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OF oce
�� CITY OF TIGARD
OREGON
Owner:_Tualatin D3v.elop.!RPt...........................Permit No.... 74-86
. ..................... ..-. ...... ......I........
Building Address......10.4.3.5...S...W......Highland...D-r.i.v.9..................... ................
75
Certificate is hereby given this.....29th of.....q14Y.................. 19......
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.
.....................
Building Inspector
City of Tigard
INSPECTION REQUEST
for
IFI ti,,, L_ \
i
INSPECTION TIME' -- PERMIT NO. :
DATE: 7 /LEL, DATE ISSUED : I
OWNERS NAME : T D C
ADDREQS: /04/35
CONTRACTOR : 7 �7U
TEST : Air 0, Water[] , Visual [ , Laboratory [
`
RESULT: Approved`[ , Disapproved [ Pending L]
SKETCH: '
I SP CTOR DATE
NOTE: Attach supplemental tett data bore a
_._ .. ...«;.wwrw,.....,,..w.....•w.w.rw+�...-..r...w��..,y..,.,.,m,-......+...e n... -.,.w•...,,.��*rrr.+..r�IMT`«. ...,,...w,..�+.+s.,...,• ,-.`...—... .....,.. .......«.r,-.>
CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE 4"lU--, 19--
N° 0240
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
TLI13"tir, �"% _ P� Wr1r 4/�1Uti
OWNER 1��►Vas10 pl(@Ilf✓ "'ADDRESS �!-� 3
J ' ' BUILDER PRONE
stuns ENGINEER
BUILDER ARCHITECT DESIGNER
STRUCTURE ❑NEW ❑REMODEL ❑ADDITION ❑REPAIR ❑_RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STOR4GE❑SLAB ❑FENCE
❑BOND El MOVING ❑CONDITIONAL USE El DESIGN REVIEW ❑COUNCIL APPROVED — ❑SIGNS `
OCCUPANCY_LAND USE ZONE_._-___ —BLDG.TYPE FIREZONE__ PLAN CHECK BYHEAT___
—---------- r sr+Larl,i n i rl y wall — ^
OCC. LOADFLOOR LOAD HEIGHT ND.STORIES AREA VALUE
BUILDING DEPARTMENT SET,TACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit —
TIIIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAIN"D IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL AN'LICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIA►.CE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State LICENSE. SEPARATE PERMITS 1EOUIRED FOR SEWER, PLUMBING AND HEArING.
Total l I!
By
-- --- APPLICANT OR AGENT
Approved Receipt No '
ADDRESS ----...------ PHONE_----
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
,?:Zz- �.�-�L� Contractor
Permit No.
Rough-in
rIXture
_ Final _
HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
r Sidewalk
Curb&Street Final
Approach
OLDG.DEPT.FINAL Y TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
w,
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :--
DATE: 21.45 ' DATE ISSUED :-/
OWNERS NAME :
ADDRESS:CONTRACTOR :
TEST : Air ❑, Water[] , Visual [9 , Laboratory ❑
RESULT: Approved ® , Disapproved O , Pending L]
SKETCH;
INSPECTOR DATE
[OTE: Attach supp1emental test darn beret]
I
Cit of
City Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :--
DATE:
O. : —DATE. / / DATE ISSUED :— I
OWNERS NAME : -L .0
ADDRESS: ._ 5 1'7t
CONTRACTOR : —
TEST : Air p, WoterQ Visual
0 , Laboratory p I
RESULT: Approved/9Disapproved Q Pending p
SKETCH: I
I
1
I
I
I
I
I
N PECTOR DATE I
[OTE' Attach supplemental cast data beretio I
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No. -/y7-Ire
Permit fee
;? Water Closets Toilets times Permit Issued Ir 7
Bath Tubs Approved by
Lavatory- Wash Basin _ ��� Building Perm
Shower =% Receipt No. jo/v
in s, Dishwashing
Sinks Kitchen
I 'Y
Sinks Ordinary Locatio of Buildin* /._7inkE.L. Bar 44
Sinks Slo
Automatic Dishwasher
Laund_ry Trays Name �& Address of Owner
Drains, Floor
_
Drains Area
Drains Re ri era or
Rain Drains
Automatic Washer Name & Address of ,Plumber , Y
-F_oqntains_,_Dr,1.nk n
Fountains Soda All
Hot Water Tank[,
Tsprinkler
ater Service
rinals Btxil_d'•n Old or N� (Alter, Repair or
atcs-Basins - ar �'Ea
awn Sprinkler_'3ystem
Swimming Pool _ Oi-her
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 commenced.
All plumbing firms omAst be licensed by the City of Tigard and post a $1,000 bond
I hereby certify that I have r?ad and examined this application and know the sam
to be true and correct. A1.1 provisions of laws and ordinances governing this ty
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.
k:• ''�' Signature of Applicant
1
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7 y `13u-II DER ( F,e ,.��U_k�, ,;u v 'E_. SJ...7`?--------1
X''__ {J'..• ,C..r. ._�. _.. r_._...._..�....-__• '
PENWIT
Ij
I'FF. ..
nr p� .. }3Y PA FI.
- --
_--
Fi,RIAS - .___ ._�_ _ _�_�� SI T,.I(��:H c ti:S'?r_'•! �.
_.__w. I�r I i"'�":^Ii'`�_S��'F;'•:L_....- ._� _ _�-.-_ ^_:;rte: h::��� r� ._...___ _ _-•
�?:-1IICTL TAL
CITY OF TIGARD
12420 S. W. Main ffrset
TIGARD, OREGON 97222
APPLICATION FOR BUILDING PERMIT
riew Construction Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING _ DATEISSUED �'I —' BUILDING PERMIT
DAT}; RECEIVED
BUILDING FEE $ No.
-�
PLAN CHECK $ --
-- -_-- --- OTHERrt..•G'•� $ �� r� _ VALUATION $
TOTAL RECEIPT 110. ,_-�_
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT li- - ��SZ MAP NY-- CENSUS TRACT JOB
Architect or Engineer`11-)[i�"- L-:--xcVC AoPI6 r 12.1 .1
Address -1.6. 1—W --Phone
Owner
PhoneOwner- sR � ----------��_- --
Add r e s s ----___—_—--Phone_�!
Builder-,5r.,- p_
Address____ _ _ --__ .--------.Phone____
BUILDING
--`-__—_Phone _—
BUILDING USE Single Res. [-.,Iti Res. ❑ Comm. ❑ Industrial 11
OCCUPANCY GROUP -I- No. of Stories---- Total Height I---- Area of Lot-----
Type
ot`-__Type of Construction I II III IV (') Flonr Area B____ 1 2—„
Set Backs: Front-tj____ Back__6__ L.Side__ J R.Side___-s-j6._
Private Sewer Pipe Size Sewer k, C Septic Tank 11Water service Pipe Size_-1," Storm Sewer Ditch ❑ Drywell❑
Street and Curb Requirements qS___ �
Driveway Width - � _No. of Parking Space._ _
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGWF.D ---
FIELD CHECK BY DATE
PERMIT APPROVED
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 to occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector.
Signature of. Applicant
9859
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 DeeQ Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY: Summerfield - Lot 1-W
As recorded in Book � Page _3, Plat records of Washington
(',ounty, Oragou.
ADDRESS OF PROPERTY s �U.
NAME OF OWNER s t lc,a.:� 1-7) ✓,_
ADDRESS OF OWNER: I CXJ -.t,.3
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be executed this ,'_[._ day r)f tAr—
O'MR 3
TimIntir v" o ont r
APPROVED: By:
Bys
Building Official
City of Tigard
SPATE OF OREGON ) ss. )
ICounty of Washington ) 1 19 V.
rsonally appeared before me the above maraud �` o
and acknowledged the foregoing instrument no
voluntary act and de
7*
7.....�e'l.`�...d9i3( Not ry :ublic iu .aioz
H Tm wigrm Dirac,.,, o1 fie—do P, i -• My Commission xpires:
BOOK �7 Ni�CEilO�
N,
O� STATE OF OREGON 1
County of Washington 11
I, Roger fhomtfenn,, Dlraefpr of Rec-nit
and Elections and Es-Officlo Recorder of Con-
veyances for sold county, do hereby certify
that the ttWhln Instrument of wNtlng was
received and wattled in btlok of nkords
Nn. ...-._ ....... .
of said Cotwtfy
Wltness my hand and seal affixed }
ROGER PIOMSSEN, vlrector of f
Records 6 Eleetlonii
Deputy
z j
EXHIBIT "A"
CITY OF TICARD
Residential Structure Occupancy Restriction
KNOW ALL MEN BY TIMSE PRESENTS, That occupancy of residential
utructure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Deec. Records
of WachinGton County, Oregon, is prohibited by tho ordinance of the
City of Tigard, Oregon;
DESCRIPTION OF PROPERTY: Summerfield - Lot .L�L
As recorcied in nook Sy , Page J , Plat records of Washington
County, Orlaon.
ADDIUSS OF I'ROYI:RTY:
NAML OF OWNER: "C. r.�c.I :u. l_ C
ADDRESS OF OWNER t I�,`1.<'X7 ,, ��,�L'
IN WITNESS WHEREOF, the unde:signed hae caused this restriction
to be executed this day of
owMR s
unl.ntir, we o „Int C
\CLI
APPROVED: By,-,
z-'
By:
Building Official
City of Tigard
STATE OF OREGON )
County of Washinston ) Is. �) �9 2-,
)Personally appeared before me the above named _
to, ,, and acknowledged the foregoing instrumd ttba
voluntary act and deed,
1ot.-,r Public :or O er,an
Nay Comm:saion Expires: