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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT ND. . `.______
OAT E : DAZE iSSUE0:_._.LL
OWNERS NAME : ��' f „ 41, _
ADDRESS : — err` 5! C. ,- / q _
CONTRACTOR :, 6_d, !23G Z. 4 3C;0
TEST-. Air 0, Water ❑ , Visual 0 , Lob oratory fi
REC"I'L:T: Approved [I , Disapproved ❑ , Pendl;ly ❑
SKETCH:
INSPECTOR DATE
ICNOTF Atterh 9urplemental tett darn here(]
q., ...,.. .. .,;qr.'.,*�C+tarrw,^,s.,t.�a•'rnaW�.n—�m+.Tr.e+m++�•• .n'pcpv'MlgpiFp" °vaAM`�1YcYhnr�,.�?i�.i,•"0/IM�tA�"Jp'.,i1R•�FI�i?4��A�'�'lAyyy/�F-n—'cr+..-�"'„�np.F**.'.^'.�'y'�y..
CITY OF
BUILDING PERMIT APPLICATION TIG ARD DATE_ 7..g.� _—__, 19_r_ 0 011
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR fHE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE—_--__--____
QWNEN_ - ADDRESS Inj(nc7- L.bBUILDER PHONE _
ENGINEER
B LLDER ARCHITECT —_ DEEIGr4ER _
STR,_ICTURE ONEW ❑REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE []DEMOLITION
0 RUSIDENCE OCOMM ❑EDUCATIONA.L ❑GOV'T ❑RELIGIOUS❑PA110 Cl ,l PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
ULt UPANCY_—_LAND USE ZONE � BLDG.TYPE_—FIRE ZONE__ PLAN CHECK BY_— HEAT...._
_--- — This ix a Iduplicata for uur reec.rde
;C�1.QAD FLOOR LOAD HEIGHT NO,STORIES AREA VALUE
BUILDING DEPARTMENT
_ _ ,ET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit � �1�•`�!'s —" — — _ - — ._e---=
` `—"-- — 71-11S 1FRMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINEU IN THE BUILDING CODE, ZONINC
Plan Check nE.GULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AUD IT IS HEREBY AGHF.ED THAT THE
%'.'0Rn WILL BE DUNE IN ACCORDANCE WITH THE PLANS AND SPELIFICATIONS AND!N COMPLIANCE WITH
Recording ALL APPLICABLF CODES AND ORDINANCES. THE ISSUANCE OF THIS PERM11 JOSS NOT WAIVE
RESTRICTIVE CC -/ENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURREN"i CITY BUSINESS
176 State I_ICFNSE, SEPARATE PERMITS REOUIRED FOR SEWEH, PLUMBING AND HEATING.
Total •
BY f oys
-- --- --- Ar+nLtrANT OR AGENT u —
Approvers Rerc-nc No
ADDRESS
DATE INSP, TYPE INSPECTION REMARKS PLUMBING UAJE
Contractor
-
-"=i' Permit No. -7o—
�>'"
Rough.-in
Fixture
Final
HEATING
Contractor
S — _ Permit No,
Gas of OilA./v
_
�- I N _ Roughvll� '
Final
SEWER4/
�� uta7-�— -•MrC"T7CJ� �i �,1, �•�
Final
DRIVEWAY
v U i-n Final _
T/v Storm Drainage
(Rain Drain) Final
Sidewalk
---- — Curb&Street Final
— _ _ Approach
HLUG.DEPT, FINAL TEMPORARY CERTIFICATE OCCUPANCI'
CERTIFICATE OCCUPANCY Final
/7, ,6 Landscaping
�_"_—� Zoning F:nnl
14091
EXHIBIT" "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MEN BY THESE PRESENT, that occupancy of residential.
structure (s) on the following described lands prior to the recard-
ing 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 determine, that the construction is
satisfactorily completed)
DLSCRI.PTIION OF' PROPEFFTTYs
lot Q, Curl Acree, Tax Map 251 3BC
ADDRESS OF PROPERTY ,-, 12370 S.W. Walnut Street
NAME OF OWNER Clarke Ind. , Inc._ _
ADDRESS OF OWNER „ 6830 S.W. Becker Dr, Portland
IN WITNESS jHEREOF , the undersigned has caused tI,i3 restriction
to he eXFCUtPd this �day of , 19-1 j
OWNE R � ('14,c K c /Nods r,riCi 1,vc
ice e,5�v7. Name
T:it e
A P P F V'FEQ1 y
By : e --
U 1 d- i n 9 D l c 18 f',a 1 1m .cnrA
C 1 t y O f Tigard � ;•` l�Qi[.A TNUMS5CN, �uat Rw�wrin AF1.• Wont
y/r _................ I—Put.
Et.................
,.. . 'Tl
STATS OF OREGON
Country of Washington ss 19
Personally appeared before me the above named
and acknowledged the foregoing instrument
to be i' voluntary act and deed.
No�sTy Pub-1 c for 0 re n"'-'
MY Commission Expires;
h pp
BOOK 984
STATE OF OREGON
County of Washinpton
RrTdE '"Ktor of esEeand cionsaix JflicioRecorder ofCon
veyances for sold county, do her:hy certify
that the within Instrument of writing was
received and recorded in book of records
No.
of sold County _...
Witness my f .nd and seal offixtd.
ROGER THOMSSEN, Director of
Records : EWlkm
�+•rvrt'f4 '� I'��
Dnxti
JUL 17 12 24 PH '74 �
M
14091
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Reotriction
KNOW ALL HIEN BY THESE PRESENT, that occupancy of residential
structure (a) on the follouing described lands prior to the record-
ing of an occupancy permit releasing the restriction in the D,,)ed
Cecords of Washington County, Oregon, is prohibited by the ordinance
of the City of Tigard, Oregon: (The City will feeue a :eleeae as
noon as a final insFection determine? that the ronstrort.i.an is
satisfactorily completHd)
U SCRIPT1ON OFPR- OPERTY: j
lot A, Curl Acres, Tax Map 251 3BC
ADDRESS OF NROPERTVt1237,0 S.U. Walnut Street
NAME E_ Of OWNI.R�GIArke Ind., Inc.
ADDP.ESS OF OWNER 8030 S.W.BBackar Or, Portland
IN WITNESS WHEREOF • the undersigned ties caused this restriction
) gra . f��r l; ; _� 19?`�.•
� t0 be executed thl@r
OWNER: CtgAKC /0.46131'el
X �
/il1C
3 V o roe 1.c '..'"...' Name
Lie-e
' APPROVf.D�
8y 1 ,I'c"17G.e Jy/r11 Q�.•w.•1. A f�..'�e
'• t ny 'iC r^ �LC��LN TNUMA LN.fist«+nu i,
City of Tigard 1Jt �L .. ..... ...... n«vh
STATE OF DREGCN . 19
County of Wae;lington ; °a ' -------^
i.
personally appeared before me the above named
/!,, ,e> ( ,, �. ,,, end acknouledggd the foregoing instrument
to be �l,�j,; —voluntary act and dead.
Public rot redu'r'n
My Commission Expirses _
ea 384 rhE302 '
1
I
e
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Reatrietion
KNOW ALL MEN BY THESE: PRESENT, that occupancy of residential
structure (s) on the following described lands prior to the record-
ing of an occupancy permit releasing the restriction in the Deed
Records of Washington County, Oregon, is prohibited by the ordinanc
of the City of Tigard, Oregon: (The City Will issue a release as
Joon as a final inspection determines ' --;t the construction is
satirfactrrily completed)
DESCRIPTION OF PROPERTYs
lot 49 Curl Acres, Tax Map 291 38c
ADDRESS OF PR0PERTY .- 12370 S.W. Walnut Street
NAME OF_OWNER: Clarke Ind... Inc.
ADDRESS OF OWNER: 8830 S.W. Becker Dr, Portland
IN WITNESS WHEREOF , the undersigned has caused this rectriLti f,
to be executed this-2— _day of
O W N E R: !L''19,e x c= Ae4,51oel" 141c
�/,c.e f��Pb i vr'�✓T Name
T i t e
APPROUFDt
nye --
Buiding Of�a�-+�
City of Tigard
STATE CIF OREGON
County of Washington
Personally appeared before me the above named__
and acknowledged the foregoing instrument
to be /�,s, voluntary act and deed.
Nc ary Public for Oregon
Iffy Cnmmissioon '-xpires;
CITY' OF TIG/ARD
12420 S. W. Main Streat
TIGARD, OREGON 97227
` APPLICATION FOR BUILDING PERMIT
New Construction � Demolish � Addition � Remodel � "tove r
ZONING DATE ISSUED--_2-1--I(Z BUILDING PERMIT
BUILDING FEE S�E_,u^� No.
ECEIVED
DATE R ?el-
BY `—'-" PLAN CHECK S, S S, �-�-__ VALUATION $
OTHER r.�..1'• s $ _Y , .' .
TOTAL/
Jf�.-t RECEIPT No. j
A /, / 7—
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT #__�� C� HAP CENSUS TRACT --� - JOA
Architect or Enc inter--
Address QQ *7e_ ��.. �,� Phone
JJ it Vy, �"• L_---�.- -
Address �_ ��— -Phone—
BUILDING USE
Phone`BUILDINGUSE Single Res. — Multi Res, Comm. IndustrialC�
OCCUPANCY GROUP_ No. of Stories 2____ ToT7ta1__ Height 20 Area of Lot/Z5t
Type of Construction 1 II III IV V Floor Area B-----
Set
- i —_Set Barks: Front_-12_ 13ack1/G+ _ I„Side -�(p R.Side
Private Sewer Pipe Size __- Sewer_ septic Tank ILS
Water Service Pi 1,e Size_,_/ -_ Storm Sewer [] Ditch � Drywell❑
Street and Curb --_----...--
Driveway width_ _ � _ — �No. of Parking Spaces
51:PARATF. PI'.RMITS 14FQUIRED FOR SEWE2 AND PLUMBIN
/ 1 SPECIAL INFORMATION
-__- .�1C 1`r.-,E! _Sr2,.-rJ•1. t�_••-..�..__.Q.1_.��_l�re-•,-Y�.-,_” �`���1_l2.!'.
�UDRESS AS:�JC)JED r1.�.- J�. S NI -_ W it l- fJ ___--
FIELD CHECK
PERI4IT APPROVEDIt is urAe rnto�xl that all work will conform with applic-t)le'rodea and ordinances
If the State fit Ore-Ion and the City of Tigard, Oregon, and that the building will
,,ut be occupied uIA,11 a Certificate of Occupancy has been issued by the City of
1-igstd Lcuildinq 1n+:pector.
filature of Xlppficant
ADDRESS ' }} ��i, t/�.L.�i:��xLt . PERMIT NO.
PERMIT CHARGE none
OWNER CONNECTION FEE
PAID BY
TYPE OF BUILDING DATE CONNECTED
SERVICE RATE -� �� ,� INSPECTION FEE A-L., `'
CONTRACTOR fl. ._ =;,;Yu!ri•_, �_ P ID BY ��.�,-iLc, DATE
SIZE OF CONNECTION �__ ASSESSMENT PAID _