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OUILDING PERMIT
PEAMI'r NO. : EIIIAIM290
CITYOF TI67ARD CITYOF'WARD [)ATF. ISF)IJED : 1. 1 12 0.1,/14 8
(,)MMUNJTY DEVELOPME.JT DEPARTMENT PA114. PMT .NO 670290
13125 SW Hall Blvd..P.O.Box 23397,Tigard,Ov3gon 97223,(503)639-4115
'301-7 111TU11177.15 E]13 5W KA11117-74TRE
Cl'1X NOV/1.01 IP S 11.3 83.4-.111 SUB: 0RUCIi. 1. 1, HK
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VALLIATTON 11 1 000 %E I FMC.,KS
FRON'T, 44 PEAP 6
0117111 CI A r5 ADUVrION DWEL.L. . LJNTTFj 1. L F.,F r I G1.11, a 105
I Y PIP.:, - !tiTNCI. .F I.-AMYLY NO F:IF.*l)l4.)0MFi r..:Y,I wAl I. rn�js,r -
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R
NIMIETPT NO.
This permit is issued subject to the regulati-ris contained In ritie 14 M.% 111J)VE) XNIGPEC'ra:)W:
of the TVAr' State of Oregon Specialty Codas,zoning regulations I 001-r.1411l",
and all other arplicab,e codes and ordhiances, and It is herebv
agreed that the work wi'I be done in accordance with the plans and
specifications rind in compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive FPAM T NG
covenants Contractor and subcontractors shall have currerl,city * -111.(YI 1:t IN
114 11
business tax permits. This permit will expire and become n,ill and (31 Y P 00611111
void if work Is not started within 180 days,or If work is su4tpi ided or
abandoned for a period of 180 lays any time after work has VT NAl.
commenced It shall be the respon-,%ibility of'he permittee to assure
all required inspections are requested and approved.
Permittee Signature
FY11 I I OVI 6.49--Alt 75,
Issi:ed By.
SEPARATE PERMIT'S REQUIRED rOR WORK OTHER THAN DESCRIBED ABOVE
BUD PING, T
RDCIIYOFTINA1-1F.4"hil NO . BU870R90
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SAV.Hall Blvd.,P.O.Box 23397,Tigard.Oregon 97223,1503)639-4175
JOB ADDRESS: 12483 SW KATHERINE ST
'TAX MAP/1-OT 2SI389.1400IWH: 9PUUKWAY
LAND 1JSE- R4.5
L OT 51ZE: VALLIAIAUN: !:iEl RACK S
FPONT : 44 f-WAR: 6
CLASS : AUD3:*Y TON DWEI L .UNITS : I I-EFT . nIGHT : 25
0. YPF : ISINGLE FAMILI NO. Hl-,-DROOMS : F X1 . WAL I (31NGI
CONST .TYPE: VA NO. PATHS : N: E: W
01 . 0111C N.I.NG
(,.)CC3.jP.GPP , : A3 VIA'
OCCUP.LOAD N: S : E : W :
TOTAL APEA
Nil'— STORIES : I IST: 336 WOF CONST* : C FIRE PET?
W.I OHT : It 2Nrj: EP(.'414'{
BASEMENT? 3ND: OCC UP. SEPAP7 PATED :
ME.ZZANINE7 0.11ASEM I T
FLOOR :-DAD. 40 GARAGE: FIRE SPPKL.P*? AL.AW?
f.I.,Ow (UPM)
HEAT TYPE---
111.AN CHECK BY : bol'
Pf.,:'MA RK S
F11EIUv%UE OF NO .
LASI REISSUE
0
W It"bertz garry PERMIT $104.5G
N
E %w knithe.r,irm tat PLAN REVIFW $67 .93
R OR 972e3 FIRE DEPT
PHONFI.- 1-11103) ils.'59601S STATE. TAX 5 .83
OTHER
C F. EVE CHARGES :
0
N SAMUELS BOB SDC(STORM)
T KAI rnAMUEL.S INC . SCIC,'1 $1 1,411W.4 1
R
A 8735 SW LEHMAN PDC(f
UP 97p-e:1i PPEPAID < >
o PHONE (503) e46-4730
R DEC.A.S I IiAl ION NO. 1;1X3.71 TOTAL. 1111111117 l 601
This permit is issued subject to the regulations contained in Title 14 RECEIPT NO.
of the TMC, State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and It is hereby I REQUIRED INSPECTIONS
agreed that the work will be done in accordance with the plans and For)T INC;,
specifications and in compliance with all applicable codes and POST 4 BEAM
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and Subcontractors shall have current city PAIN IMAINS
business tax permits This permit will expire and become null and FRAMING
void it work Is not started within 180 days,or it work Is suspended or I NSULATI ON
abandoned for a period of 180 days any III a after work has GYP. BOARD
commenced a r
. It shall beluxtsponsihilit ermittee to assure F I NAL
all required ins? pproved
.jKWn,.
P e I m I t,v lit,
Issued By
(1041-1 FOr.1 INSPUT"tION A1,1119-1-11.15
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF TOA RD PLAN CHECK APPLICATION
01YOFTWARD PLAN CHECK I
COMMUNfTY DEVELOPMENT DEPARTMENT ORROON
1312SSWHORBlvd.P.O.Sm 23397,T19W.Oregon 07^.19(503)M4176 PERMIT fi
—-- DATE, ISSUED
JOB ADDRESS: /�LJ r_ fj f �', TAX, MAP/LOT_
SUB: � OT: LAND USE:
VALUATION: SETBACKS: FRONT- REAR: .LEFT: --- RIGHT:- <��
WORK CLASS: HEIGHT: TOTAL AREA: 3�,
USE TYPE: E FLOOR LOAD: / 1ST:
CONSTR TYPE: < HEAT TYPE: 2ND:
OCCUP GROUP: ti_ �t DWELL/UNITS: _ 3RD:
OCCUP LOAD: NO BEDROOMS:_ _ BASEMENT:
NO STORIES: NO BATHS: (,ARAGE:
IMP SURFACE: _
APPROVALS REQ'D SPECIAL NOTES ITEMS REQUIRED
PT.ANNING: REISSUE OF: _ LIST SUBCONTRACTORS:
ENGINEERING: LAST RFISSUE: BUS TAX:
FIRE DEPT. : FLOOD PLAIN/ CALCULATIONS:
OTHER: SEN LND.: TFUSS DETAILS:
PARKING PLAN:
LANDSCAPE PLAN:
PLAN C'iECK BY: OTHER; _
COMMEM.'S: � `{Cmc C Ca
ACCT # DESCRIPTION �- UNT
OWNER 10-422 Building Permit Fear
NAME: 10-431-600 Plumbing Permit Fees $-
ADDRESS- /,2•� G 1 10-431-601 Mechanical Permit Fees S
I�zz� r 10-230-501 State Building Tax (5X)
10-433 Plane Check Fee ?
Pl(ONE: ,- i 1 C1 30-443 Sever Connection (20X)
30-202 Sewer Connection (80X)
CONTRACTOR 30-444 Sever Inspection
NAM'L. - .91 S '� .51-448 Street System Dev. Charge (SDC)
ADW S•- `' 011/ 52-449-610 Parks I System Dev. Charge (PDC)
F- 52-449--620 Parka If System Dev. Charge (PUC) �-_
31-450 Storm Drainage Syst Dev Chrg(SSDC) -
PHONE- 10-230-505 TRFD (95X )
10-435 TRFD (5X) 3
ARCH/ENGINEER 10-230-506 Washington County Fire 11 (95x)
NAME,: 10-435 Washington Couiity Fir,- (11 (5X)
ADDRESS: 10-220 Amart/Wedgewood -
_���� TOTAL _c`2 2 `..
PHONE:
- ---~��- _ PREPAID __.
REC A
BALANCE DUE ! i ✓ ;?
APPLICANT SIGNATURE
Received By: Date Received: LZ I/. 7
h
<� 47, C' u v '<
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I
1
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :
DATE : G 11-a/r3 DATE ISSUED :,GELD
OWNERS NAME : —
ADDRESS: laµ 3 �w (Nat � _�@�
CONTRACTOR : -- - -- -
EST ; "doter CI , visual I.] , -aboratory p
RESULT ' hp ,raved Disapproved I] , pendinq
SKETCH:
INSPECTOR DATE
NOTE Attooh —r-,c1ne.ntal teat data hr;reto�
PLUMBIAG PERMIT APPLICATION
Jurisdiction of
`No. Type of.' Fixture Fee Permit No. �
IPermit fee � +
6 '1 Water Closets Toilets ° " Permit Issued
Bath Tubs Approved by
Lava torWash Basin Building; Perm-if.'��`�
+ Shower u- Receipt No.
Sin s Dishwasing _
Sinks Kitchen -`
Sin s Ordinary Location of Building
Sinks, Bar
Sinks Slop
Automatic :isFwas er_ '
Disp sal
Laundry Trays Name &. Address of Owner 1�11u�3_,._„ f "
Drains Floor
rains Area
Urain� Refrigerator
_
Rain Drains 5-
Automatic Washer - Name & Address of Plumber
Fountains Drinking
rounta i. is, S,
rHot Wa tearik
Water Service Size
Urinals Build 1-1Old or New) (Alter, Repair or
7 c�Fi-B aand Install) 1e..t.0 ex-i
Lawnprinkler System
_1 SwiT11ming Pool 0Fier
S rinkler System �
This permit becomes null and void if work or construction authuri.zed is not
commenced within 60 days, or if construction or work is suspNnded or abandoned
for a period of 120 days at any time after work is c;mmenced.
All plumbing firms must be licensed by the City of Tigard and post a $1,000 bond.
I hereby certify that. I have r-ad and examined. this application anci know the same
to be true and correct. All provisions of laws and ordinances governing this type
of work will be complied with whether specified herein or not, the granting of a.
hermit does .not presume to give authority to violate or cancel the provisions
of any other state or local law regulating construction or the performance of
construction.
d —4zw..�'
Signature of ppi i ,:-_i
CITY OF TIGARD MCI-TAl1`..CAL IF
PERMIT' MO. i�l i •" _ RECH2 r' No.
by FEE GO"
1. Permit shall be obtained prior to commencement of installation.
2. Permit shall be obtained for all appliances which are to become
a fixture to the building.
3. Relocation, replscj�ments, alterations, or changes to 'burners and
ducat Work require permits.
4. All work to be concealed must be inspected before cover up.
*w Installation Replace ❑ Relocation ❑ Addition ❑ Alteration
CONTR.� L1�L._._ x111OWNER
ADDRESS 70 5 .W �-- } U �, WORK ADDRESS
APPLICANT Ar;Rp 4- 1TELEPHoNE NO. _�-(fir ,
FURNACE - MANUFACTURER I.C' IV -�C TELEPHONE N0. ./
HEAT Input rai ing (Btu Per Hour) 1/_a' rp_ Vent Size L`1 Flue Size
FIM OIL [jGAS '"' rr ��ELECT L_.J OTHER
TOTAL 961. FT. Top Floor Main Floor Basement
GENERAL
ITEM NO. T ' ITEM NO. FEZ
Issuance of Permit MOA
ilers Over, r0 H
mer �0 UO ur andl:in 10 U 0 r7M
Uver 1 ur an ri er QoQ
oor Furnace , "
U-0-ora ve ca er.
il an
nts
ae oo no sem0 mes c Inc nera ,or
ere o U cE$ nc nera or 0
ers o 1er Not TT-sTee --
i o . ers o ---�--- •
Y
+ INSPOCTOR S COMMFNTS /l
2Z)
f
APPROVED BY DATE
_ ISSUED BY .�
TE a
,,
Signature of Applicant
�) A7 r� tt u'n t hw ri Y1F+ �i1:.rBet Permit No. 117Fiy .
Address .� � — -
Permit char9C -- -- ----.
Connection fee
owner
Paid by
Type of building lje-I PLO—.— Date connected
Service ratQ Inspection fee
..,.,___.
Contrac•�or1. -_.___ Paid by �_.. & _ Date
Assessment Paid.
Size of connection 421 -----®-""" -'�
et s»< ser w A wv Asa
i
City of Tigard
INSPECTION REOUEST
for
INSPECTION TIME : PERMIT NO. : -"7`d 2
DATE* // L0172 DATE ISSUED:
OWNERS NAME : -- ---
j
ADDRESS :CONTRACTOR : - - - 4' - ._-.. ------- --
TEST. Air ❑, Water p , Visual Cry Laboratory p
RESPLT. Approved D, Disapproved ❑ , Pending []
I SKETCH.
I
I
I
I
i
INSPECTOR DATE
INOTE Attach supplemental test data herrtd
I
fC' '
UNIFIED SEWERAGE AGENCY NO. ..__ 4769, _
WASHINGTON COUNTY DATE
CITY OF____ v __..Tie _�.�_____
APPLICATION FOR SEWER CONNECTION PERMIT
OWN E R: ____ . .____.._.__._-_D�nials, Wiggins & Dsr►iels
OWNER'S ADDRESS: .19� B.W. Burnbaw
---------_____.
STREET
97223
CITY STATE ZIP
BUILDING SITE: LOT____ +__-___ BLOCK ADUI"TIONaro t_lkY_ _ _
TAX LOT NO. ------ TYPE OF OCCUPANCY _ _ Reaideuoe
i ADDRESS 12483 S.N. .Katherine Street
I
DWELLING UNITS - a FIXTURE UNITS
SURCHARGE IF APPLICABLE _
450
PERMIT FEES ____ INSPECTION FEE 25_..__. TOTAL DEPOSITED
t
(NEW) (EXISTING) BUILDING SEWER SYSTEM _.. _ .. .___ _ Tigard
�i
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER :,YSTEM.
LINE SIZE 411 INSTAI_LEH -_ -"a �,.—
RECEIVED BY_ NCY R j-Ti
A
(AGEITS NT)
COMMENTS:
This Application and permit expires in ninety (90) clays. The amount pais' will oe forfeited
should expiration occur.
' .
IN
CITY OF TIGARC) `
Ism ► W. sw„ stiw
119AND, osseoN d1Rr7
APPLICATION FUR BUILDING PERMIT 6
New Construction Q Demolish Addition Remodel CJ Maw
TONING R-7 _ DATE ISSUED 11-6-72 _ BUILDING P
E
RMIT
DATE RECEIVED 11-2'72 BUILDING FEE f 80.00 No7 '21v
AT By PLAN CHECK Sr�- 0.00 _--.— --
OTHER $ VALUATION S •
TOTAL $�IJD.00 RECEIPT No.
TWO SETS OF PLANS AND PIAT PLANS MUST BE FURNISHVI? WITH APPLICATION
LOT 1 4L MAP 1 Rai j>3B CENSUS 'rRACr �+-i/.__ •1c�J� 1
Architect or Engineer D.M.D.
Addrens S.M. Buruhso Phone
Owner D.M.D.
Address_._.._._____ S.M. Burnham_._._ _ .------Phone---.-
Builder—
—__._..—._.__ Phone--,._Builder— D.M.D.
Address _ S.W Burnhae _ Phone
BUILDING USE Single Res. Q Multi Res. El Comm. Industrial
OCCUPANCY GROUP— I—_ No. of Stories 1 Total Height_lbr Area of Lotlaw.
Type of Construction V Floor Area 9 --- 1 14-5 _ 2
Set Stacks: Front 20' Backer! L.Side 10-1--- h.Side,i!
Private Sewer Pipe Site 40 Sewer Turd U.8-Aseptic Tank El
Water Service Pipe Size---kk' storm Sewer ® Ditch ❑ Drywall
j S+ceet and Curb nequirementsbtistl _
Driveway Width 181 No. of Parkins Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
s
ADDRESS ASSIGNED—,— 12183 s.Y. Katherine Atreet
FIELD CHECK BY Ei2 _ DATE
PE1114IT APPROVED BY
It is understood that all Kark will con(m a with applicable codes and ordinaa
of the State of Oregon and the City tit Tigard, Oregon, and that the building
nOt be occupied until a Certificate of Occupancy hss be n issued by the City
,,
Tigard Building Inepector.
gnalure or App cant
. q.