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City of T igard
74
' Nc'�TCTION REQ`w"'Ee`
far
!NSPECTfON TIME: PERMIT NO.
DAT E .'
DATE
OWNERS NAME :
ADDRESS : 4� , 14'Co #441 f0Z
CONTRACTOR ' ,.�z .7.
rF-3T ' Air Water C1 , Visual 0 , y
PESULT' Approved oisopprowed r ,in ;
SKETCH.
o— r_CT 0 P DATE
I
1
City of Tigard
INSPECTION REQUEST
for
IINSPECTION TIME : 1 L-2 PERMIT NO.:
DATE: LZU1 DATE ISSUED:__Z
OWNERS NAME : �1' L� E /D /ao 3-w ���,{/o►�,�
I ADDRESS :
CONTRACTOR
TEST: Ai► ❑, Water [:3 , Visual Laboratory ❑ '
I RESULT: Approved Disapproved ❑ Pending ❑
I SKETCH:
I
i
I INSPECTOR DATE
ICNOTF : Attach supplemental test data heiero�
■r ra t: w w w rrr
I '
1.191.3
1,MUDIT "A"
k
CITY OF TICARD ,
Residential structure Occupancy Restriction
KNOW ALL MN BY IMSE PRcSEh,a, That occupancy of residential
r .
ctrueture on the following described lands
(; ) g prior to the recordinE;
of an occupancy permit relcasin3 the rcctriction in the Deco Records
i
of 4fochington County, Ora4on, is prohibited by the ordircne9 of the i
City of Tigard, Oregon:
DESCRIPTION 0: PROPERTY: Swrnerfield - Lo' 'Z 171
As recorded in Book Pa f Plat rocords of llnshi:stun 1
County, Oregon.
I
ADDR7;,8 OF t'R0P1:.RTY:_/n
NMiL 0^ Owam r, ]r�a lri ;vL _ Cc,/ to 132=94__ lcl� ------ /
ADDRc.,B Or 01-IT it4 GJ. JI cam
�—, ITJ u =,ss IM,REOr, the undersigned hau caused this restriction
` o to be ex this y jw day n�' � "+ 1924
VJ:p
zr
o � U'.,iVr:n• j
a
Tunl.ntin i:.'v ooxent omcam�. 7^c.
` i Ncct;a Q
APPROVEDt Dytti _ '�+,•� �' •!
r
Byl
/ o
wilding Official rll.alerr�eerd....._{F 17}._10d.ar.._ AM.Fn
City of Tigard / OOCR THOMWN.DIM-t"nl Penn.1��+[Iwotion.
c
STATE OF OREGON ) Co. LY
County of Washington )
—A<raonally appenrad before mo tho above nnced .�.��, �� a
q,,,,-... and. acknowl.edscd the foregoing Instrumcntrlto be a
te---- voluntary net and deed41iokr"yrubita�fo/O
k,$4airt�' I
ran :
EXHIBITIT "A" 1,1913
CITY OF TIGARD
Residential btructure Occupancy Pectriction
KNOW ALL MIN BY THESE PRESENTS, That occupancy of residential
structure (s) on the following described leads prior to the recording
of an occupancy permit releasin, the restric.!a-.r in the beet. Records
of Washington County, Oregon, is prohibited by tha ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY. Swnmerfield — Lot
As 1ecorded in Book PaSre 5� , Plat records of Wnshirgton
County, Oregon.
1 ADDRESS OF PROPERTY:
NAME OF [�C✓,S',
ADDRESS OF OWNER: c
IN WITNESS WHEREOF, the undersil,ned has caused this restriction
to be executed this 14 I day of
OWNER:
s
"'ua i.atin '::v .cr;rent omr,=:r••.
Nc7'
APPROVEDt Dye !Z ����--1r-•�,��, ( !/,
i
Bys
13' �.lding Official �� P11wAt�tr�:md.......kt..... r�.. 147`tet.........AM PM
City of Tigard �M00CR T110WI NgDe/ nr n1 Rrnerde k Eiwrnone
i
STATE OF OREGON ) ss. 0
County of Washington )
rsonally appecred before re the above named _
and acknowledEed the forejolnl; instrumen^ to be
voluntary act and deed.
P�.. . ry Fublie ion' 0. ion
�:� � -- ---
_�: L.G. �_,,
.r
1p
STATF OF OREGON 1
County of Woshlrgton 1t
I, Rn9er Thomssen, 01'Ltor of Records
and Electrons and F.■.Officio Retarder of Con-
do hwebY cerflfy
veyarxes for sold county, o) writing
that the within Instrument of records
received and recorded In book
of sold County
Witness MY hand and seal affi ER 'THOMSSEN,Director of
Rads 6 EMcttioro
�)(ItI"
neo�ty
Jua 26 10 51 AM'74
�r
E)GLIBIT "A"
CITY OF TIGA1tD
Residential Structure Occupancy Restriction
KNOW ALL 14EN BY TUTZE PRESENTS, That occupancy of residential
structure (s) Ln the following described lands prior to the rec )rding
of an occupancy permit releasin., the restriction in the DeeL Aocords
of Washington County, Oregon, is probibited by the ordinance of the
City of Tigard, Oregon:
DF.SCRII'TION 07 PROPERTI.: Summerfield - Lot
As recorded in Book, Paps , Plat records of Washington
County, Oregon.
ADDRESS OF PROPERTY: ��
NAME OF OWNER f-'j._�
ADDRr.SS OF OW��F.a2:_Z 5 6 [,J. /��
IN WITNESS WMLEREOF, the undersigned has caused thio restriction
w
to be executed this �[�` day of Jyc2e. 19-711.
OW'NL'.R:
s
Twil.atin PQ1 .onrrent y.'amc-�n•.. c
APPROVED: 8yZ`,y f?�/ •r l
i'tlo
By: _
Building Official
City of Tigard
STATE OF OREGON 66.
County of Wauhington )
rsunally appeared before re the above named
and acknowlcd3ed the foregoing inst.rumenieto be
vol•unt.nry nct and dred.
r;Otfl y Public foxfrecon
._
pop �—
Cry l � t7 � .....
/.�n_8UILDER � VALUE 3!�_jS/q FEE iae DATE b-/C/-?
LOCATION /o/ev �� 1.�•.-.P� �C� n W N E R�sa._ L�1`4 ,�r,,,
inn ," P�
_ MAf LOTS TYPE
PLUMBER . �s�- ", rc i'1 I T ;� -G�d �C F E E -�
SEWER, PERMIT FEE MECHANICAL PERMIT
71% -/o/
1
DATE _ _ by DATE b
Excavation Fill Y Air conditioning
(.4 ootin s F oundat.i.on Ventilation
Forms _ Sprinkler system
Slabs j Mason r Flues
Reinforc:inq_Steel� Fire doors exits
Structural Steel 7- -7Gara e Floor
- L Plumbin R . I . fit dos Orivowe 3e-
'.ciof Flashin9 Sewer
F"3me Storm Drain .�
i' Fath Wallboard Parking
Heating Fence/screen
L'ator Heater L I A -) Final A _
.� _•c,' _.fes-• Z... ,.. � /
e-
CITY OF TIGARD
12470 S. W. Mdn S►r:N►
TIGARD, OREGON 97727
APPLICATION FOR BUILDING PERMIT
New Construction V Demolish Addition Remodel lJ Move
ZONING_ DATE ISSUED_`&-1 (��]'/ - -` BUILDING PERMIT
BUILDING FEE $ ' No.
DATE RECEIVED_L -/LL•' ' L'
PLAN CHECK $ f'6
B" �. -_ VALUATION $
OTHER $_._
TOTAL $ RECEIPT No.�?tory
�
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT 1i- ' 1 MAP N_ CENSUS TRACT � T_ _ JOB k_ 5z_j 7
Architect or Engi.neem_-.�__Ln,'_
Address 1S3C2C7 -�3-��_��___L� .�L�- .-
Owner -3cr.._ J____-------_.__------------------- ______--
Bui lder!�,&,,,� --e--
Address _ -----------Phone
BUILDING USE Sr-ngle Res. F1 Multi Res. Comm. FJ Indubtrial�
OCCUPANCY GROUT- - No. of Stories - Total Height- Area cuf Lot
Type of Construction I II III IV Floor Area B-
G n
Set Backs: Front�Ql _ Back 4�-3 L.Side���� _ R.Side `r��
Private Sewer Pipe Size_y�r — Sewer ,45, Septic Tank I�
Water Service Pipe Size-__N� Storm Sewer � Ditch ❑ Drywell
Street and Curb Requirements_ -
r
----------_-,_-----__-__--_.-._ ----- -.
Driveway Width_L�_ No. of Parking
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFOO�RMATION
r1-__1
ADDRESS ASSIGNEUM /( ,1[ D 1e' $ -__------
FIELD CHECK BY ------ ----- - --------,----DATE
PERMIT APPROVED B
—.
It is understood that all work will conform with applicable codes and ordi,,?nces
of. the State of Oregon and the City of Tigard, Oregon, and that the C,ui.ldinq w411
not be occupied until a Certi _icate of Occupancy has been issued by the City of
Tigard Building Inspector. _
Signature of pplicant