11780 SW 114TH PLACE 11780 SW 114TH PLACE
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ADDRESS PERMIT NO.
PERMIT CHARGE none
OWNER CONNECTION FEE
PAID BY
TYPE Or UJILDING DATE CONNECTED
SERVICE RATU INSPECTION FEE
CONTRACTJR PAID BY DATE
SIZE OF CONNECTION ASSESSMENT PAID
CITY OF TIGARD MECHANICAL PERMIT
DATE_ - y PERMIT N0. _ 7 �/,. S "I RECEIPT tO. � 1DOO-
BY ---_ ----- FEE N' 7
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, replacements, alterations, or changes to burners and
duct work require permits.
1+. All work to be concealed must be inspected before rover up.
New Installation M Replace U Relocation ❑ Addition ❑ Alteration ❑
CONTR. ,fh N,!1�—.�n �.i.Ls l __,.��_ _ OWNERJ_ri,�
ADDRESS LS5�L `~�:_ - T3�_t L�ui�_^_fit WORK ADDRESS .ZZ 2 SV✓_�1_�._L'�•
f n ri7 Cy .7 .._ APPLICANT -
TFLEPHONE NO. _ �,�_'�71 -_
FURNACE - MANUFACTURER �: TELEPHONE NO. _
HEAT Input rating (Btu Per Hour) OD oQo _ Vent Size .S'_ Flue Size
FUEL OIL ❑ CAS ELECT OTHER
TOTAL SQ. FT. `i r--F- eor _ _ Main Floor J2_Q0 �._ n �
GENERAL —.__._..__"'....._...._...........,._.�-�..._._
ITEM NO. FEE ITEM NO. FEE
For Issuance `of Permit 0 13oilers Over 50 Hp
New-Under 100,000_ Btu 4.00 Air Handl in 10.000 CFM__�_
New - veri ,000 13tu AirNandl�ng Over ]0_000 CFM
Floor Furnace '- 0E,vaporative Cooler ^' 5:0
ITall -Floor --S eFd ed .00 _.----Vent Fan
n-YE l- Vents - :UD^ Ven n'___�_ _-_ 3,0
Re-ipa-ir - Heat & Coolinx+.00 Nood� . X
-J
Boilers Under 3 H _ -x+.00 — DumeMc Inciner"- a�3r^ _,5.O
Boilers 3' 0`15 H 7.50 Zcinm wlncineratoor 10.0
Boilers 157to�30 _ 10.00
H01ers TO to 50
INSPECTOR' S CODi,lENTS _ -7'
APPROVED BY DATF. ISSUED BY _ _ DATE
Signature of A pticant
I� ■ .� ! t di
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City of Tlgord
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT 14(J. —
DATE: -//LJ-Z /3 DATE ISSUED : L—L—
QIWNER5 NAME : ?
ADDRESS: Cr' .�2, � • ,`" —
CONTRACTOR :
FEST : lair u , "erCl , Visual Ll , Laboratory []
: .. RESULT : Apnroved C7 , Disapproved ❑ , E-,endi,ig L] _
SKETCH:
INSPE T6ji DATE
[NOTE: Attach supplemental leaf data beretQJ
City of Tigard
INSPECTION REQUEST
for
{
SPECTION TIME' — PENiv,IT N0. :
DATE : ��� •� J DATE ISSUED :-
iNERS NAME :_..ZILL
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ADDF�E5S:
)NTRACTOR c , � - ---
=ST ; Air L- , Visuall< , Laboratory (]
SULT . Apnroved , Disapproved ❑ , Pending ❑
(ETCH:
i?3
NSPECTOR DATE
TE Attach supplemental test data berets]
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City o and g
INSPECTION REQUEST
I
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' �NSPECt10N TIME : y PERMrr NO. . .
DATE . ')ATE ISSUED -
I OWNERS NAME '
I ADDRESS '
IC0 N 1 R A C T J R : ___.--_-- ----—
TEs 1 _3 . 'vv ater 7 Lr1
RESULT .4� prw ed Gi-s p rov0 j
I SKETCH:
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INSPECTOR DINE
`NOTE: Attach supplemental !0rst .: u#n ne►et]
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City of Tigard
INSPECTION REOUEST
I for
iNSPEC'TION __ PERMIT NO. . . --
DATE ./..Q:� 7-,Z `)ATF ISSUED'--.
OWNERS NAME —
I 40DRESS ' _
C 0191 R A CTU R : —1----------
TES
..---TES I Nrlter ,
RESJI.T
SKETCH: {
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I INSPECTOR DATE l!
d
CDTE ' Attach supplemental !est ., uov neret] i
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WIFAWIRTRAWAXWWWWOt
C
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. '.Type of Fixture Fee Permit No.
Permit fee _____
Water Closets Toilets ' Fermit Issued
Bath Tubs Approved by -
�► Lavato Wash Basin Building Permit
Shower _ Receipt No. y, -,- 2
tiin � �D_lsh�was�ing
nts Kitchen _
Sinks Ordinary Location of Buildin _
:eq
yin smear _ _Z _
inks�Slor -- t
Au t.oma.tic D ish, ascF Q.
_ Dis o^al -
Laundry Travis Name & Address of Owner
Drains, Fl.00r__ - --
llrazns Area
Dra_rl j 9 e r.�Qera ar
Ra-n Drains
Automati.c7 asher Name & Address of P t d,
Fountains riinking--. _ ---,
ountains oda
1 -Hot Water an _ _ lS5,5 s r stills•, „ [Ag
Water Service(Si Size - _ Pordand, Ur1oa )z..33
Ur.�nals Buildin Old or_New Alter, �tepalr or
T - ns a
a - sins - az'
Lawn :;r. stem _ —
w,mmi.rr Pool I -� CitFer
� Sprink er aystem _ _
This permit becomes nulland void if work or construction authorized is not
commenced within 60 days, or if construction or work is suspended cr abandoned
fcr a per.od of 120 days at any time after work is commenced.
All plumbing firms must be licensed by the City of Tig6rd and post a $1,000 bond
I hereby certify that I have read and examined this application and know the stimmf
to be true and correct. All provisions of laws and ordinances governing this tyl
of work will. be complied with whether specified herein or not, the granting of a
permit 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
�7cnstruction.
Signature of Applicant
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u�tt(fii�t,q �' .�ealinx�
Pordsin(l, :3
City of Tigard
INSPECTION REQUEST
for
NSPECTION TIME :._ /.'L�' r)ERMI'T' NC. . ...-.._.- �
DATE : "Y%z3 'SATE ISSUED'.
I OWNERS NAME
I '
ADDRESS '
I C,)N`r RACTUR ..� --
I
1'E I ^4er -
RESULT
SKETCH. / ,✓ �,,
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i INSPECTOR DATE
IL ATE : Attach supplementol rornt]
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of Tigard
INSPECTION REQUEST
for
. ._._ _ c.: ' w .l I cam✓ _ . ..
rJt;PECTION TIME . PERMIT NC.
DATEATE i S S U E D
OWNERS NAME : - S - I
-
ilN rRA1.TOR : — —. - - ---- - - - ----
EST
RESUL _ _N r�;ved _ ... 'uppt V
SKETCH:
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i
NSPECTOR DATE
[OTE: Attacti supplemental fast uut.: l-er t
1
';ity of Tigard
INSPECTION REQUEST
f o r
NISPECTION TIME PERMi V vC
DATE . DATE ISSUED
OWNERS NAME : 71)0,,6z"S
ADDRFSS.'
rpA " ,rr) R
EST i or c-; 'j j b •ct r
RESUL 1',)',olAX Appt—.ed C
S KETCH.
IINSPECTOR DATE
[NOTE * Aticen suppiemental test uu.lc lipr •toJ
L
18118 EXHIf.IT "A'•
CITY OF 'IGARD
Residential Structure Occupancy Restriction
KNOW ALL MIN BY TFC:'SE PRESENTS, That occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restriction In the Dee,. liecordu
of Washington Cuunty, Oregon, is prohibited by the ordinance of the
City of Tl;;ard, Oregon:
DE.SCRIITION OF PROPERTY:
oT io of 114;r Vi_,aCIL
Ste. 34 1-1 , CZ l uv, w•,.-�
ADDHMjS OF E'RO}LwyT 780 ,�
NAME OF OWNER: �OrV ��C�r�e.L A C
ADD:iz;;; OF UWNUi• 13970 t), cti, c /v-
IN WITNE;;S WHMW, the underuigned lac, caused this restriction
to be executed this. 91 day of /ate"i
OWNER:
APPROVED: by= •�._.
T.tle
By: fi 41
LIQ► �7
building fftcLal
Clty of Tigard
nncEN THoMARt".4 wd�a h.rmn�
STATIC OF OHWON ) ss.
County of Washington )
Personally appeared before me the at,ove named
_ and a_ktwvledged the ie,re$aing Inatrument to be
volku.tary act ani Jeeu.
,'• .. Public for
Notary low gun
14Y Casur'salon Expires:
V C
• s
CITY OF TIGARD
17420 S. W. /Mrin lfnd
TIGARD, ORIGON 1Tt2!
APPLICA'T'ION FOR BUILDING PERMIT
t New Construction a Demolish ❑ Addition ❑ P� m , : 1 LJ Muve F-1
ZONING R--j DATE ISSUED b-15-73 BUILDING PERMIT
DATE RECEIVED June 4, 173 BUILDING FEE $_ No,',, lnw'
HY 'PLAN CHECK $ 44.X1 ~
____96 -- OTHER $ VALUATION $ 24,5W-dO
N . r.�.A! f�!
s� RECEIPT No.
TOTAL $� _.J% � �v
TWO SETS OF PLANS AND PLAT PLANS MUST BE FURNISHED WITH APPLICATION
LOT 1_10 _ MAP A� _ CENSUS TRACT W-1) JOB 1
Architect or Engineer 2Ua&j Loualao
Address --- ^- Phone___`_
Owner aams _� (IA,"4y1
Address_f� r`rr ' ,n c� 2x -Phone___
Builder
Address.
BUILDING USE Single Rea. ❑ Multi Peg. ❑ Comm. ❑ Industrial
OCCUPANCY GROUP_ No. of Stories.1,. Total Height lb-- Area of Lotu,JDU
Type of Constructiun V Floor Area B --- 1 1656 2 ------
Set decks: Front _r Back 25r ',,.Side 1'� R.Side 71 M
Private Sewer Pipe Size 4" Seer usa T1J.rd _ Septic Tank F]Fater Service Pipe Size -• Storm Sewer ❑ Ditch ❑ Drywell❑
Street and Curb Requirements wining -
Driveway Width_ No. of Parking Spaces_ 2
SEPARA'T'E PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFOIMATION
ADDRESS ASSIGNED 11(du B.M. 114th Place
FIELD CHECK BY-__ BC. �- .-..._...DATE 6-15-73
PERMIT APPROVED BY��1���
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, anti that the building wil
not be occupied unt) 1 a Certificate of OccWNf2t•y has Ibsen isWd by the City of
Tigard Buildinq Inspector.
gnaturp oy App ant
mdIlklu.,k w.
UNIFIED SEWERAGE AGENCY No 878 _
WASHINGTON COUNTY OATF _
CITY OF -/D _.
APPLICATION FOR SEWt_R CONNECTION PERMIT
OWNER ok"i __
OWNER'S ADDRESS: _1,5 17O �r.k4�__.. ._MThI
aTRaET
CITY aTATI nc
BUILDING SITE: LOT._...IA2--. BLOCK - . J ADDITION jLq_
TAX LOT NO TYPE OF OCCUPANCY _ ____._._—
c
ADDRESS Il.� _Kr_�L4 r-LaCA _.._-
DWELLING UNITS L----�� __ FIXTURE UNITS
SURCHARGE. IF APPLICABLE
PERMIT FEE 450 INSPECTION fEE .7j-_ TOTAL DEPOSITED
INEWI (EXISTING) BUILDING SEWER SYSTEM __✓_,-5 1 '610420
r
The Applicant agrees to comply with all rules and regulsof the Unified Sewerage Agency
APPLICANT `7L
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SrWER SYSTEM
N
LINE SIZE INSTALLER ..
RECEIVED BY
IAOENCV ON ITS AUfNII
COMMENTS ...
This Application and permit expires in ninety 1901 days. The amount paid will be forfelt"d
should emptfahtln occur