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City ofTigard
INSPECTION REQUEST
T
Tor
INSPECTION TIME : PERMIT NO. :
DATEDATE ISSUED'--L--L
OWNER-I NAME : �r,LL
ADDRESS : / 3.2- S' S :� f34,,12fk `ir7
TEST' Air 0, Water El , Visual 0 , Laboratory 0
RESULT*. ApprovedX, Disapproved 0 , Pending L]
AT,1, �nJ"T FNDC: Tr3fOR T{!
SKi'T H: TSSiJA ICE OF BUILDING i'I'%i VIT
UANNINC, DEPT.
?UDLIC WORKS' r--I)T. �.0 r ��> ^- �__S'
3U J T,DITTG LT PT.
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-CTOR DATE _.
ENOTE' Attach supplemental lett data heret�
LWA
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : /1 �� PERMIT NO. :
DATE: ,2 DATE ISrUEO:__1_l
OWNERS NAFAE : R14-c All; Lc
ADDRESS :
CONTRACTOR :
TEST: Air ❑, Water C7 , visual,�, Laboratory [:] r
RESULT: Approved [] , Disapproved , l
_Y _ , Pendln9 0
SKETCH:
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INSPECT DATE
I [NOTE Attach eu
pplemanta! tie} data heret]
F.
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CitY of Tigard �
II NSPECTI ON REQUESTI
for
NSwecrfoN TIME:
DAY E: .� �S - EIRA41 T N0. '__.---.--._ I
DATE ISSUED / /
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ADDRESS: ._ a X15' S �i I
'ON TRA CTO R
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BEST : Air [fir Water Q -� --
faual Laborat y
RESULT. A Q
pprove d
Disapproved Q
Pending L]
KETCH:
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INSPECT R
DATE �
ATE: Attach sUPPlementai -est data heretp�
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City of Tigard
INSPECTION REQUEST
for
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INSPECTION TIME: 0 PERMIT NO. :
:
DATE: 2 A)OZIal, DATE ISSUED : I
OWN E RS N A M E : LBdZ tiA LL
ADDRESS: y _�.L w ���'x.>✓, �n, c 7`
CONTRACTOR : z2 LI-AS'
TEST . Air U, Wa rN p , VisualX Laboratory p
RESULT'' Approvo d Dieapprovet Q Pending p
SKETCH:
INSPECTOR DATE
COTE: Attach tupplomenta I tett data earetar
MAWR
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Cit of
City Tigard �
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. : _ I
DATE: DATE ISSUED :--,/
DWNF.RS NAML
ADDRESS: . f 1 / - — cjo-
CONTRACTOR ,
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TEST : Air E], WnterD , Vieuai Laboratory p
I
RESULT. Approved O , Disapproved Pending
SKETCH:
DIC PA PROVED
CITY Or TIGARD
J` DATE
TITLE_____ - _ --- -�--...J.�
INSPECTOR DATE
NOTE Attach supplemental test data beret]
City of Tigard
INSPECTION REQUEST
for
SPECTION TIME: �:�_. PERMIT NO. :
DATE: �1� DATE ISSUED :—/--/'
;NERS NAME .'
ADDRESS: �� 1 _�fy1 ,7
)NTR,ACTOR :
.ST . Air CJ, Water � Visual Laboratory p
A.
�SULT : Approve isad�� M, Pending p
,CETCH:
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/20 rL
,�r9it�(>C-�' lJC'7t/� yr�it✓
7
INSPECTOR DATE
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I
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ALL SPACES MUST BE ENDOW 13 D
PRIOR TO APPROVAL OF THESE FLANS
PUBLIC WORKS DEPT.
BY._-- _ ---- -- DATE_
PLATIN!:!G DEPT. -
DY_ _ DATE.
BUILDING D: ;-r. - -
L''Y. DATE
COUNTY H",L.TH C)-,rpT. GY.
DA I
-
7IG ,f2D 6i'.•',�R c.f:,r.
BY DATE
G;;NEZp.L TL'L::PHONE BY
U S A D A 7,7—
BY_.__—_� DATE—_,_
I ry• W. N4TUR,1L GAS
.__..
P. G. E. D:.TE
T. R. F. D. 13Y,-_ DATE—
BY..__ _ - DATE--
DISAPPROVED
CITY OF TIGARD
BY' ;it7A 73
l'ITLEAG�
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ADDRESS _ ,A7 �'--Is��. _ pE fi(nIT N0. �9(i ---
PFRMIT CHARGE
OWNER �. a iL - CONNECTION FEE
PAID BY _
TYPE. OF BUILDING ; _ DATE CONNECTED
SERVICE RATE � INSPECTION FEE ----
LONTRACTOR , �'Z PAID BY DATE
SI7_E OF CONN 'TION ,W __ _ ASSESSMENT � PAID �—
I,
1
�ity of Tigard
INSPECTION BEQUES T
for
!NSPECTIQN TIME . . l>C. PERMIT NC.
DATE , J JATE ISSUED
)WNERS NAME : _
ADDI(eSS.
Wo —
EST ' Y ter[7 , '_ rbc►et)r,, _ r
RESUL. suppt�.ad G endioq I] I
S KETCH:
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INSPECTOR DAT
NOTE: Ati lCh suppiementol test uuie hereto !
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City of Tigard
INSPECTION REQUEST
for
i`,SPECTION TIME: � ' ` PERMIT NO. : -.
DAT E : ? 322 D AT E I S S U E D :
A � i
JNERS NAME : ��/��
A LID R E S S 43a-f_s
)NTRACTO R : - -- -- -
=ST : Ait u, Water[] , Visual �, Laboratory ❑
cSULT. Apnrc)ved Disapproved ❑ Pending Ll
(ETCH:
I
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INSPECTOR DATE I
TE Attach supplemental test data hereto]
1
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City of Tigard �
INSPECTION REQUEST
i
for
SPECTiUN TIME'- --- PERMIT
DATE: il/g�?JVZ� DATE ISSUED
INERS NAME : -
A D D R E S S: -
)NTRACTOR :
I
.ST : Air U , Water , Visual ❑ , Laboratory ❑ i
_-SULT . Apr.roved O , Disapproved �.�,_Perldiny L]
(ETCH:
I
I SPECTOR DATE
1E Attoch t ipplementol test data hereto]
City of Tigard
INSPECTION REQUEST
for
SPECTION 'TIME. -'P6 PERMIT NO.
DATE: IL Z2x33 DATE ISSUED '. Z-.-
INERS NAME ' r --_--
ADDRESS:
)NTRACTOR -
_ST' . ,,Ir Ci , Water 11 , Visual', Laboratory 0
Disapproved Q' Pendilig U
ESULT . Apnroved Qisapp ,
(ETCH:
0 AJ
Te
INSPECTOR DATE
� ' Attach
a hereto
supplemental test dat ]
I
u
i City of Tigard
INSPECTION REOUEST
I
for
INSPECTION TIMZZ : PERMIT NO. :
DATE: // DATE ISSUED: __Z —Z—
OWNERS NAME : —
IADDRESS : _/3--) 5 ,��.� t��•<� _ --
CONTRACTOR :-----
I
TEST: A r '13, Wctei pi� Visual fr�, La" ,ratory El
RESULT. Approved, , Disapproved J Pending ;]
I SKETCH:
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AN3PECTOR DATE
OTE : Attach Ipplementol fest data heret01
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City of Tigard
1
INSPECTION REGUEST
for
INSPECTION TIMIz'--L2-,c.r� PERMIT NO. :
I DATE * /-1 4-ZL DATE ISSUED'
..!_L_
I OWNERS NAME : —
ADDRESS _1�e
I
CONTRACTOR :--
TEST '.
ONTRACTOR :--TEST : A r LI
. , Water Li , ��istsaX, La'' ratorY PI _ RESULT. Approved �' , Disapproved 1 , Pending �]
SKETCH:
I
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INSPECTOR DATE
I COTE Attach u
J PDIemental test data here}]
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : �1� PERMIT NO. '
I DATE: LL1.�%.?3. DATE ISSUED'-
-Z--L-OWNERS NAME :
I ADDRESS :
I CONTRACTOR
TEST: A r J, Water ❑ , wisuciX La` ,rat( ry [1
J RESULT: ApprovedXff' , Disapprwled _] , F1.9nding []
I
SKETCH'
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INSPECTOR DATE
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INOTE : Attach supplemental teat data heret]
1
4535
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupeny 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 De!+d Records
r,f Washington County, Oregon, is prohibited by the ordinance of
the City of Tigard, Oregon: (Thv City will issue a release
as Bonn as a final inapaction determines that the construction
AS satisfactorily completao)
DESCRIPTION OF PROPERTY:
Tax Lot 2000, lot 14, Tax Map 2S1 2DB
Burnham Park Subdivision
ADDRESS OF PROPERTY: 13255 S.W. Burnham Court
NAME OF OWNER: Arthur Pruitt
ADDRESS OF OWNER: 6339 S.W. Peyton Road, Portland, Oregon 972x9
IN WITNESS WHEREOF, the undersigned has caused this
rnatriction to be executed this j day of ,( 19j
OWNER:
APPROVE[): Title
By: / \ r� —
u 0 1c
Cit, Tigsrd
STATE Of' OREGON
raunty of Wsahington ; on. (�-,._1 , 19 -1-2)
Personally appeared before me the above named C w +"X ^_
\' y Ott and acknowledged chn foregoing
instrument to be y�ad� _ voluntary act and deed.
Notary VublTr. for Ora on
My Commission Expire _
,,/j�
ni.e .,.e.„d �G...-1.7....to.7,eN.L`_'..A x.+at
Roots?NOM FI ftec—d MerdS•swaft"
so�K 949 i,,v564
ao
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UNIFIED SEWERAGE AGENCY NO. 4896
WASHINGTON COUNTY DATE 10
CITY OF--- r�15 � -- – -- - — -- --- --- —.—
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: C-U
OWNER'S ADDRESS
STREET
CITY - --- - STATE ZIP
BUILDING SITE: LCT BLOCK ADDITION 8v12A1_a_^W9 _ ut
TAX LOT NO. _ TYPE OF OCCUPANCY
ADDRESS / _-' ,�St!r�. $vew t44N1 CARW X _
DWELLING UNITS. FIXTURE UNITS_ _—
SURCHARGE IF APPLICABLE____-__-_
9W ate' o
PERMIT FEE_450- INSPECTION FEE e�" _ TOTAL DEPOSITED
INE (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
r� . . - -(
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE -
q,, __ _- INSTALLER
RECEIVED BY.
I k INC Y pR1T$A INTI
COMMENTS: fJl�� 1�'�Vrt� 73 - ai - _-
This Application and permit expires in ninety 190) days. The amount paid will be forfeited
should expiration occur.
i
CITY OF TIGARD
11120 i. W. Main Ore*
TIGARD, OREGON VW
APPLICATION FOR BUILDING PERMIT
New Construction Der dish ❑ Addition ❑ Remodel Move lJ
ZONING DATE ISSUED [O -!�L- BUILDING P.:RMIT
BUILDING FEE $-R3 02!: No.
DATE RECEIVED �(�p
BY PLAN Fdt VALUATION $
OTHER r b,r�Trt 5 1 x4
TOTAL $ -I RECEIPT
TWO SETS OF PLANS AND PLOT PuANS MUST BE FURNISHED WITH APPLICATION
LOT M /¢ _ M5
AP A Z_( -117a CENSUS TRACT _ L-, '� JOB A
Architect or Engineer_ 1U 41►�So'.. L✓LA�VUF.acT__?_.' =� C -
Address _Phone
Owner SAM
Address __ Phone
Builder `Zp11C1R. ----------- -
Address _•___ _�__ -_Phone
BUILDING USE Single Res. ❑ Multi Res. El Comm.
❑ Industrial❑
OCCUPANCY GROUP _ No. of Stories i Total Height Area of Lot
Type of Construction I II III IV ® Floor Area B-__ 111 _-• z_
Set Backs: Front=a I Back L.Side R.Side Q
PrivateSewer Pipe Size4 _- SewerU�01/ -.- jUtdj.I�PPtic Tank ❑
n (�'
water Service Pipe size_ Storm Sewer., Ditch �❑ DryweI ❑
Street and Curb Requirements__-
Driveway Width 17 ' _ _ No. of Parking Spaces_ Z-
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNEDZ`S_�__ 1
FIELD CHECK BY
e-00"
• _ �-_ --- -•--------_ DATE,/L� -4-i�
f'
PERMIT APPROVED BY
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, anti that the building wil
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector. ke
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