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9255 SW INEZ STREET-1 9255 SW INEZ STREET c3 � ►i a rb -- _ m o i ISa 6 h-I O w i rn w oc Ei � J I LI Tit i KUIBIT "B" 15514 CITY OF TIGARP CUITUICAU OF OCCUFANC( kW HLIAA;;E of IWt iTHLCTION The City of TLS%rd hereby certifier that the occupancy of the folloving described structure or Nremisec vitb -aspect to vhich a restriction of occupancy YUB, on November 1 1� 9? recoraed in &wit 951 , i'a®m . 425 _ ,, Deed Record of Washington County. Uregon, is hereby authur ized acrd approved. DESCRIITIUN OF YAt1I'l Ti: lot 12, Penroee Terrace, Tax Map 251 IAB UWNU: KurtBelt BUILDING I£RMIT NIMER: 73-239 BUILDING ADDftL;S: _j2r This iw to oartify the said structure meet^ vith the require- marts of the Building Cude of the City • f Tigard and the ebuve referenced re,ktrl:tioh hereby releaned ani ters,fiated. IN WITN= 'WT[EREUF, the undersigned authorized officer of the City of T Bard han caused thi9 certificate and rolea:.e of restriction to be e:uecuted this .; day of 1j , Title: JTATA of uRW oN County of Wa.;hington )ss. On too 5 clay of personally appeared before me the above named .L✓ vhone sighOL-l" .gear . hereon and who arknowledgeu to me t he ehoecuted the new in hi lffical capacity on behalf of the City of T:gani. tar FC o9rmgori My Ct Ss a Iran: cw rammer,b`w..,a Ok..,.„,. -� �� ���b � "� � r ��u[ f� `� ���� � ` . �� � � � �► � � � � � � �� � ��a � �� � ; A • CITY OF TIGARD MECHANICAL PERMIT DATE.fo �.' �� PERMIT N0. _� -�� ��_ RECEIPT N0. _�� 01 • FEE By neem n't of 1. Permit shall be obtained foroalloappliancesewhich are ttolbeco�n� • 7, permit ,shall be obtained . a fixture to the building. Beocation, replacements, alterations, or changes to burners 3. vire permits. duct work req u-1 All work to be concealed must be inspected before cover up. = Rept ace �- Relocatiori Addition [j Alteration New Install<„ on OWNER_ ADDRESS WORK ADDRESS APPLICANT Qawc czg��s• TELEPHONE NO. TELEPHONE NO.. FUR!N'ACE I11ANUFACTURER O____ Vent Size ��� Flue Si.7 a ,,� l HEAT Input rating (Btu Per Hour) 1A, Do I I � OTHER FUEL OILF-1 GAS n ELECT 1-1 ---- Main Floor BaNement Floor TOTAL SQ. FT. Top----------- GENERAL FEE � --- --_—.._._ ITEM �^• N0. 1 ITFM N0. of Permit 3,00 Boi_ler5 0�. J For Issunnc©•_ — Air_Handling 1_0,000 UFM _ New rider 100,L000 Btu 4.00 _ andlin Over ].0 00 . CFM New v0 e r_100 000 Uup0� Air_N _ _�_Furnace --_x+:00 Evaporative Cooler Floor �7}.00 Vent Fan em_ - Meat & CoollnVen --- t3oilersV�+.00JA6-1-1 e rsy3 o 15 � __ _'•5�_' ��mm_��Inc�n`era dr ,�,__._ Boilers 1.0.00 Ohe�r I�o�_ ,LMs�ed INSPECTOR' S COMMENTS APPROVED BY ________ DATS ,� �_ __� ISSUED BY __� _ _ DAT& �-M )� 1 w I I I Get,V of Tigard INSPECTION REQUEST I for IINSPECTION TIME : PERMIT NO. : DATE : DATE DATE ISSUED:__L_ L. OWNERS NAME . �f �� 4)0 L- ADDRESS : 1 ( iu _ CONTRACT 0 R .__ -----.--------- _— TEST. Air 0, Water ❑ , visual 0 , Lcboratory ❑ RESULT. Approved Dt3vwv�d PendlnC ❑ SKETCH: t oil L-10 gess /V I INSPE TOR DATE IOTE : Altach supplemental test data herat01 w ar ■r w r, w � � �► �r � I ' City Of Tigard gand INSPECTION REGrUEST f or, INSPECTION TIME : , .3 e- PERMIT NO. : DATE: 66 i21LV� DATE ISSUFD:.--Y—i, OWNERS NAME : IADDRESS : t -- --- ICONTRACTOR : — — ------ TEST'. Air CI _ Waver E1 , Visual i.] , Laboratory [] RESULT. Apprcved 0 Disapproved Pending Ll SKETCH: Pit dr ele To I ?-rejX p —TNSPEICTOR DATE ICpTF . ,(�tt,3ch %upp!ementa! feet date heret,� I i ALL SPACES MUST BE ENDORSED PRIOR TO Ah OVA! OF T ESE PLANS ! PUBLIC WORKS pF_PT Y _ OATE� PLANNING LEPT. BY_- DATE---_— BUILDING CEPT. BY.- _- ^'TE_..__ COUNTY HEALTH DEPT. l3Y_ CITY ADMINISTRATOR BY--- DA-!T - TIGAF2D WATCR tiiar. GENCRAL TELEPHONE EY D U S A BY._.. N. W. NATURAL GAS P. G. E. BY T. R. F. D. • � Oji , , �'. �,;>•�'1i 1�!!�.slri l�iytltr r.z t,t;;, r r.li�,' f, , 1 . 1 j,.. h MIA i; 1 J 1 i i I Citi, of Tigard INSPECTION REQUEST for INSPECTION 114 : --Z PERMIT NO. ' --..- DATE O. : --.._DATE: _y_112 _ DATE ISSUED'_..1.1_.._ 0 W N E R S NAME : inv ,ADDRESS : ����� CONTRACTOR :____�_Z- ,FEST* .'FEST: Air D, Water p , VisualA 11 Lohoratory p RESULT: Approved Disapproved p Pending p SKETCH: I I 1 I I I I INSPECTOR BATE ICOTE Attach supplemental test data horst I i WAMEWINA Aran I Cit I y of Bogard INSPECTION REQUEST for INSPECTION TIME: PERMIT NO. : DATE: � DATE ISSUED :. _" OWNERS NAME : ADDRESS: Z _S' CONTRACTOR : -- TEST : Air p, Water C] , WsuolD , olYbrotory Agu [r]l RESULT: Approved !3Disapproved ❑ Pen S KETCH: r I i Amex;. vVn ., 7`0 0ar4 erg`. I 'INSPECTOR DATE ! NOTE Attach supplemental test data hereto �r � III II� 111111 II" IIIII� � � IIIII� 1 City of Tigard INSPECTION REOUEST _ for 'NSPECTION TIME : " _ PERMIT NO.: - DATE: 31''SJ DATE ISSUED: / OWNERS NAME : �-c''E= ----- ---- ADDRESS ' 92S-E "�' l t�,G�� CONTRACTOR '---- TEST'. ONTRACT0R :----TEST. Air U, wo'er [] , Visual [�C, Laboratory ❑ RESULT: Approved , disapproved 0 , f'endinq [❑ SKETCH: _ jf- �/rte/" Vt,�vuy INSPECTOR DA7F NOTE Attach supplementol toot data hereto G� ly y Addeeee—q', ,�s -� Permit Na. _.� Permit charge Owner ��w .t � Connection fee Paid by _ 'Type of building ' ,- Date connected Service rate do inspection fea Contractor rte" -�' 1� Paid by date Size of connection Assessment paid il: � � �w RI[ �Ir � R► � �I I I City of Tigard INSPECTION REOUEST for INSPECTION TIME : PERMIT NO. .' — DATE : O. :DATE : ��LL� . DATE ISSUED: OWNERS NAME :-� _R s AFiDRESS : CONTRA "TOR :__ Z pz_, I TEST. Air ❑, Water L-] l,, VisuaLaboratory El RESULT: Approved.�k'.T, Disapproved ❑ Pending ❑ I SKETCH: I I I I I I INSPECTOR DATE ' COTE : Attach supplementol test data hereto I 0 i I I City of Tigard INSPECTION REQUEST for 17 INSPECTION TIME : " PERMIT NO.: DATE: -51 DATE ISSUED: OWNERS NAME : ADDRESS : -2y,5- t-a , CONTRACTOR :_ k' L-- TEST: Air O, dater tj', Visual , Laboratory [] RESULT: Approved`O , Disapproved O , Pending [] SKETCH: INSPECTOR DATE [OTE : Attach supplemental tact date hereto] i I Mumul I amity of Tigard INSPECTION REQUEST IN I for ;NSPECTION TIME . __ _. _. _. PERMIT NC. DATE : JA E ISSUED OWNERS NAME ADDRESS : .., CIN TRA'".T n R " EST N ter 0, c! +R.ESUL _� r�;veA U -Upp� ,,r;d G �a�»��_U I SKETCH.' 7 1-�, L L INSPECTOR DATE II 50rE: attach suppiementai test 0utu —r tuJ I UNIFIED SEWERAGE AGENCY No _ 4907_ WASHINGTON COUNTY DATE t CITY APPLICATION FOR SEWER CONNECTION PERMIT OWNER In;. Kvrt PI.i� 11 OWNE P ', 40019195 _ 91t5�K.JIIa Sh•n�n�Ohit�1,iY _ ._____..__._.....__.___ _.. 011111' cIvv lunl®tln B Or ,r�__ HUILDING SITE; LOT_ _.._ BLOCK ADDITION TAX LOT NO ..__._ ..__ TYPE OF OCCUPANCY IYtldrilC!.. ADDRESS 92$5 .5_Tys Inez DWEI LING UNITS 1 FIXTURE UNITS SURCHARGE IF APPLICABLE _..___.._._. .__.__. . PERMIT FEE pg INSPECTION FEE 25 TOTAL. DEPOSITED 475 (INE W) IFXISTINGt BUILDING SEWFR SYSTEM _._ Tigard TO, Aiwh(.,r•t agrees to comply with oil rules and requtaliom of t1wUnified Sewerage. Agency APPLICANT1N\ 1-3,Jj, SEWER PERMIT "I", VI IJ%IIT AUT14ORIZES CONNECTION TO THE SEWER SYSTEM. nr' INSTALLER Kurt Bell „I I I fl Hy VLLI fid C� .IDIr V I� ll.•I.� to r OA ITf AOfMTI t`jppf // c .,A 1.N1c t-�IrLt f tt,.% Apnl,cehcrn and hermit Pxoitri in ninety 1901 days The ,inti/tlnl v.+ld wlll he faflnilr,l shrn,Irl OX04,811l„t Occur c � (MS EKH2lIT "A" CITY OF TIGARD Residential Structure Occupany Restriction KNOW ALL REN BY THESE PRESENTS, that occup&ncy of residential structure (a) on the following described lends 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: (Tile ,:sty will issue a release as f000n as a flsal inspection determines that the constri)Oion IN satisfactorily completed) DESCRIPTION OF PROPERTY: lot 12, Penrose Terrace, Tax flap 251 11AH ADDRESS OF PROPERTY: 9255 S.W. Inez "ME OF OWNER: Kurt Dail A OR SS OF OWNER: ®125 N.Y. Shenanddoha War, Tualatin OrsAla.__ IN WITNESS WHEREOF, the undersi;ned has caused this restriction to be executed this _r_ day of OWIIER: APPRO VED: / -'Tills Byl /Building c i s 4, mtp,rr C'a 0.,*aarA- Clty of Tigard STATE OF OREGON County of Washington es' _ :S , 19 Personally appeared before as the above named ',�v + end acknowledged the frrsgoing Instrument to be voluntary act and deed. Notary ub c or a gon . Ry r.ossission Expires: Am PA 951 .:4z5 7 G4bb�C � �•�, m N w _ � V9 a K m v 1 EXHIBIT "A• CITY OF TIGARD Residential Structure Occupany Restriction XNDW ALL ALN BY THESE PRESENTS, that occupancy of residential structure (a) an the following described lands prior to th, recordi:ig of an occu +ancy permit releasing the restri*tion in the Dead Records of Usehington County, Oregon, is prohibited by the nrdinen a of the City of Tigard, Oregon: (The City will .esus a raleess an soon as a Ileal Inspection deterainve .het the r,onstructton :q satisfactorily coaplateo) SCR P 10N b► PROPERTY: lot 12, Penrose Terrace, Tax Map 231 11Ae ADDRESS OF PROPERTY: 92f" i.4. In4oz NAME OF OWNERt Kurt gall_r ADDRESS OF OWNERt 6125 N.u. Shenandoha War, Tualatin, Orscnn IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this day of �, 19:.- OWNF R: Rose ----ti----=--1"+— all APPROVED: T syt— City of Tigard STATE OF OREGON ) •• County of Washington ) 19 Personally appeared before as the above named t ! and arknowledged the foregoing Instrument to be voluntary act and deed. k, --, Notary itblic for regon My Commission Expires: CITY OF T'IGARD 17420 A. W. 100n Mnw TIGARD, 04004* "723 APPLICATION FOR BUILDING, PERMIT Now Construction �X Deswlish C1 Addition Remodel 0 Move 0 CONING&7 DATE ISSUED 1L15-j,3 BUILDING PERMIT BUILDING FEE $ 94.00 DATE: RECEIVED NO. 73 . 239 BY PLAN CHECKTecordin9 fWXATION $ 28,790 OTHYR TOTAL $145.94 RECEIPT No. TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNIISHED WITIl APPLICATION LOT 1 asapass, Wr!__24.L­4jAS_ _, CENSUS 'TRACT , i�••a- JOB 1� Architect of I:ngineer_ Knigh A Piercy Address 2735 N.E. Broadway, Portland Phone Fwner_!^ jt_ 1L" 1!. gall A,.dress 812S N..Y. Shenandohe Way, Tualatin Phone guilder William C. Beesuv Address 2190 Fernvood Circlet Lake (jayego_ _ Phone636-_1594__ BUILDING USE Single Pen. N Multi Res. Comm. Industrial C )CCUPANCY GROUP I w No. of Stories I — Total Heright`___ Area of Lot Ty1v of Construction XXj) cXXg0ItXX)=X V Floor Aron B _ 1 464. 2�„_ Set Backs: Front- 211� dack____M4' L.Side_J _-_ R.Side 51 Private Sewer Pipe Size 4* Sewer Al"_jlpe V Septic Tank 4ater Service Pipe S1ze4s Storm Sever [] Ditch hryweII l� Street and Curb Requirements Driveway width 4,A- _— ___ _—No. of Parking Spaces, 2 SEPARATE PFPMITS RFpUIPED FOR SEWER AND PLUMBING SPECIAL INFORMATION ADDRESS ASSIGNEU�i FIELD CHECK 9Y--_..w_ ]p In.1S,22______,,, PERMIT APPVVED It is understood that all work will conform with applicable �Nides and ordinances of the State of Oregon and the City of Tigard, Oregon, and that the building wi: not be occupied until a Certificate of Occupancy has been issued by the City of Tigard Buildina Inspector. ] Signature of"A pllc n PL tiIBl NG PERMIT AFP1JCATIGN Jurisdiction of __---_-----__-- - Type of Fixture Fee Permit No. No• Permit fee _'-• Water Closets (Toilets r,. C 0 Permit Issued Bath-Tubs _—_ o Approved by Lavato_ y _a_sh_B s?�_- -_Sl Boilding Perm t �i Shower _ - _ r Receipt No. _Sin sDlshwachin-___ S�_nks ._Kitchen_____� _ Sinks Urdinarx_� _.__ Locat:ion of F.iildir.g_S - ks ._Bar ---------- -----c -__—.� �sG.. 1 = JZ Sinks, Sl Slop_ ._ -_ ._-..��--��•�y�;�..-�� ��ti1.�..cs_---_.-- - -- Automa t7 c Di- iiwasher__ J• o & Add:ess ,of Owner ---•--•____-- - --- Nam -._. ------------ D:-ains.t Floor Dra,.ns Area___-- -------- nra_ns�_Refr_lgeratar — ----- ---• `�---- Ra-_n Urai.ns Waaher Name__ .7' 'o� & Adare� of Plumber Autuinatic �� � � ciunta�insrin�c-in _ �•1�• ;` '.�-�`=�- - --- +Foun _�� y ! � �_ �'�-� Ho L, Water Tank _ ___�'`, _ �, -- -- Size 3 T- 7- -vice _ Water Lei vice l ____�Z_ �-° ' Buildin l Old or New Alter Re air or Urinals Ol --�-�-5 �—L-----_—. Ca tcn_-Bas1ns_`Yar.d ---- _nstal -----. - ---- - _ Lawn_Spr i n n l e r_System - - ,ng Po o1- -_.-- ___-__ Other --- _�p7.in_kler d is no This permit become- null and void ifwork oorwork r ncisosuspendedauthori7or abandoned cor-i�nenced within 60 days, or if const for a period of 120 days at any time sifter work is ccmmenceda All plumbing firms must be licensed by the City of Tigard and post a $1,000 bond. I hereby certify that I have rpa.d and examined this application and know the same to be true and correct. All provisions of Jaws and ordinances governing this typ of work will be complied Edith whether specified herein or not, the granting of a pexmit does not presume to give authority to violate or cancel the provisions lating construction or the performance of of any other state or local law regu construction. Signature pp .L •r