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BUILDING PERMIT APPLICATION TIGARD DATE_ 30110 9. ,19 03 4468
11 IF UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE 643-0 ,
OH AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE 6^"i-90'
LOTNO._167W, Lit I R&
OWNER 't0ti1 , .� .� t. JOB ADDRESS 10130 SW tiinbland or, _—
ARCHITECT
`�ion ENGINEER 'tlst.
BUILDER or.rentc► C.+rmmat. Inc. ADDRESS 12550 9U 2nd BewYwrtDESIGNER Sorr*nto Co
STRUCTURE ❑ NEW ❑ REMODEL [*ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION
MRESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS 0 PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE
OCCUPANCY R-,l LAND USE ZONE -SP1) BLDG.TYPE FIRE ZONE — PLAN CHECK BY tl HEAT_ l;aSa
Construct Den addition to single a family dvellinw 4@p carreetion sheet attached.-
pl!arts. or r�erlt. —.�. ---. -----��
SEWER PERMIT M
OCC.LOAD FLOOR LOAD 0) HEIGHT i NO.STORIES _ I AREA 119 NO.BEDROOMS_ VALUE
BUILDING DEPARTMENT SETBACKS FRONT _ A,"REAR LEFT SIDE RIGHT SIDE
Permit 50=50 THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE,ZONING
X2.83 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE
133.55 W11H ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal RESTRICTIVE COVENANTS.CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax
.IJ7 LICENSE.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HE
85.35 SDC-
Total - - ! Ti64
t=
PDCN APPLICANT Ol` AGENT
By
Approved dW1t Receipt No. ADRESS _--.— _ --------.- _. ------- – PHONE
i
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rough in
Fixture
Final
HEATING
Contractor
Contractor
l Irrm it No
Gas or 0,1
I'llnugh in
Fin-;
FWER
DRIVEWAY
Final
Storm raitiage
lRain Drain)Final
Sidewalk
Curb&Street Final
T
Approach
BLDG. DEPT. FINAL _TT64P6R_j�RY CERTIFICATE OCCUPANCY Final
Crp'rip-CATE OCCUPA14CY ,
Landscaping
Toning Final
4054 EXHIBIT "B"
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND RhELH:ASE OF RESTRICTION
The City of Tignrd hereby certifies thAt the occulvtncy of
the following described structure or premises with respect to which
a restriction of occupancy was, on May 15 1974
recorded in Book 975 , page 195 f, Decd Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRI WION OF PRGPERTYt
Summerfield - lot 21.8
As recorded in Book 34, Page 5, Plat records of Washington
County, Oregon.
OWNER: Ernaat_A_haring
BUILDING 1'Ei i,r NUMBER: 74-78
BUILDING ADDRL.9S11013Q_a�W• Highland Drive
This is to certify the said structure meets with the require-
ments of the Building Code of the City of Tigard and the above
referenced restriction is'hereby released and terminated.
TN WITNESS WHEREOF, the undersigned authorized officer of the'
City of Tlgnrd has cau;;ed this certificate and release of restriction
to be executed this
gay of
'ritl- '
C! CQ ZDER 4,
STATE OF ORNOON tom'
i
County of Washington )ss.
On this _� ^y day ofr , 19�, personally
appeared before me the above named __�/AR whose
signature appears hereon and who acknow edge-----d to roe that he executed
the same in his offical capacity on behal-f of the City of Tigard.
Z1i
1P otr�ry ub f Oregon
MY ,,Css_ issp�ion expires:
nn e� poets rHOMbMK ft*@W d&womb a ramiw,,
BOOK J94 rnlEll45h:...`................
`f�cccAcQ�' ,....awh
trnt
j,3
o
p
ASS
i t at
t �� �
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :
DATE: 1 DATE ISSUED :- Z
OWNERS NAME : T
I
ADDRESS: i0,13 o ";5 ��. �'.1 �yl�✓�,.- ��'.
CONTRACTOR : - eL.-r �2,4v _
TEST : Air ❑, Water❑ , Visual ❑ , Laboratory ❑
RESULT: Approved , Disapproved ❑ Pending p
SKETCH.
I
IFfOKEItTOR DAT E
5077: Attach supplemental tett data beret]
9
ALL SPACES MUST BE ENDORSED PRIOR TO
ISSUANCE OF BUILDING PERMIT
PLANNING DEPT.
PUBLIC WORKS DEPT. � _ �jbi. 7�
By - Dato
BUILDING DEPT.
TUALATIN RURAL
FIRE DEPT.
APPRO VFD FlO-'
CITY C.-'
PERMIT I,DL} :: c S
9
I
I
I
City of Tigard
INSPECTION REQUEST
I
for
O d -- s�
INSPECTION TIME: 21,. 04) PERMIT NO. :
DATE: Z Z ZtDATE ISSUED : I Z
OWNERS NAME : -;E -42 c - - --
ADDRESS:
CONTRACTOR .
TEST : Air ❑, Water , visual iK, Laboratory p
RESULT: Approved Disapproved 0 , Pending p
SKETCH.
I
qevrt) 4mu� -71 2f
i
I
I
I
INSPECTOR DATE
[OTE: Attach supplemental flet data beret]
i
I
I
City of Tigard
INSPECTION REQUEST
I for
INSPECTION TIME : PERMIT NO. :
I DATE: 12Y121! DATE ISSUED:. 1. I
OWNERS NAME :
I
ADDRESS :
CONTRACTOR : �rL%� �� '" _ �• }.
TEST:Air O, Water X, visuab< , Laboratory []
RESULT. Approved , Disapproved O , Pending ❑
I
SKETCH:
I
I
II
INSPECTOR DATE
I [OTE: Attach supplemental test date beret-10
1
r
i
r r s r
PLIMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No.
4 -ti Permit fee V SIuA,, 4uae�at,
Water Closets (Toilets) Permit Issue -�
Bath Tubs Approved by
Lavato Wash Basin �: Building Perm
Shower _ Receipt No. loa j q
in s Dishwashing
Sinks Kitchen
Sinks Ordin_ar Location. of Building
,yin s Bar_ .W-ZA&'q ---
Sinks Slop _ cciwr �Ert �1
Automatic Dishwas
/
Disposal �-�-
Laundry Tra s _. �" Name & Address of Owner sr�
_Drains, floor _ �✓ Com'
Drains Area /A'� //
Drains. Re rieratordM42 ___ _
Rain Drains
ll Automatic Washer N e & Address o' Plumbe ���'' Z
ftFountai.ns,
oun tains rin in Soda .Oa �c-� /ot Water Tank ater Service Size rinals B Sold or/ (Alter Re air or
aiGf�=L�asins - arm nsteawn Sprinklerystemwimming PoolOtD�ier
rinkler System
This permit becomes null and void if work or construction authorized is not
commenced within 60 days, or if construction or work is suspended or abandoned
for a period of 120 days at any time after work is cowamenced.
All plumhl,:.a firms must be licensed by the City of Tigard and post a $1,000 bond
I hereby certify that I have read and examined this application and know the sam
to be true and correct.. A11 provisions of laws and ordinances governing this t
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
construction.
%r
3 0 ignature of Applicant
City of Tigard t
INSPECTION REQUEST
for
INtPECTION TIME: Am PERMIT NO. :
DATE: J- 1;7ZZ,V DATE ISSUED :--
OWNERS
SSUED :_OWNERS NAME : '
ADDRESS: -7
CONTRACTOR .' ,
TEST Air O, Water[] , Visual O , Laboratory O
RESULT: Approved O Disapproved O Pending O
SKETCH: 5 �� 7y
INSPECTOR DATE
507E. Attach supplementei tN# fff• 1fret]
Cit J Tigard
Y g d
INSPECTION REQUEST
for
INSPECTION TIME: /I
PERMIT NO. :
DATE: GATE ISSUED :—
OWNERS NAME :
ADDRESS: -_�1,
CONTRACTOR :
TEST : Air ❑, Water❑ , vieuol�, Laboratory ❑
RESULT: Approved�, Dioepprovsd ❑ , Pending ❑
SKETCH:
I
-
INSPECTOR DATE
[NOTE: Attach SUPPlemental tett data beret]
City of Tigard
INSPECTION REQUEST
for
r
INSPECTION TIME. PERMIT NO. : —.—
DATE:
O. . .—.DATE: :�4,/-2J DATE ISSUED :
OWNERS NAME : —
A D D R E S S: --�-----
CONTRACTOR : ��— ��r
TEST : A:( u, Water El V-,sual Laboratory ❑
RESULT: Apnroved Disapproved C] Pending ❑
SKETCH:
INSPECTOR DATE
(NOTE. Attach supplemental test data beret]
F,XRIBIT "Bo
CITY OF TICARD
CERTIFICATE OF OCUoVANCY AND RELFASF, OF RESTRICTION
The City of Tigard huleby certifies that the occupancy of
the following described structure or premises with respect to which
a restriction of occupancy was, on -May 15 1974,
reconled in Book _q7e�, Page 195____ _ `____, Dced Record of Washington
County, Oregon, is hereby authorized and approved.
DE5CH111MON OF PROFERTY1
Summerfield - lot 218
As rocorded in Book 34, Page 5, Plat records of Washington
County, Oregon.
..Ernaat_A hering-
BUILDING PERMIT NUMBER: 74-78
BUILDING nDDtF.sst 1013QHighland Drive
This is to certify the .said structure meets with the regnire.
ioer.ts of the Building Code of the City of Tigard and the above
referenced restriction is*hereby released and terminated.
IN WITNESS MIMOF, the undersigned authorized officer of the'
City of Tigard has caused this certificate and release of restriction
to be executed this day of 19—
Title:
5TATF OF ORPMN
ss.
County of Washington
On this _ day of __, 19—, personally
appeared before me the above named __ _ , whose
signature appears hereon and who acknowledged to me that he executed
the same in his offical capacity on behalf of the City of Tigard.
Notary Fublic of Oregon_._._ �_�__
My Commission expires:
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occuixincy Restriction
KNOW ALL MLN BY MESE PRESENTS, That occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy pe n it releasing the restriction in the Deec. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Turd, Oregon:
DESCRIPTION OF PROPERTY: uwn,,rfield - Lot
As recorded ir. Rook , Page , Plat records of lJashin(ton
County, Orn^on.
ADDRESS OF PROPLIi'PY:
WE OF OWN::R:
.ADDRESS OF OW:1ER:
-,-==
IN WITNESS MILREOF, the undersigned. has caused this restriction
to be executes this '7 day of p2-116 197
T
OWNER.
�
APPROVED: B�- Name
By=
1 ing Official
City of TiGard
STATE OF OREGON
County of Washington ) _ _ CA , 19zz
ersonally appca.red before me the above named ,
% and acknowledged the foregoing instrument be
voluntary act and deed, r
k c 'f� tot, Public for eon
I� Nov COmm'tiaion Exp res:
'
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MLN BY TID: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. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY: ;ummerfield - Lot Z_Ja
As recor Teri ir. ?'ooh1'nge _, Plat records of Washington
County, OT"j;on.
ADDRESS OF PkOPERTY: 1 �ZV��• '"IIJ(�VIA �r iy e
OF OW11FR: 'P--- r��dr:'A =c.�In A
ADDRESS OF OVNER: 1 Z U."O
IN WITNESS WHEREOF, the undersigned has caused this restriction
}I.
to be executed this '7 day of N/ 19'7L/.
OWNER:
:ualetin Jr v eat C nnv. 'rc.
Name
APPROVED: B
T: le
;ilding Official
City of Tigard
STATE OF OREGON ) se.
County of Washington )
)Personally appeared before me the above named o,
and acknowledged the forer 4.13 instrument t4Y be
�oluntr,ry act and deed.
o ,ry Fublic f r rcgun
My Commtssion Expires:
ROGER TIMMR.4EN. Drf*.xor of Rr.'.. N
ro�e 975 Pu 195
74
73i C g�•�n �
.CD
a
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m
x
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o
0ND
W
CITY OF TIGARD
12420 S. W, M&In SOW
TIGARD, OREGON 97227
APPLICATION FOR BUILDING PERMIT
New Construction Demolish El Addition 11 Remodel El Move 11
ZONING _ _ _ DATE ISSUED --7- _ BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ /.;Z I• 5 y No.
BY -- PLAN CHECK $ (,,D. ?S -7 y�
-- -- OTHER $-_L 1 L ���o s�j9�VALUATION $ 37, 1111
'fi`lYtt $ RECEIPT No. l- -1 -
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N__yAjF5_ MAP fly CENSUS TRACT _ _ J013 IN
Architect or Engineer,c•.�� ��y�� .,� I _- s,-�� �' �, _�_
Add ress_j_5 3L__ ��
c�X7L_ 116.}�` / �"_��.�'-1�`�
____ ___Phone._( �-31S2L__
Owner L�:c..-�. - __�1 � �L117_r7_ —� _ --------�c
Address \_ ��.�C� S \Jtl. ��-�f�l?I I�C'-1= l� Phone - __q
Builder
Address
BUILDING USE Single Res. �- _ Multi Res. Comm.- Industrial
OCCUPANCY GROUP -T: No. of Stories------. Total He.ight`1 Area of
Type of Construction I II III IV G� Floor Area B` I)3_f j
Set Backs: FrontBack L.Side
Private Sewer Pipe Size _�-- Sewer X;s-,_c C;1} Septic Tar.k El
Water Service Pipe Size �&" Storm Sewer`-® Ditch C] Drywell❑
Street and Curb Requirements__C,_�,_ I-elti I I _
Driveway Width IF) No. of Parking Spaces Z_
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMHING
SPECIAL INFORMATION
ADDRESS ASSIGNED
FIELD CHECK
PERMIT APPROVED HY/,
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 building will
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector. ���
Signatuie of Applicant