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BUILDING DEPARTMENT, TIGAND 1�7
�> PLUMBING PERMIT
holder of a valid plumbing contractors license is hereby
kutho ized to cause plumbing'work as herein noised to he installed in accordance with the plumbing code of
"Iigard. Such installations require inspP:.tion by the City Inspector who shall be notified not less than four
'4) hours prize. •n the time the installations are ready for inspection. City of Tigard Business License required
for all ccrr.urairtors and sub contractors.
r , �
Qwner � _ _ Add;eSs_ '�' � _slLt1Date�_._ 'r_)
NUMBER OF TOTAL PERMIT NO.'S
TYPE OF PERMIT ITEMS FEE ON EACH A141C1UNT (Office USPOnly)
R I D E N LLA_ _r
Single Famil -1 bath-each 2500 i -
OuPI±.-Each 1 bath unit 215 r j
Additional bathroom:-each 1000
Mobil; Homs S ap c3-each 15.00 _
,_ NOIVIDUAL FIXTURE FEES
I to 50 Fixtures In 1 building-each 3,00 `
_ 51 12_100 F.,jtures in_1 builr,ing-each 2.50
IO_t :0 200 F-xwret in_1 bui0inc-each 2__00 -- - ----
'200 or more Fixturet in 1 budding-each _____ v _- �!1.50 -T —
-
MISCELLANEOUS `
Suilding Sewer-itt 50 it, 1000 --
Sewer-each additional 100 fL 10.00 --` -
V11a:er Service to building 3 5.00 -
Private
Systerns-each 100 ft. 10.00
I�Other 15cecilyl• -
PERR'IT - For Plumbing Inspection Phone 6994171 `
3; 'late c� _ Plumbing Contractor By
TnTa.t
i
City of "Tigard
INSPECTION f FQU ES T
for
3' _CTION TIME: PERMIT NO. :_�
- --
DATE: DATE I S U .D :___L_L__ l
I'
IMERS NAME '.
ADDRESS: � _ L
)N-n A CTO R : _
-.ST : Air U, Water[] , Visual j, , I_aboratiry ; 'I
-SULT . Approved, Disapproved El , Pending [j
CETCH:
INSPECTOR DATE
TE ' Attach supplemental test doto heret�
I
I
;;ify of
INSPECTION REQUEST
NSPECTION TIME: PERMIT NC
DATE: .�,'� ' '� DATE ISSUED .
OWNERS NAME : -
ADDRESS: �_�—__ _—
f,0 N r R A TOR : --- -----
i EST ter El . V:stuai '] . '_aboretory rJ
RESUL';" lkp roved, , ;upprooad G , ;=e►tdioown
S KETCH
INSPECTOR DATE
LNOTE : Attach supe emental test data heTet�
I
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : _ PERMIT NO. : ._____�
DATE : DATE ISSLIED:__1_ I
OWNERS NAME ' L
CCNTRACTOR
TEST. A r U, Water K, Visual 0 , La'- ratory p
RESULT: Approved Disapp oved 1 , Pending Lj
SKETCH*
I
+I
I
I
I
I
I
INSPECTOR DATE
ILNOTE . Attach supplemental test data heret]
est,
City of Tigord
INSPECTION REQUEST
for
NSPEC TION TI ME :. PERMIT NO. . --_
DATE.f ')ATE ISSUED_–�–%—
OWNERS NAME ' —r,,
ADDRESS : 14-T S"DO rrrr,xc�ie��,n
C,IN-I RACTrJR :.`Fl 12'
ru�ter
RESULT NpprJ�ed,— i rpprova�
SKETCH:
INSPECTOR DATE
EMOTE: Attach suppfementaf 'e-t .surr+ osrefl
f '
u
City of Tigard
INSPECTION REQUEST
for
I Oce"
INSPECTION TIME : PERMIT NO. :
DATE: / _L�9173 DATE ISSUED :_.1_.L_
OWNERS NAME �—
ADDRESS: ze(35 _
CONTRACTO — _
TEST : Air ii, Woterp , Visual p , Laboratory ❑
RESULT: Apnrovedli<, Disapproved ❑ Pending []
SKETCH:
INSPECTOR DATE
[OTE' Attach supplemental teat data beret]
City of Tigard
INSPECTION REQUEST
for
INSPEu'11ON TIME : — PERMIT NO. :
DATE: // k'7/79DATE ISSUED: . Z
OWNERS NAME :
ADDRESS :
CONTRACTOR :-/,07# 7 _
TEST; A r D , Water p , VisuaISQ , Lat ,rotary [1
RESULT: A.pproved`i4cl- Disapproved , Pending p
SKETCH:
INSPECTOR DATE
Attach supplemental fest data heret:01
� Jurisd�a�.io� s�
Type of Fixture fee �'1!� 4% No� - P
ft11 it too
POMIt 1004
i� Mit
ApaFoved by
At= a In IpttiIdtng Po
ower ROGOW No,
nks. LO ip of Hui ung
_�_ --�—
1212t .1 1"AA i
ga4t !fid ^3 s o fOwn
nn .... .._._ . ...__.__....
aing
c •a-Fier Name Address of P- be
na l
a r
er Service
vr gr
This pemi.t becomes null and void if Fronk or construction authorimed is not
c�iced within 60 days, or if conatrwtion or work is suspended or abandon¢
for a period of 120 days at any time after work is com enced
All p lusbix4 firms mat be l i.-c*aoi by tb* Cite► of Tigard and past a $�,CQO bond
I henry certify that i bavo rwe,d and exar9ned this app1i.caticin arW know the same
to bu true and correct,. All pr*Yi.aiws of 14two and ordinances governing this type
of wir'k will be coWli ed with w:hsthtr epecM f.4t herein or not, the granting of a
perait does not preowas to giv4 outhortty to violat( or cancel the provi.st)xis
of arry other state or local Law r*VAUtl.ng conet,,uction or the performance of
ncostruction.
i
6 4"40f
0
8914
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Deed Records
of Washington Cuunty, Oregon, is prohibited by the ordinance of
the City of Tigard, Oregon: (The City will issue a release
as soon as a final inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
sqL'.elk ,At \a - '-_ti:�� -�
�s R%-%..a� q'*tc� '\— 000
P\4�C t\l �Ow cf a O� '*k ft
ADDRESS OF PROPERTY: ve_
NAME OF OWNER: tit x, - t*L the z. S,c d.� w. tom.\\_
ADDRESS OF OWNER:
Q owl\oe-'c? , G r' !-
IN WITNESS WHEREOF, the undersigned has caused this
restriction to be executed this a day of _tie, , 19-1-
OWNER:
Hams
APPROVED:
ey:
Building Official
City of Tigard
STATE OF OREGON
County of Washington °8' November h , 19 73
Personally appeared before me the above named
Roy Brown and acknowledged the foregoing
instrument to be his- voluntary act and deed.
� 7 I
4." u U
�, N�afy Public or Oregon
STATE OF OREGON
i +` My Commission Expires: 1/16/75
ss
County of Woshirq,ton
I, klgi r Thouen, Director of Records
and Fe
m
ctions and Ex-Officiu Recorder of Con-
r veyonces for said county, do hereby .Vtfy_�
that the within Instrument of wrlllpe(yp .X E u
received and recorded in book of rKo
of sold County
Witness my hand and seal affixed. 418
ROGER THOMSSEN, Director of Rr)ip 055
f��l
Records 4 Elections _^�
1R 12 N3 u
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
structure (a) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Deed Records
of Washington County, Oregon, is prohibited by the ordinance of
the City of Tigard, Oregon: (The City will issue a release
as soon as a final inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
{�.�. �t..c..o t a►!.c�. �r c4 c�e,`t-. j'>,�as�� "S C��p\o'C
ADDRESS OF PROPERTY:
NAME OF OWNER: Mr . 6. Mrs
ADDRESS OF OWNER: '3 Q,c�
IN WITNESS WHEREOF, the undersigned has caused this
restriction to be executed this day of , 19=Ly
OWNER:
Name ,
DQE
APPROVED: ^/ Title
By: f
Building a
City of Tigard
STATE OF OREGON
County of Washington i all. fieve , 19
—9+
Personally appeared before me the above named
Fief Risen and acknowledged the foregoing
instrument to be his voluntary act and dead.
-1--t ti_�z«
Nary ub c or Oregonub a or Oregon
My Commiacion Expires: _
perm,
CITY OF TIGARD
12420 S. W. Main $4 **1
TIGAR9, ORIGOM 9'TM
APPLICATION FOR BUILDING PERMIT
New Construction X❑ Demolish ❑ Addition ❑ Remodel Move❑
P-D 11-6-73 _ 1
ZONING DATE ISSUED BUILDING PERMIT
DATE RECEIVED BUILDNG FEE $94,,22_ No.
r'f
PLAN CHECK $
— 47.00-� �';r'ZJ �
BY OTHER $ recordSkA�UATION $2685:5
TOTAL $ 145.94 RECEIPT No. 9 1 3.z
-6-1-3
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT M 7 MAP N CENSUS TRACT JOB M
Architect or Engineer Tualatin Development Cc. _
Address 15300 S.W. 116th Ave. , Tigard, Oregon Phone
Owner SPAS
Address Phone
Builder Same
Address Phone_
BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP I No. of Stories 1 Total Height` Area of Lot4jo_
Type of Construction XIXXIIXXXXXXXXWXXV Floor Area B---- 1 1668
Set Backs: Front—Q- Backer L.Side At R.Side y d►
Private Sewer Pipe Size dot `_ Sewer1eingi Eif-ij_ Septic Tank ❑
Water Service Pipe Size_ 1/4n Storm Sewer Q Ditch ❑ Drywell❑
Street and Curb Requirements as required by subdivision ordinance and P-D
Driveway Width 18o No. of Pa:ki.nq Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND l:UMHIN„
SPECIAL INFORMATION
ADDRESS ASSIGNED 10135 S.W. Century Oak Drive
FIELD CHECK BY� J8 DATE X11 41 AX 11-6-73
PERMIT APPROVED BY b"�)
It is understood) that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of Occupancy has been isaugd by the City of
Tigard Building Inspector. ♦ _ __
Sig ature o Applicant