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BUILDING PERMIT APPLICATIONcoF TIGARD DATE - '-7 113 1454
THE UNDERSIGNED HEREBY APPLIES FOP , .r'ERMIT FOR THE WORK HEREIN INP.ICATED BUILDER PHONE_ -OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONG
LOT NO.
OWNER • • a.�t.F•f•iE} JOB ADDRESS .1.'.:Lc,'',,: p�•�'I.�l•}- (T�� _.14OMEADDRESS
ARCHITECT
ENGINEER
BUILDERADDRESS DESIGNER
STRUCTURE ❑NEW ❑REMODEL` )QADDITION ❑REPAIR ❑RENEWAL ` ❑FIRE DAMAGE []DEMOLITION
RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOVT ❑RELIGIOUS❑PATIO ❑CARPGRT ❑GARAGE ❑STORAGE❑SLAB [:]FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED []SIGNS
OCCUPANCY I .L.AND USE ZONE_-. M_..BLDG.T YPE __FIRE ZONE `� PLAN CHECK By------ HEAT—
= troop+`aati L_ 1 5� _,terictl ax'_L at._.r.lq.q.r u fAjand to axi ;LiLl" UIL
0".LOAD____ EhQQ9_10A._Q ._ . _ .-_. _ HEIQH'! NO.STORIES-- 9HEF�---- — NU�E�PQyMS YflLF _ 'ii•__..__
BUILDING DEPARTMENT _ SET BACKS FRONT REAR LEF i SIDE RIGHT SIDE
Permit L i __—_-
� aai Aar a� � wlr aw rt a �
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
Rough-in 4
Fixture
Final
HEATING
_ Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final _
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach
SLOG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
( Landscaping
Zoning Final
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CITY OF TIC*ARD �C
OREGON
Owrler:..Tu latin Developcnent..C4...................Permit No.......7.4...11.4....
Building
Address-----------1.0.2.7.0---
...... ..........................
Certificate is hereby given this.29th-----day of.......July,_. ].9......7.5
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.
i�
.. ............................
Building Inspector
�—-,-•----art � J .�: � r
1�tM IN U f
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :
DATE: 'Z DATE ISSUED : /
OWNERS NAME : L'
ADDRESS: r,iI�ei !�
CONTRACTOR :
TEST : Air ❑, Water❑ , Visual ❑ , Laboratory [3
RESULT: Approve 61K , Disapproved ❑ Pending ❑
SKETCH:
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IN CTOR MATE I
[OTE: Attach supplemental test data ee►etai
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City of Tigard
INSPECTION REQUEST
for
0
INSPECTION TIME : : PERMIT NO.:
DATEATE ISSUED:._ Z
OWNERS NAME :
ADDRESS 40 T
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CONTRACTOR :- 1-7rlv—)
I
ITEST* Air❑, Water ❑ , Vieualok, Laboratory ❑
RESULT: Approved Disapproved ❑ Pending ❑
SKETCH:
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INSPECTOR DATE
5QTE: Attach supplemental tett date heref]
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i
ICity oand
"SPECTION'
Tigard
I for
IINSPECTION TIME :_J' PERMIT NO.: ---
DATE: , DATE ISSUED:--L
v
OWNERS NAME : � -'-
i ADDRESS :
CONTRACTO R : �
II . , Laboratory p
TEST Air D, Water ❑ , Visual
RESULT: Approved , Disapproved ❑ Pending ❑
I SKETCH:
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I INSPECTOR DATE
IOTE: Attach tupplementof tett Roto heret�
I
ewr e� .er rw � e: A ew .s es
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :.-5,) - PERMIT NO.:
DATE: DATE ISSUED:——Z---,
OWNERS NAME : TZ7 --
ADDRESS :
CONTRACTOR : ---
TEST: Air O, Wuter ❑ , Visualx"r Laboratory [�
RESULT: Approved ❑ , Disapproved , Pending ❑
SKETCH:
IJr.XI- 7,b
I
I INSPECTOR DATE
ICOTE : Attach supplemental test data here11
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EXHIBIT "A" 11914
CITY OF TIGARD
Renidential Structure Occupancy Restriction
KNOW ALL 1,2N BY TI SE FRESENTS, That occupancy of residential
structure (s) on the following described lank prior to the recording
of an occupancy permit releasing the restriction in the Dee4 Raeords
of Washington County, Oregon, is prohibited by the ordira,."ce of the
City of T11;ard, Oregon:
DESCRIPTION OT PROPERTY: f;mm"rfA e1.6 - Lot L[r l
As recorded in Book 3q , p,,;- h -, Plat records of <<'aahi.r.{{ton
County, Oregon.
J
ADDRESS OF 1'11OPI.RTXs _moi✓��y nt,"C.
AME
NOF OWNER: � Cj ,()TJ t't_- IJC�/�11,&,L 41
ADDMSS OF OWNER [J
IN WITPrESS Wk1L•'REOF, the undersigned has soused this restriction
to be executed this /N day of
MMA RR
Timla.tit is c].onm zar',•;r.
( N�.
APPROVED: B7y 3
Titlo
Byt
Bgllding official lot t.00ta..��.:.:ml?k,.. _1eTfa1.....,,el AM.rM
City of TiCard r T"'IMRSM.thmmoe of"a—vis M r��rnon.
STATE OF OREGON ) sa.
County of Waahin„vton ) ��•*� i 19�•
ersonally nppeared before we the above na:1;ed
and acknowledged the forcRoin,{ instrum, t to to
voluntary nct and decd.
,; , ry FuLlie i r ar
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f
STATE OF OREGON
1
County of Washlnptdh
and ELcR�er Tfsomsfen, Olrecror of Records
ons and E..-Offldo Recorder of Con.
rances for said county, writing do hefeb
t the within Instrument of Y certify
received and recorded In book �frycords wm
No.
of sold '
Vrltn.ss my hand and seol offlxW.
ROGER
Rec-Nds 3HEOIettSlorse' Director o}
/I(�I" ,
Deputy
.JUN 26 10 51 AIX fla
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EMIBI^. „A„ 1.914
CITY OF TIGARD
kResidential Structure Occupancy Restrictioa
t
X:r'OW ;,IL M'A' BX TIIL'SE P aSEII03, That occupancy of residential
s',ructure (s) on the following described Lands prior to tte recording ,
a �y •
of an occupancy permit releasing, the restriction in the D2cc: Records
of Washington County, Oregon, is prohibited by the ordir-nce of the
City of TiZard, Orceon:
l
Ur,:;CRIc''TIOY G? PROPERTY: Summerfield - Lot
( Aa recorded in Book �, Paga y , Plat recorn:. of Washington
` County, Oregon.
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ADURF M OF PROF.RTXt P 1 �•7C7 `� GJ, � �-------
ftMtis' OF O4idGR:-L1lII Lam,..��C.l�f.
r�-
ADn_Rss or ow��F.s ,c, .�..
IN WITNESS WifLituOF, the uneuraicncd has caurcd this ror.triction
1 1�' TA-
9`
to be executed tylia dey of , _� i u`
aj 7
04tti'l:�i t
Tu-jlntin. C.' clor.:r_h/ Comr.snv. Inc/1
g "
ApPR0VE,01 "-
, 1110
lays
4a �C ��..� /,
la nae�d.N� �••——lOr.._ai. ,..A.M.F NI' t
lding Officia
City of TiCardl T110M!tSEN.O,�noe nl M,«.id�6 flwol�nn� 11
e,,....•. li d ' n.•,
STATE OF ORF•GON ) as.
County of Wnchington ) _.
oraona11y appeared bofore me the nbove nnaed
andl1cknowledged the foregoing inatrume t to be
!'__..--•--�voluntary net and d'ccd,
In
i� ry Public�r &'r"n
1981 1-,__357
1
11.11
CITY OF TIGARD
Rosident:al Structure Occupancy Rcutriction
KNOW ALL MEN AY 11IF-SE PRESENTS, That occupancy of 'residential
structure (s) on the following described lands prior to the recording
of un occupancy p•nrmit relcasing the restriction in the Deco. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Ti,ird, Oregon:
DI•.'SCRIt r.TON 0: PROPERTY: Summerfield - Lot T!Zq
As recorded in Book y , Page 5 , Plat records of Waz3hir.Rton
County, Oregon.
ADDRES7 OF PROPERTY: )61.7 S.L✓, b] lih A) 1-2eWit.
NAMI: OF OWNER: T..t 7e,/f3q- '11 ' il,rti'7 lO
ADDMNS OF OWNER: I`i" L� J L✓. n ,
IN WITrrESS MIMMEOF, the undersigned has cauccd this restriction
to be executed thio � � day of �1j.,e-
19 .
OWNER:
Tun1. tinfiA clonr Ccnr, m . irr
Na
APPROVED: B 'r 1_d? �- "r� ! ,
Title
BY.
Luilding official
City of Tigp:rd
STA'T'E OF OREGON )
sc.
Cowity of Washington )
�• Personally appeared before me the above nnm;cd
and ncknowledGcd the foreCoi :3 instrum'.nj to be
voluntary act and decd.
o` ry Publie 0 0 e�;on
'�- ��_. �U A L U E �rS/6' - F E E /pG�o D A T E
TYPE_ 4c`'
PERf1IT ECH/ ICAL PCR17T
AT E _ f-v _ DAT!- _ Ll
_-xcevation Fill _ _ --- Air condi t:----7
cotinns o'un a r Ventilation
orms � _____ -
Sprinkler s stem
`'.lot-�s _ fV1asonr Flue- -.—.-`
einforcincL Stcel Fire doors/exits
Structural Steel - -
s-���� Garage Floor
rl.umbin� R
o�' ;j � -7� D'rivewa
Flnshing -
-, - Sewer L j
- =-=�--cmc _ Storm Dram lr
I_atn WaI1 car _ parkin
-
I'Eatwng Fence screen
a', c Heater _ _- 1�7 Final
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L74- 1 q 7
CITY QF TIGARD
12420 S. W, Mein Street
TIGARD, OREGON 97227
APPLICATION FOR BUILDING PERMIT
New Construction Q Demolish ❑ Addition ❑ Remodel ❑ Move ❑
7,ONING --_ ._-i— DATE ISSUED_6_1�- - - BUILDING PERMIT
BUILDING FEE $ [ j �`( No.
I)A'['F, RECEIVED (�/y.�'7/ _ -�r-
/7 PLAN CHECK
BY VALUATION $
OTHER/Ir�r.�. r $ l/ [
TOTAL/% SY:ir.$ _ _T%J RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT # r!_rfy�_ MAP # CENSUS TRACT _`- - JOB
Architect or Engineers2,AaAu-,_ v>z:_ e�5��
Address
Owner <S Q. e _-�_ _ ——- ---- ----- ----- - - _--- -----
Address Phone
nuilderc .,
Address
BUILu NG USE Single Res. R Multi Res. L� Comm. ❑ 'IndustrialL.J
OCCUPANCY GROUP-J;�_ No. of Stories i _ Total Heiqht Area of
Type of Construction I II III IV CD Floor Area B_- _ 1_1Z �, 2
Set Backs: Front_A_D Backe, L.Side- �I - R.Side_-Yr
Private Sewer Pipe Size - Aj Sewer k:" r; Septic Tank ❑
Water Service Pipe Size__ �&A Storm Sewer Ditch ❑ Drywell 11
Street and Curb Requirements_a� r
Driveway Width" ��� - _ _No. of Parking Spares_
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMHI"G
SPECIAL INFORMATION
ek A�Y_-1:L''_ .+ r .� i r /._(G - ![.'',
----__-------
ADDRESS ASSIGNED- 2'?t_)�/ /v cJr.,, --
FIELD CHECK BY� -_�— _ _--DATE_e:�//j
PERMIT APPROVED B��.�,.,,�
i
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.
Signature of Applicar(t