12490 SW KATHERINE STREET 124SJ SW KATHERINE STREET
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BUILDING PERMIT APPLICATION �"R'13 CITY DtCA T E D r3L)ILE)F'
THE UNDERSIGNED HEREBY APPLIES FORA PERMIT FOR THE WORK HEREIN IN, 0vv?4E:R PHC1141 - ..' -
OR AS SHO'�.'N AND APPROVED IN THE ACCOMPANYING FLPA.4N AND SPECIFI eTIONS LOT NO---
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. ILOCRV,A L
':�r)D F�L MAC) IVION, REPAIR
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51.]PATIO OC AR PORT
FSIDENCE OCOMM
IN
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R M I T. 6
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-C. LQAD F LQ0'9,40f0.
't BACKS REAR
ED IN TH! FJU)1 t
vrnit "LISJFCT TO THE pEt (,ONTAIN
• JI-41S PERMIT I LE ODES A 0 nRDIN'-vCLS AND IT 15 HER�FIN �e-'Rvl i
A-Ft'q.ILATInN!; AND ALL APPLICAR
I.n Check NE IN ACCORDANCE VVITH 1�-I: PLANS Ahlo SpECIFICATIONS ANO IN COMPL10J' F
A'JRK WILL. BE DO THL Issi,JANCE OF THIS pFAMIT DOES Ni.
AND ORDINANCL'S CITY
ALL APPLICABLE CODES ub total z ANTS, CONTRACTOR SUB CONTF41%C10"S TO HAVE CURRENT
IRED FOR �FYYER pi til,o9l NG ANDA 4.1 ING
RLS I RICTIVE COVEN
St,jw Tax LjCt:�,ISE SLPARA'tE. PE.viMITS REOU
t3DC
Total nc#
ev '4-p6-L-iCAN1 OP AGENT
Receipi No
Approved
SDC
PDC
CONNECT
5 P E L T 10 N-
---7-
SEWER 5URCHARGE
Comments :
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7
BUILDING PERMIT APPLICATION TIGARD DATE ' �� ,y_._- `i 3162
THE UNDERSIGNED HEREBY A PPLIES FOR A PERMIT FOR THE WORK IIFREIN INDICATED BUILDER PHONE 6:Cll�-a 8t�E3
OR AS SHOWN AND APPROVED IN THt H;COMPANYING PLANS AND SPECIFICATIONS OWNER PHONE
LOT NO.
OWNEH °+uemy Brenes JOBADDhESS12490 SU Katherine Street _
ARCHITECT
ENGINEER
BUILDER ADCAESS DESIGNER
STRUCTURE ❑ NEW FI REMODEL LA ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOOTION
RESIDENCE ❑ COMM ❑ EDUCATIONAL 11 GOVT ❑ RELIGIOUS El PATIO O CAR PORT ❑ GARAGE ❑ STORAGE ❑ SLABO FENCE
OCCUPANCY 2-'3 LAND USE ZONE fi�7 BLDG.TYPE 51N .FIREZONE i _—PLANCHECKLIY _ L9R HEAT_=�
Construct bedruum addition to singly family duallinr�.
SEE PERMIT # 315'1 (St..1 FOLDEF, F(11-i PLANS)
SEWER PERMIT#OCC.LOAD LOAD FLOOR LOAD HEIGHT NO.STORIES 1 AREA 11 U NO.BEDROOMS 1 VALUE $3 f 760•
BUILDING DEPARTMENT _ SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 28•00 _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 11IS HEREBY AGREED THAT THE
Plan Check .14.00 WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF TH1S PERMIT DOES NOT WAIVE
Subtotal 42,00 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY 13USINFSS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATRIG.
State Tax 4'� 1.1�:
Total 243.12 SDC -
By P 1
PDC# APPLICANT NT OR AOE
Approved 11 F3cp low Receipt No. ] t 4DDRES8`--_.--- -- PHONF
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
s^ .� ( �Yl►!1 — --— — -- — Contractor
Permit No
�G f Rough-in
L
Fixture_____Final
HEATING
Contractor
Permit No.
Gas or Oil
-- Rough4n 0
Final
SEWER — -
- Final --
DRIVEWAY
Fins]
Storm Drainage
(Rain Drain)Final
Sidewalk
Curb&Street Final
Approach
BL1DG3 DEPT.rINAL �TEMPOR.ARY CERTIFICATE OCCUPANCY Final s
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
Y
1
L
S'
7
BUILDING PERMIT APPLICATION TIGARD DATE --=`._____ 3155
THE UNDERSIGNED HEREBY APPLIES FON A PERMIT FOR THE WORK HLREIN INDICATED FSUILDER PHONE = �
OR AS SHOWN AND.APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICP,TIONS. OWNER PHONE
LOT NO.
OWNER jjQB y_BC_eCI�. _... JOBADDRESS _IZ49I _-;,ZW !'�haj.j ik3
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE__ ❑ NEW ❑ REMODEL_ 12 ADDITION_,❑ REPAIR —❑ RENEWAL— U FIRE DAMAGE ❑ DEMOLITION
ORESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T El RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE C i STORAGE ❑ SLAB❑ FENCE
OCCUPANCY _E_—,3 _LAND USE ZONE _ L'77 BLDG.TYPE E.,P�FIRE ZONE 3 PLAN CHECK BY SIC R HEAT __-
Construct addition to single fa!n dwelling. 0 4�
SEWER PERMITS
OCC.LOAD _ FLOOR LOAD 'HEIGHT __' NO.STORIES 1 _ AREA U'7 NO,BEDROOMS — VALUI62 s 784•
BUILDING DEPARTMEN7SET BACKS FRONT _ REAR LEFT SIDE RIGHT SIDE
Permit _ t2.4.00 _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
REGULATIONS AND ALL AF•PLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 12.00 WORK WILL BE DONE IN ACCORDANCE WITH THE !'LANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE_ CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total 36. 00 _ RESTRICTIVE COVENANTS. CON-iRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
— LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATINn.
State Tax fi;' . 96
—' SDC—
Total 3 J.96
- --_—I ppCS APPLICgNT OR AGENT
By _ 1 _
0C R ----�Receipt No — —_ --- ----- ---
I Approved ADDRESS PHONE_
M
BUH-UNG PERMIT APPLICATION!'' DATE
'f HE UNDERSIGNED HERESY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED
OR AS SHO'v','N AND APPROVLDIN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER
LOT NO.
vNER JOB ACIORESS
Cllii:-T
ENGINEER
LIESIGNER
ILOER
RUCTURE 0 NEW R FMODE L -WROITION REPAIR ORENEWAL DIRE DAMAGE.--.13.0, -101
51 rP 1GF C)SLAf 1
ESiDENCE nGOV'T 014�LIGIOUS F]PATIO EICARPUHT C1,11"AGE
1CCUPANCY0'f-J LANOUSE /GNL�X- -7 .8LDC, TYPE IRE ZONE 3 PLAN C"ECK Pl AT -t,
PERMIT
CQ,.LO-A-D F L 00 R.L QF.Q HEIGHT NO.$(091 _$ AREA. V
BOILDINC, D E I'A R W.E'N T E A R .2- 0 LEFr SIDE PIG311,11 SIDE
j F;4CNT F1
irmit
PE NMI t 1�� ISSUED SUBJECT TO THE REGU(ATIONS CON TAINE 1) IN THF FILM 1,Di' 'i
1, i
I.n Check i1r'GULATIOMS AND ALL APPLICABLE CODES AND ORDINANCES AND IT IS HEPF(q*v . (JPFFD T4A H(1 Vol I H
r.iRK WILL BE DONE IN ACCORDANCE WITH THF PLANS AND SPECIFICATIONS AND IN COMPL I'Nr
M on NUT V,,AI%JF
ub total AI.L APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PENMIT LS
-,/F CURFIC N 1 0'Y RuSINF5%
CJ r.,-.SIRICTIVE COVENANTS CONTRACTOR AND SUR CONIRAC.IORS TO Ht
S'd
(e T a x . 9 / SEf'AnATE PEHMITS kEOUIRED FOR SFWER, PLLJ',A8]NG AND HEATING
Total :3 6, 6
V R-P li-L-1c 4 i;f-0 i
Approved Receipt Nu
SDC
PDC
Co CTIO
�5 P L T
SEWER_XN
CO CTIO
SEWER 5 P E L T I
SEWER SURCHARGE
Comments:
----------
.. O,F
CIN
AC
CITY OF T1GARD
✓Y ORHGON
Owner:..._ ...Kl.yu................................ . . ....Permito. -74-44. _....-
Building Address
Certifiente is hereby given this......xthi...day of....9apLrn�er
that said building msy be occupied and
that it complies with all requirements of
the Building Code for the City of Tigar ,
AIF as approved by the Tigard City Council,
nuil nspertor
RT sn.•we, w11
:lit y of Tigard
INSPECTION REQUEST
f 0 r
NSPECTION
-IME . FERMI F NC.
T
DATE '. DATE iSSUED
OWNERS NAME
A r)D R E S S
* EST * . - jY, ter[] ,
RESUL p, raved Sd ' ; ,UPPIT-A 0
3 KETC H
.73
INSPECTOR DATE
[NOTE.* Attacti suppieme-itol test ujlL Ler- t0
City of i igard
INSPECTION REQUEST
fr)r
�NSPECTION irIME ' PERMIT NO. . .
AL�— ')ATE ISSUED
OWNERS NAME ' KI-YdO?,— I
A D D R E S 5 - /2� I6 47 4el
C+1 N I R A C T 0 R
RES010- I) d 'I
SKETCH:
C)
rIN P F ��TJ�R DATE
EN:OTE: Attach supplemental —rof 1�1
I y f T go rd
INSPECTION REQUEST
for
iNSPECTION TI ME PERMIT NO. . .
DATE. UTE ISSUED'-.-.,,-'--.-,-
OWNERS NAME '
ADDRESS 46r2-2
N I RA C T 0 R A-1
Tf:S'l -j ,
RESULT
SKETCH:
INSPECTOR DATE
Ct:40T At t a uh supp I emen.'a I !v-,l i u• :,Pre t-10
City of Tigard
INSPECTION REQUEST
_ for
INSPECTION TIME: PERMIT NO.
DATE: Vii'' //V) DATE ISSUED :_
OWNERS NAME :
ADDRESS: '
CONTRACTOR : --- ---- __-..-
E ST : ,' ., '.Voter[] , v:suai 111 , I_aboratory f=j
RESULT : Ap,,roved :)ijapprooad G , oerldioq p
SKETCH',
SPECTOR DA
NOTE : Attach supplemental test data bereto7
I
73
,1, Yy0
Ar.
loll
t
✓M++ ��wyy�.roMJ
� COY of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : = PERMIT NO. : .
I
DATE: - --,' Z-7MI' DATE ISSUED*
__L—L--
OWNERS NAME : .4 ' �-f '
IADDRESS : / �/L) kj� ,t`` -i�,.A.__
CONTRACTOR ----- •
i 1-EST' .3 , Water L-1 , "isi-GI 7 , La' sato►; 171 -
f RESULT. Approved El , Disapproved ,( , F -ndmy L�
I SKETCH: a,,Y
flu T /N s��,tr�o,s., iM ovnv v qLL
I �.� .,��� r��•y �ti+e
Pc t/^nA
I
3
INSPECTORDATE
IC07E ; Attach supplemental teat data beret]
1
.. .r .. a .�
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: _ PERMIT NO. :
DATE: _SL1 DATE I SSUEU :-IL_
OWNERS NAME . �Irre '
ADDRESS. 1�4.Y__.__._ *---.._. 7 2—Y—
C 0 N T R A C T O R : _.__--_. —. --_ - .------ .---
TEST : Air ❑, Water ❑ , Visual [] , Laboratory L]
RESIULT : Approved C; , Disapproved O , Pending
SKETCH:
-� 'TL& OR k
'):
INSPECTOR DATE
COTE: Attach supplrmental test data hereta
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME' _, � PERMIT NO. :_ `�3.,c:. 4
DATE: r' 25 DATE ISSUED :_'?L/�
OWNERS NAME :
ADDRESS: ---
C 0 N-r R A C TO R
__C0N-TRACTOR _, Z —..--
i E ST : r�:r , 'ANater❑ , V:aua, I_aboratary (_j
RESULT : /kp,,roved l :�i�uppro�ed G Fendi ig
SKETCH.
INSPECTOR DATE
NOTE Attach supplemental test data heretal
Address 1,7Ago S_i.i_ Katherine -- Permit No. 4936
Permit charge
Owner pAtar K1vm_ connection fee 425
Paid by Peter Klym
Type of building Residence Date connected 5-9-73
w
Service rate i-nnTe r mn n t h __ Inspection fee 25
Contractor
Peter Klym Paid by same Date
Size of connection All Assessment Paid
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. :
DATE : 7 / ZZ 2 3 DATE ISSUED : i 1
OWNERS NAME :
ADDRESS: � -
CONTRACTOR
EST : Air L , ,Noter%, v: ,uai>k, 1_aboratory f]
RESULT: Ap,,roved , :Iiziupprotiad G Pendinq r]
SKETCH.
INSPECTOR DATE
NOTE : Attach supplemental test data hereto]
i
O.W iJ�r�•r•y,Ftr!�. .. ..a.�.n .g.w�.r�r.•�wr�rynn..�.,r-,...� ...,.o,.w ,.
A+.iir
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixt arm Fee Perm:.t No.
Permit; fee �_��
Water Claset_ Permit Issi.jed
Bath I_'ub•s _ _ _ Approved by
Lava-tory-TW +_sh B._� =- r1— - Building Fermi'. �i.
Shower __. _—_' ` Recei.p t No.
a.in K tchetl
Location of Buildtr.g
_Aut��ma +;► i
-Di —_ .—.__
Lau.ndriiPT_ s_ __-- --- Name ddry�:, i OW1
D,a iris,,F l c o r__ — _. .. �=- �4•-+-- -__��.�.—_ -
11-a:.nJ, Area __
F Dr•a,_r.;,,_RST brat 7r
I41 Ra-ti Drams
-1Ut7c�matic Washer _ Name & ddrE �,s „t
Fountains Or- n in > _ �
- 'ountairis� cda
Hot Water Tank .g~
_ WatF?r Sere%'- "_iz�
Building Cidr__�;� ' Ai. t�r', Re-pair
-Basins____-�'ar
_ c7 �ns
�_._ �a"L
Lawn 3 rinkl e r_ >y!;' ___._.—
3w�mming 70 1 _- ------- bt, FT _— —_ __-•------______.�---
— -Z)Er.inkler Sybtem_This p�!rmi t becomes t, ,l 7. and vu-Ld i.f work or constrtinti .n `.h: x
::cmmenced w; thin 60 1-.,v - . -f, if constructir_n or, wozk %-,a� ., nderl at;d^ntd
fir a peri cid of 12.0 day; at ;_any time after work 16 c .mment-,-1d.
All plumbing firms must be licensed by the City of Tigat,-! and post a $1,000 bond,.
I hereby crrtify that I have --ad and examined this appli :ati:;n and kn( w the same
to be true and correct. All provisions of laws and ..•rdirtance,3 g•:verning this type
of work will. be complied with whether speci.fi.ed h"rei.n r r- ro',t, he granting r)f a
permit dt.:es not presume to g-ve authort-ty to viola • r an- e'.1 the provi :;.t ,ns
of any r Cher state r local law regulating cons ti uc ti on r the performance f
construction.
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME . PERMIT NO. .
DATE: /y 7-7 DATE ISSUED:� 3
OWNERS NAME . ;1 J- -- --
ADDRESS :
I CONTRACTOR : -____
TEST. Air ❑, Water ❑ ,�Vjsual , Labaratory ❑
RESULT: Approved 0--, Disapproved L] Pending ❑
SKETCH:
I
I
I
I
I
INSPECTOR DATE
[OTE : Attach supplemental test data ho-et]
1
CITY OF TIGARD
124" L w, wM !MN
110AaD. 0080M "US
APPLICATION FOR BUILDING PERMIT
New Construction O I,t,..l�:is Addition 0 Remodel Move
ZONING fl.T _ DATE ISSUED h.J.Tt BUILDING PERMIT
DATE RECEIVED 4•LO- [BUILDING PEE $ No. W
BY PLAN CHECK $ a QT►�Ogp.00
OTHER S 10.00 VALUATION
TOTAL $ •110 RECEIPT No. �(rZ
TWO SLTS OF P'.ANS AND PIAT P1,ANS MUST BE FURNISHED WITH APPLICATION
LOT 1 n MAP 1 UL MAA CENSUS TRACT b-Zy _ JOB
Architect or Engineer Deaald kiss _ _ -- ---
Address_�__ ____
.Phone_ 58,_„+cA.
Owner Peter 1(l.
Address Nouta _Phone_/t!t-�-j19/
Builder---
Acid
uilder_ _Acidress _ Phone
DUILpING USE y Single Ree. l.S! Multi Res. ❑ Comm. 0Industrial
()CCUPANCY GROUP_^ No. of Storiesl Total Height-'-- Area of Lot-09p—
Type of Construction gUX=X3@2jXXX= V Floor Area B_..— 1__ 2�__.�
Set Backs: Front SB w Back�2 _ L.Side }� R.Side-18_
Private Sewer Pipe Size �1^ Sewery &Tj0j&__ Septic Tank
48ter Service Pipe SizejL4"__ — Storm Sewer l.L Ditch ❑ UryweI
Street and Curb
Driveway width_ 1A� _ __.._._ No. of Parkinq Spaces _ 2
SEPARATE PL:RMITS RFOUIREU FOR SEWER ASID PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED— _. _-� o4-
t.
FIELD CHECK BY-- —DATE , WA-
PERMIT APPROVED By
It is understood that all work will conform with applicable codes an ordinances
of the State of Oregon and the City of Tigard, Oreqon, and that the building will
not be occupied until a Certificate of occupancy has been issued by the City of
Tigard Building Inspector.
SiAl
gnature cant--
,
i
UNIFIED SEWERAGE AGENCY NO. 4836
WASHINGTON COUNTY DATE 4-19-73 _
CITY OF
J
APPLICATION FOR SEWER CONNECTION PERMIT
1
OWNER ..- __ -.-_—_--- Peter Klym
OWNER'S ADDRESS: .------Route- 3 Box 113
STREET
Cornelius ore®on
— --- ------ --- ---- _ ...... --------- --
CITY � if-ATE 21P
BUILDING SITE: LOT ,------_ BLOCK _____..___.-_______ ADDITION —__may-__ _
TAX LOT NO. __.____-.__ TYPE OF OCCUPANCY - Residence -
ADDRESS _1? S.W. Kstberiae _
DWE!_LING UNITS - FIXTURE UNIT;'
SURCHARGE IF APPLICABLE
PERMIT FF - _425 _ INSPECTION FEE 25 . .... TOTAL DEPOSITED _—_ 4>o
(NEW) j(EXISTING) BUILDING SEWER SYSTEM ZU= Tiord
The Applicant .tgr,,vs to comply v,ith all rules and regulations of the Unified Sewerage Agency.
APPLICANT
--
SEWER PI=RMIT
I THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
41
LINE SIZE -.__ �_ INSTALLER _ Peter >Klym
RECEIVED BY
1AGNMY OR ITS nGE
COMMS TS' ;1L'cf �f9. rft�3 _
_ .._.._
�'�;+c. hu•!� 1 � J, ---
O
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
Should expiration occur.