14410 SW 94TH AVENUE I
14410 SW 94TH AVEIM
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CITY OF 1111rct 19 07241
BUILDING PERMIT APPLICATION TIGARD DATE ----- —• 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED OWNER PHUIJE —
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS.
OWN E R
Samuel11SamuelNullicCia t ADDRESS I.441U �.L.,• 94th Ft. BUILDER PHONE
_ --- —'—'
(,1r�1�C.)r'1 I-{l7rr%3 II'f113TG1.k?iRlf.JtII1A
TRRCHITF'ENGINEER.T _ DESIGNER
RUILDER �
SUCTURE []NEW D REMODEL DADDITION C1 REPAIR URcNEWAL ❑FIRE DAMAGE DDEMOLITION
D RESIDENCE []COMM EJEDUCATIONAL CGOV'T C,RFLIGIOUS OPATIO [:]CARPORT UGARAGE D STORAGE USLAB []FENCE
DBOND []MOVING []CONDITIONAL USE —_ CDESIGN REVIEW CLOUNCIL APPROVED _L ISIGNS
OCCUPANCY—LAND USE ZONE_., BLQG.TYPE FIRE ZONE` PLAN CHECK BY A_,__ HEAT-
_ __..
lfgplsce 5/8 gyp damaged by tlrw_
f)CC,, LOAD FLOOR LOAQ _ HEIGHT NO.STORIES AREA _VALUE
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit i24.QO
THIS PERMIT IS IS'>UED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULA'IONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 11 IS HEf;EBY AGREED THAI THE
WORK W'i.L BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
012 RESTRICT!VF. COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State t.ICFNSF SEPARATE PERMITS RFr7UIRCD FOR SEWER, PLUMBING AND HEATING.
Total
By APPLICANT
Approved
ADDRESS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING
DATE
Contractor
Permit
ermi
P t I
No.
Fixture
Final
HEATING
Contractor
Permit No.
I Gas or Oil
f2 �—uin —
Final
WSEWER
Final
DRIVEWAY
Final
Storm Drainage
(Pain Drain) Final
Sidewalk
Curb&Street Final
Approach
7
BLDG.DEPT. FINAL------ TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCI IPANCY Final
Landscaping
I',Zoning Final
'� a�n.,,/' �• ������ y .ilk.�y. �''r ��"u/ �'Nl�!`, ,� ��'�'�r '� '�'�" �1� ,.,J�.'''Aii ,�,Ya�w,
r A t40t_
Yl # +
1
OF
OCC
CITE OF TIC�AI�D C
S` OREGON '
r r
Owner:....$.:...H.....Ma_llicoat 74-124
............................ .....-..Permit No._.......----.-------.
Building Address.......14410_ S..W. 94th Ct. ;.
Certificate is hereby given this...2-�....day of......December
...................... �.
that said building may be occupied and
that it complies with all requirements of
! the Building Code for the City of Tigard,
as approved by the Tigard City Council.
Building Inspector
� r
01
Qen.•e.� I,tMO IN Y.�..
I'
FMIBIT ,.e„ 12117
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND RELEASE OF Ph:3TRICTION
The City of Tigard hereby certifies that the occupancy of
the fo_lowing described structure or premises with respect to which
restriction of occupancy was, on June 19 , 19 74
recorded in Book 98n_, Page , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF PROPERTY:
lot 28, Penrose Terrace Subdivision.
01JNER; S. H. Mallicoat
BUILDING PEW+IIT NIMER: 74-1ZQ
i
BUILDING ADDRESS: ] &la_ c I.I onfh Ct
This is to certify the said structure meets with the require-
ments of the Building Cude of the City of Tigard and the above
referenced restriction is hereby released and terminated.
IN WITN93S WHEREOF, the undersig.ied authorized officer of the
City of Tigard has caused this ce -tificate and release of restriction
to be executed this �Y of 19�•
Title:-
✓
STATE OF OREGON ),;s
County of Washington )
On this ,c(r t� day of , 19�T, personally
appeared before me the above named _, whose
signature appears hereon and who acknowledge,? to me list he executed
the same in his offical capacity on behalf of' the City of Tigard.
Notary 7P-lis of Oregon
r !; MY Commisoion expirest
_N...__.a.........AM
f r4atII THOMMIRM,d,tMy
soo4005 FALE.9911 6 �,
STAFF OF OREGON
p /�F
Cosmty of Worhinpton
I, Roper Thnmsssm, Dlrecty, of Rec-ds
and Elections and E.Officio Recorder of Con
veyonces for said county, do hereby certify
that the within Instrument of wtltlnp was
received and recorded In book of runrde
No. _._._�._._ _.....
of sold Courtly
wltness my hand and seat affixed.
ROGER TNOMSSEN, Director of
Records & Election
Deputy
49 AM '14
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : All, r'" PERMIT NO. : — —
DATE: /2 IA,)1' 2f— DATE ISSUED'--Z- L
0WNERC NAME : /2" --
ADDRESS :
CONTRACTOR :
TEST. Air O, Water ❑ , Visual 0 , Laboratory ❑
RESULT: Approved Disapproved O Pending L7
SKETCH: Al" •.,� �,; .. r.�=
(
I
I INSPECTOR DATE
CNOTE : Attach supplemental test datc hereto
1
ALL SPACES MUST BE ENDORSED PRIOR TO I
ISSUANCE OF BUILDING PERMIT
I
PLANNING DEPT.
Py Date
PUBLIC WORKS DEPT.
By Date
BUILDING DEPT. _. _.
f By Date
TUALATIN RURAL
FIRE DEPT. By ^� Date
APPROVED FOR f;U..S'_'}iaCl'IOI1
CITY OF TIGARD
PERMIT # ADDRESS
.., TITLE DATE
4
TPi s 7l.-ev"P'9 �+c,J Nc�2•l
C q-Te i (�LY►�u N'Cl ti t o tk'iIV G
POZC
Two P'aT,o oc�v,'s �iz c�►� o�
�eti�T
/ 14 C;P r-) -6e E)r a--) ►3 C (P OI-c'
7
ati3rq,� P�►,��3„�G
i,w�T4�-r r✓ U ���”�/ U 71,41
i
■ WEN ■ ■ 1f "'� ■ ■
I
g r
� ity of Ti hard
INSPECTION REQUEST
for,
I INSPECTION TIME :-L3t) -9= PERMIT NO. :
I DATE: 1).i DATE ISSUED"—Z. L
OWNERS NAME : Ll&jL41:4
I ADDRESS :/yam/;/J
I CONTRACTOR : __._...._____—
TEST: Air 0, Water p , Visual 0 , Laboratory (]
I RESULT: Approved 0 , Disapproved 0 , Pending Cj
i
a
r
a
3
r
s
ADDRESS w PERMIT NO
PERMIT CHARGE
OWNER 5. �✓ `f)� ,�' c,�, CONNECTION FEF
P A I D B Y _
PE OF BUILDING DATE CONNECTED /0 -7 _
SERVICE RATE I&A INSPECTION FEE
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION ��� ASSESSMENT PAID
t
r
-44
I
City of Tigard ,
INSPECTION REQUEST
_ for
INSPECTION TIME: - � PERMIT NO.
DATE: DATE ISSUED :.__1_L_ I
OWNERS NAME :
ADDRESS: ,'.T/i) ,_��
CONTRACTOR
TEST : Air p, Water p,, Visual, Laboratory p I
RESULT. Approved ( Disapproved p Pending p
SKETCH.
I
1
O
I
1
INSPECTOR
10111: Attack supplemental test date berth I
i
City of Tigard
INSPECTION REOUE: ST
for
ZJCIZ;
INSPECTION TIME : PERMIT NO. .' -_.
I DATE : DATE ISSUED: L
OWNERS NAME .' i_ ,_ i eosg7_.
ADDRESS : .Z�ZIO gY CYT, — —
CONTRACTOR
ITEST. Air ❑ , Water El , Visual It, Laboratory ❑
RESULT. Approved , Disapproved ❑ , Pending [j
K E TC _..�...�
I S H.
I
I
I
INSPECTOR DATE
ICNOTE Attach supplements, test data he►et:01
i
Iffwxff
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME ' PERMIT NO. :
DATE ' G' DATE ISSUED:-_1-L_
OWNERS
ADDRESS : IL?71910
CONTRACTOR :------------
TEST'.
ONTRACTOR :------------TEST. Air I], Water ❑ , Visual El , Laboratory Cl
RESULT: Approved , Disapproved G , ' ending U
SKETCM:
SPECTOR ^DATF
COTE . Attach sugplamentol test dote hsrsta0
w wjff>traw
I �
City of Tigard
INSPECTION REQUEST
I
for
INSPECTION TIME: PERMIT NO. : ,.— 1
DATE: h !� ��T� DATE ISSUED :—I--Z—.
OWNERS NAME : I
ADDRESS:
CONTRACTOR :
TE ST : Air G, Woter O , Vi sual [] , La boratory p
RESULT: Approved , Disapproved 0 , Pending O
SKETCH.
� fat<-► _...1�
IXS�TOR DATE
CN01E : Attach supplemental lost dcto beret]
3 �.�
UNIFIED SEWERAGE AGENCY NO. ___ 4976
WASHINGTON COUNTY DATE
CITY O F-_-
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER:
OWNER'S ADDRESS:0?.`�-� —
STREET
ITV STATE y� ZIP
BUILDING SITE: LOT�.e____ BLOCK ___ ADDITION
__Y.Gllll _tL[._.C.2.La ao,_t
TAX LOT NO. _. _— T YPE OF OCCUPANCY _—.-
ADDRESS
DWELLING UNITS- --- r ------------- FIXTURE UNITS
SURCHARGE IF APPLICABLE .----
PERMIT
PPLICABLE .PERMIT FEE -- w---- INSPECTION FEE 2_ TOTAL DEPOSITED . SaZS Y
NEW (EXISTING) BUILDING SEWER SYSTEM __ -------
The Applicant agrees to comply with all rules and regulations of the Unified Sewere2e Agency.
a APPLICANT
l
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE __..-... INSTALLER .
RECEIVED BY
'1 E C OR ITB AOENTI I -___
COMMENTS: 7`` o�`/ / –u ��
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
j should expiration occur,
CITY OF TIGARD
12420 S. W. Main Str"t
TIGARD, OREGON 97229
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish ❑ vidition ❑ Remodel ❑ Move❑
ZONING DATE ISSUED ��{ BUILDING PERMIT
BUILDING FEE $ C^ No.
DATE RECEIVED ,. )/)9 / 7-[,�,
BY / 7 1 l(, PLAN CHECK
v. 7� OTHER h11- $'�"5 VALUATION $ pab
TOTAL,/% ST-� $ �, �� RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT # 28 MAP # CENSUS TRACT JOB #
Architect or Engineer____ L. M. Bruninier
el
Address 1304 S. W. Bertha Blvd. --- Phone 246-3022
Owner S. H. Mallicoat
Address 10920 S. W. Mira Court, Tigard, OR Phone 620-3748 -
Builder S. H. Mallicoat
Address Phone _
BUILDING USE Single Res. ❑x Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP No. of Stories 2 Total Height!-I') Area of Lot,
� • �
Type of Construction I II III IV l i Floor Area B`_— 1 1 �2 `/>3_L
Set Backs: Front 20' Back 151 L.Side_201 R.Side 5+ ,
Private Sewer Pipe Size Sewer q01_ Septic Tank ❑
Water Service Pipe Size 3/4„ Storm Sewer ❑ Ditch ❑ Drywell❑
Street and Curb Requirements___
�•�_� ______
Driveway Width_ 26, _ +U _ No. of Parking Spaces 2
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED
FIELD CHECK BY--- �-W -- _ _DATE_ f
r�
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, anc the building will
not be occupied until a Certificate of occu ancy has bee ue he City of
Tigard Buildinq Inspector.
5 gnatur� of Applicant _
11159
EXHIBIT "All
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MEN BY THESE PRESENT, that occupancy of residential
structure (a) 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 ordinance
of the City of Tigard, Oregon: (The City will issue a release as
soon as a final inspection determines that the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY:
Lot 28, Penrose Terrace Subdivibion
ADDRESS OF PROPERTY: m in 6 W 9404 p.
NAME OF OWNER: 3. 1!. r^fallicfie t
ADDRESS OF OWNER: 11192n S.J. Mira Court, Tigard, Oregon
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be axeruted thls1 4ttt day of lung , 19 74.
OWNER:
a �
Name
Title
APPROV�LY7
B y 4-lig /es-P --
ng 0 ic1aI-
City of Tigard
STATE OF OREGON
�a County of Washington ss June lith , 19 7(1
Personally appeared before me the above named
G_41_ MalliruaL and acknowledged the foregoing instrument
to be voluntary act and deed.
STATE OF OREGON � eta Pu_ c or Oregon
County of Washington a Illy mi Son Expires:
i Raper Thomsen Olreitpr of R4aitl1 ` .�` :'
and Elections and E.Of�i io Retarder of Lon
1r.
veyarxes for mid county, do hereby certify
that the within Instrument of writing was
received anBOOT, (�hld recorded In book of records 980 uA19
of sold County
Witness my hand and seal affixed.
ROGER THOMSSEN, Director of
Records 6 Elections
Yl Clep
Deputy
Jug 19 9 sa AN'T►I
11159 !
I EXHIBIT "All �•
CITY OF TIGARD
Residential Structure Occupancy Restriction
II XNOW ALL MEN BY THESE PRESENT, that occupancy of residential
I structure (a) 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 ordinance
of the City of Tigard, Oregon: (The City Will issue a release as
soon as a final inspection determines that the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY:
1
ADDRESS OF PROPERTY: +11'.ln..r;..+e. r.4.it }`
NAME OF OWNER:
h`
ADDRESS OF OWNER: rt nir' T'
IN WITNESS WHEREOF, the undersigned has caused this restriction
to Co executed this 1 ,'I day of__.,u;,,;
OWNER:
r
0.
Nama
111, t t vt :
I
APPROUEDr)
911ding O rd a
City of Tigard
H STATE OF OREGON
I v o County of Washington ; ss 31jno 14Lh , 19_74
o
Personally appeared before me the above named
dr >>t. and acknowledged the foregoing instrument y
P = M to tai' voluntary act and deed,
STATE OF OREGON
u tJ t o ary Pu.—'Ft or regon
County of Washington rr
411 , f.l y 4mm1 ion Fxpiras:
S I Rnoer Thoma+,qq DlractGr of gje aiu.:•v' 7 yt �C% JJ
-• and Elrctiont and Ex-t)IIicto Recorder of cnn-
vevonces for void county, do herby ee t+fy
c„' •� _ thot the .1 hin irm"nent of wtlnrq was
rete+ved and retorded In book of record, (ls[1 �ncE379
Es. Nn. _.............._._...- _._............ UCK t!l VV
of wild County
u � �
Minns my hand arks Wal affixed. ) M�
ROGER 7tIOMSSEN, Mom? of !!
S pecords d Elortions y'
'P(I�1.1
M►y.v yra•.•r..: Mputy
Jmj ill J 58 All X711
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