
PERMIT NO.: .5�ze)/ ` 6
SITE ADDRESS: /44(65- -51 E,1
SUBDIVISION: ,r LOT#:
SIGNATURE: `'"'' DALE: / t�(/
.__ /
(OWNER/AGENT)
RECEIVED
VERIFIED BY: �.. DALE: 1/7//
OF GARD)
Tree location verified per approved site plan.
I:\Building\Forms\StreetTreeCertificate 05/30/2012
K
WASHINGTON COUNTY
'03-igiz,s, OREGON
Standard or Alternative Onsite System
Except for Commercial Sand Filter, RGF and ATT Systems
CERTIFICATE OF SATISFACTORY COMPLETION
NAME OF PERMITEE:. l,,)tAr1 _7 ,�'1.T1..t 1/,:i ��'Ail�t` I'1 01-‘-(1.7
__— __ PERMIT#:------ ---
Property Address: H `116 _;:)vi 1 ;7-1"' /1:1L-.N Ji,:-_____ MaptTax Lot#: 3\ -,'1;;,h. �,<.,�;
Final Inspection Request and Notice Acceptance Date: ,=.12:::b'f w
Inspection Date(s): 1st I i , `l; 2nd 3rd __._ 4th__ 5t
t
Correction Notices Issued: CI Yes `'j No
System Inspected 13y:__i__A : -1 i.. 1-t�:t :_�
t 31 " i l..>17.•_1-.15 ____ Name of Installer: (.2.: i'F iv r"r t.
Periodic inspections may be required for all Alternative System installations OAR 340-071-0260.
All systems must be operated and maintained in compliance with OAR 340-071 and must not create a public health hazard
or pollute public waters. An authorization is required to change the use of or increase the projected daily flow.
The area of the initial system and the identified replacement area must not be subjected to activity that is likely to
adversely affect the soil or the functioning of the system. Such activities may include, but are not limited to, vehicular
traffic,covering the area with asphalt or concrete,filling, cutting,or other soil modification activities.
In accordance with Oregon Revised Statute 454.665, this Certificate is issued as evidence of satisfactory completion of an
onsite sewage disposal system at the location identified above.
Issuance of this Certificate does not constitute a warranty or guarantee that this onsite sewage disposal system will
function indefinitely without failure. Conditions imposed as permit requirements continue for the life of the system.
This Certificate of Satisfactory Completion (CSC) is valid for a period of 5 years. It is valid exclusively for the septic system
installed and connected to the facility as referenced herein. Upon expiration of this certificate, rules for Authorization Notices
or Alteration Permit as outlined in OAR 340-071-0205 and 340-071.0210 apply,including payment of an additional fee.
Certificate Issuance Criteria:
A CSC - System Inspection
Ci CSC - Operation of Law-7 Days Notice
la CSC - Pre-Cover Inspection Waived Per 340-071
Vo j..-Zi ,,—
A
'tutft ri dAgent (Signature) 7 itle —'if�ate
llfr ..__.___
To be valid,this document must be signed by an "Agent"as defined in OAR 340-071-0100.
i
Department of Health&Human Services-Environmental Health Division
155 N First Avenue, MS-5, Hillsboro,OR 97124-3072
rev 10/1 1/06 Phone:(503)846-8722•Fax:(503)846.4490 d www.co.washington.or.us
AS-BUILT DRAWING OF THE CONSTRUCTED SYSTEM
Name of Property Owner: VVI Ct r r
Site Address:(include city,state,and zip) / 11/ S" iv I7-
�� ! /
Township:
2 S , Range: / Lir -TSecr,.
tion: �.� [ Tax Lot#: 300
Show all wells within 200 feet of system, length of each drainline, measurement to tank from two locations,
distances from closest property lines to drainlines and septic tank, dwelling,outbuilding(s), and any
encumbrances.
0
. . . . . . . 1/
. 7 . . . . . . . . . . . . P ► •
. . . . . . . . . . .
~ " 3 •
.� . .
r . . . .
. • z
NZ
t
I
bI
System Construction Completed By:(choose one)
D Property Owner
FiC DEQ Licensed installer: Ce Atte mail 6-`-t/alt.() 3 S S-2
Business Name DEQ License#
I hereby certify that the information provided on this final inspection request and notice is correct and that
construction was completed in accordance with OAR Chapter 340 Divisions 71 and 73.
Owner/Installer Printed Name: ft L 141 /14(1'? 'f
.,S
/` Date:/1)2 7-1
Owner/Installer Signature: !
08/2016
Page 2 of 2
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, , am the general contractor or the owner-builder
at the following address:
Site Address: is'! ,�,S ›.,.<_„, i, /L____ /(602
City: —''J ( /
//6,4 /--/)
Permit#: i�/ � ( Z j
Subdivision/Lot#: �–'
and/or
Map and Tax Lot#: G 7i4 OcWC
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.
/1 --
%�
�f / /
Signature: -./ =i Date:
General Cont acto o e , er-Builder
I:\Building\Form\RES-MoistureSensitiveWood.doc 09/25/08
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: r x( C 2_ Jurisdiction:
Site Address: / -
Subdivision/Lot#:
and/or
Map and Tax Lot#: /r ( '47 Ci( C)C) •
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)1
ir
Signature: 1 �At ,4•F / 7q.' 7 V
L Date:
Owner/General Contractor/Authorized Agent
Print Name: C �
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.doe 07/01/08