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12111 SW 125TH AVENUE I1L11 SW 125TH AVENUE cn -1 cu _r-_ Cn ua to Flo � � y rl >4 I�j rn C14 r% '7 I I .3 7 I y l , City of Tigard INSPECTION REO U E ST for INS?EC TION TIME :-- PERMIT NO. I DATE: i1111Z,� DATE ISSUED: .—L-, OWNERS NAME : ADDRESS : �rti ICONTRACTOR :— ' t 1 TEST: Air CI , Water [] , Visual �, &-aboratory p I � RESU!T: Approved t'sapproved L7 , Pending [j S , i i I I I INSPECTOR DATE I :NOTE : Atlach supplemental test date beret City of Tigard INSPECTION REQUEST for - J f (J 1Lc�a i INSPECTiON TIME: aUte PERMIT NO. : DATE: /,.?VI-2 ✓ DATE ISSUED :--L-/-- OWNERS NAME : - _ __ I �- -. ADDRESS: lel 11 CONTRACTOR " - TEST ' ONTRACTOR : _TEST : Air (,, W rater Q , Visual , Laboratory p I RESULT. Approved Disapproved CJ Pending p SKETCH: I Z- t)jh i INSPECTOR DATE I 101E Attach jupplemen;af toot data beret 03 1 (. 1 t is w wzwffw Chfy of Tigard INSPECTION REQUEST for QCL)(' INSPECTION TIME. PERMIT NO. : DATE: f-� DATE ISSUED :—/ OWNERS NAME : k/ a- Ss ev . ADDRESS: /.2//) S ck-J S1 CONTRACTOR : c, _74ft 11(f0 SS ea-- 113 TEST : Air Q, Water 0 , Visual D , Laboratory ❑ RESULT: Approve , Disapproved EJ , Pending ❑ SKETCH. INSPECTOR DATE L01E Attach supplemental test data hc►eta] 1 1 I City of Tigard INSPECTION REQUEST I for INSPECTION TIME: PERMIT NO. :. DATE: . Im_'ZrY DATE ISSUED '. _ I OWNERS NAME : ADDRESS: ,.,CONTRACTOR : _ � — I TEST Air p, Wa;wr[] , Visual p , Laboratory p RESULT: Approved Cl Disapprovsd 11 Pending p I I SPSPECT0R DATE LNO1E Attach suppiememfol teal dot,, hareto, I ! f I City of Tigard INSPECTION RE � G?��ST � for INSPECTION TIME: �� °p PERMIT NO. :--.-- DATE: O. :__. _DATE: DAT ISSUED : Z i OWNERS NAME : e�-c! SsEyC . I ADDRESS: CONTRACTOR : TEST . Air p, Watery , Vlsual j�', Laboratory 0 RESULT. Approved Disapproved O Pending p SKETCH.� I I I I I I I INSPECTOR DATE I CNOTF. Attach suppletnentat test data bereloi I 1 ADDRESS PERMIT N0. PERMIT CHARGE OWNER C`Si �K�\fir ila�o CONNECTION FEE 45-0 PAID BY -- TYPE OF BUILDING DATE CONNECTED SLRVICE RATE pc,c� _ �____T INSPECTION FEE S z CONTRACTOR PAID BY DATE . .. ��.. -_ ---- _ SIZE OF CONNECTION 'u�� ASSESSMENT �r PAID _ t � ss � I■r � w■r � City of Tigard INSPECTION REOUEST for INSPECTION TIME : PERMIT NO. : DATE: DATE ISSUED:—/ OWNERS NAME : .�.1a ADDRESS : CONTRACTOR : , - -.--- TEST: Air O, Water 0 , Visual l , Laboratory [] RESULT: Approved Disapproved U Pending L] SKETCH: /o'�c �•'� �- ' "' INSPECTOR DATE LNOTE : Attach supplemental test dato horst] City of Tigard INSPECTION REQUEST for _ iNSr'ECTION TIME : '• �' ��uyDATE I ISSUED:__.t'_ DATE* �`_L---- IWNERS NAME : Q Al r t4ADDRESS : zLl CONTRACTOR :----- - — TEST. Air 0, Wafer Q , Visual ❑ , Laboratory ❑ RESULT: Approved Disapproved 0 , Pending p _ SKETCH: NSkCTOR DATE CN01E Attach eupplementol tett dato heret] 1 I Cit of Tigard City g d INSPECTION REQUEST � for INSPECTION TIME: =/, PERMIT N0. : DATE. _ "1'112 DATE ISSUED :__._—L_L_ OWNERS NAME : � � V�p ADDRESS: _1 CONTRACTOR .- _ TEST ' Air O, 'sYnter O , Visual O Laboratory p I RESULT: Approved* , Disapproved O Pending p SKETCH. I I I I I INSPECTOR UAT E 40TE Attach supplemental test data hereto] Ai w tiC / I I City of Tigard I ' INSPECTION REQUEST 0 for NSPECTiON TIMPERMIT PERMIT NO. : —_ DATE: 3.LlQZ$j DATE ISSUED :__1..1_._ I )wIINERS NAME : -- --- - I ADDRESS: -5 � -- :ONTRACTC R : r�•�E' t1j` r� ____ I rE ST : Air 0, Woter^ , V` al Laboratory [] I RESULT ' Approved Disapproved 0 , Pending p K E'r C N. _010, �j�� t i✓ C (iso I I I INSPECTOR DATE OTE Attach supplemental tett data hereto] I i it i I Cify of Tigard INSPECTION REQUEST for INSPECTION TIME : _ PERMIT NO.: DATE: ,3 -' / DATE ISSUED:_1� OWNERS NAME ' - �ARQ104 /I�i 3ic ADDRESS : CONTRACTOR : __ _ TEST: AirO, Water �C VieualX, Laboratory ❑ RESULT: Approved) , Disapproved ❑ , Pending L] SKETCH: INSPECTOR DATE [OTE : Attach supplemental tett data hest] CITY OF TIGARD P. O. Box 23557 12420 S W. Main Tigard,Oregon 97223 noromber 28, 1 l7 i Mr. Peter Klym Route 3 box 113 Cornelius, Oregon RE: SEWER PERMIT NO. A887 On August 29, 1973 the UnifieJ Sewerage Agency issued you the referred permit and according to our records no action has been taken on your behalf to use the permit. According to the regulations of the Agency, all permits expire 9n days from the date of issue with the fees being forfeited. This requirement is also a part of the regulAtions of the State Department of Environmental Quality as incurpereted In the Agency's waste discharge permit. The Agenr..y has been lenient in not forfeiting chis permit prior to this time; therefore, unless you tak[ positiv3 action to use the permit within the following 30 days said forFeil.ure will be made without further notice. If we ran provide any information concerning this matter, please du not. hesitate to rontact us. Sincerely, 1 � James Brien Acting Building Official J8/fs sTe* T a 1L,f1 70 /V0 4.r 'Il 0 106 K atm >?� UNIFIED SEWERAGE AGENCY NO. WASHINGTON COUNTY DATE C I T Y O F---LL–ALD —_ - - APPLICATION FOR SEWER CONNECTION PERMIT OWNER: — TL 1�"r ALM " .ET - OWNER'S ADDRESS: SSI,... /o�''S ��y.�- _ --------- --- aTRF ,t3 �+ —%6 ITV 6TATE BUILDING S11 E: LOT BLOCK__..___---- ADDITION jEc�+Cwr+ TAX LOT N0. -" - — TYPE OF OCCUPANCY . Idlll �",v �- ADDRESS__ .�Zl--�r- ______ DWELLING UNITS-- -_. FIXTURE UNITS O$ —r.0- SURCHARGE IF APPLICABLE Ov 11—cl PERMIT FEE -4��Q--- INSPECTION FEE-91K TOTAL DEPOSITED � � 4 (NEW) (EXISTING) BUILDING SEWER SYST01 e The Applicant agrees to comPly with all rules and regulations of the Unified Sewerage Agency. APPLICANT 1 SEWER PERMIT THIS PERM11 AUTHORIZES CONNECTION TO THE SEWrR SYSTEM, 1 LINE SIZE , 4 ` ._____ _. INSTALLER -_.-- - -- __ - -----.—.-- RECEIVED 8Y (AGFNef opt ITS A61NT1 r COMMENTS. '{ i This Application and permit expires in ninety (90) days. The amount paid will h� tot eihtd should expiration occur. i a 1 I s 1819 EXHIBIT "A" CITY OF TIGARD Residential Structure Occupancy Restriction KNOW ALL MEN BY THESE 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" Records of Washington Cuunty, OreEon, is prohibited by the ordinance of the City of Tigara, Oregon: DESCRIPTION OF PROPERTY: =nT V `t3zoar V.�,by ADDRESS OF PROPERTY: laIll NAME OF OWNER: l't>Tic� KLYM ADDR&I,S OF OWNER: r%?1. .3 /3eh //i C' ,�.J i ,,•<, UeE ._ q111? IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this day of U., lye, Lj OWNER: :lime APPROVED: By: T.tle Byt 11�c �:u,. . 1 o IQ ?t4'4 k.�4M PM h0tilding Official D-1,11 ..-m. City of Tigard STATE OF OREGON ) as. County of Washington ' , 191 Personals,, appeared before me the above riameedd � C._._. and acknowledged the foregoing instrument to be , 1 vol ;.ary act and deed. �� • It Notary P 11u for Oregon. Aly Co'^m'ssion Expires: Bn 945 [ALE770 Uz8 ! _ � }f�� t 60 % I� $! c ■9um �(} E CITY 4F TIGARD 17420 S. W. Main Skeet TIGARD, ORRGON WM, APPLICATION FOR BUILDING PERMIT New Construction El Demolish LJ Addition Remodel l� Move ZONING R-7 DATE ISSUED --i-23-73 BUILDING PERMIT DATE RECEIVED XA 9, 1973 BUILDING FEE $__�6 .00 No. 7+3.104 BY_ FS --- PLAN CHECK $ VALUATION $ 24,050 - OTHER $ 10.00 TOTAL $ 99.00 RECEIPT No. TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION LOT M A s MAP M231 3BB CENSUS TRACT W-i9 JOB N Architect or Engineer _Doaald Brim. Address 5930 State St., 561. L_Pa _JPhone _ Address 9.W. 125th 1ve. Phone— Builder --- Builder r,.,� (leroeliue ,,j lf./ ,� Phone Address _ --- -- BUILDING USE Single Res. 0 Multi Res. Comm. D Industrial OCCUPANCY GROUP I No. of Stories 1 Total Height_ 14' Area of Lot 8,000_ Type of Construction V Floor Area B_ —_ 1 16 � 2 Set Backs: Front 20' _ Back 45' L.Side_- 51 --. R.Side 8�1 Private Sewer Pipe Size 411 Sewe rues ! ij Septic Tank Water Service Pipe Size_ �� Storm SewerllC_I Ditch ❑ brywe11 ❑ Street and Curb Requirements_- Weting� r)riveway Width 18 _ __ No. of Parking Spaces 2 SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING SPECIAL INFORMATION Q ITT T v ADDRESS ASSIGNED 40M B.W. 1251h Ays. FIELD CHECK BY IC DATE. 5-23-73 PERMIT APPROVED BYE,�,.�,� ✓.� ____ It is understood that all work will conform with applicable codes and ordinances of the State of Oregon and the City of Tigard, Oregon, and that the buildi,ig will not be occupied until a Certificate of Occupancy has been issued by the City of Tigard Building Inspector. 5 qi natuir_ of A p icant - i