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'I , PLUMBING PERMIT N
holder of a valid plumbing contractors license is hereby
authorized to cause plumbing w rk as herein noted to be installed in accordance with the plumbing code of
T1gard. Such installations require: inspection by the City Inspector who shall be notified not less titan four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
'.r all contractors and sub-contractors.
Owner
�, i i i t��!i�1 i ' �a
+� -=L- AddrE$3 `K•-�
TYPE OF PERMIT PAJMeER of TOTAL PERMIT MO.'S
ITEMS PEE ON EACH AMOUNT IOltict Use
R Only)
3i le Family-11 bath-each- 25.00
—_
Ou le■-Bach 1 batA unit
_—-
Additional bathroom -080 25.00 --
10.00
Mobilo Noma S ac"ech
INOIVIOUAL FIXTURE !*EES 1
1 to SO Fixtures in 1 buildinorach --.
it to 100 F!Xtural in 1 buiVM=ach
101 to 200 Fixtures in 1 building-each
2211 or mns cunt r F Ix
in 1 buildino-tach 1 ��
MISCELLAN80Us � — — -
avildl $ewer-tst SO ft. "" y -
Sawor-each additlonel 100 ft, � �9 ""�•1
Water r Servide to buildino
Private water Svstsms-each 100 ftd.00 ---
Other ISoaeiF )- _ 10.00 _
PERMIT for Plumbing Ina vection Phone 63.x4171 �....
3%State Plumbing Cantractor 8
To,TAL RECEIPT N0. Is and By Y
sn •� o w .�
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CITY OF TIGARD
OREGON It
+ Ommer:..... ua.i.a.t-in...f)uvvel pmant. r.umpany.......Permit No-73-.22.0...--..
Building Address..... 1: ? Q_ Qa.k...Rr1.v.e.... ...........................
Certificate is bereb.• piven this._.ath... (lay of.....Eeb.ku.ar.y.......... 19---7.4.-.
s( *: that said building may be occupied and
that it complies with all requirements of
s•�'" .::. the B •
,, •� uilding Code for the City of 'Tigard,
i. •
•_� + ' as approved by tbi Tigard City Council.
{ / Building Inspector
:a ? Vii/ ���+�� �, ��,.k.17r Y�` moi' �,p., �•a �-. ,���f �T3 ,��.��� � l w4'�
OF TIGARD HEAT:NG FERMTT
dPEI'P NO. �` / 5 nECEIF'I' NO.Di►TE4 ___-__ -'7nFEE
rmuhaabta%n.ea prior to commencement-af-in aYlation.
Erf
1 o Fe - --._=
2e permit shall be cbtainod for all appliances which are to beca-me a fixture
to the building
3, Relocation, replacements a7.4_r ... _•....', , ... c changes to r :, Der s arwar
.d ,�uct
require permitse
4� All work t- he cc-cea.led must be before cover uv. ❑
New Installation plat 0_j2 pelocaton F1Addition L] Alteration
' CWINI ER !!!P>
ADDRESS _ /,;?�'C� 1�j,, 0Ci'
CC>>.1�G� WOPK ADDRESS �,5' �G� .CP,
AFFL--.CANT _� =<l it
/ TEI.EFHC-NE NOa l'
FURNACE - A'jkNTJFACTURER .� ' TEiEFfiCNE. NO.
BEAT It put rating (Btu
k/ rer Hour ) �C` • r� Vent Size _._ ___�_____ Flue Size =
FUEL OIL ❑ GAS k4 ELECT ❑ OTTER __- - -------------
TOTAL SQ. FT: "Pop Fluor Main Floor Basement
GENLRAL
ITEM NO. FEE AWT ITEM NO. FEE AM'
____ 50 HL_.__�_ __..� ..� '�3�q 00For Issuance of Permit 3_O . k _ Boners aver - 0New - Unde.rl00,OGGBtu 4U Airr Han3linq 10� 000_CF'M -
New - Over IOOs 000 it _ Y5�0 Ayr _Handl i ng }ver lOZ 00_0 CFM _ 5.00
Floor Furnace _ 4.,0 Evaporative Cooler 3.0
Wall - Floor - Suspended 4.0 - Vent Fan 3.00
Install Vents 2�O __ Vert Svstem �______.__ --
Re air - Heat & Coalin 4�O __ Food_ __ � __ �__._-_ _ 3000
—p-_ _ r_ -_ - 00
Boilers Under _LHp 440( Domestic_:nccinerator 50 —
Boilers 3 �0-15 Hp _ _7 5 CcianIncinerator20.00
Boilers 15 to 19-1!P---- _O,0 Other Not Li. ted -.--- _ 3 0
Boilers 3O to 50 HP 115OC
INSPECTOR' S COMMENTS �_ - ---•---- ----- _------_ -
APPROVED BY �- - -__ DATE ISSUED BY _ DATE --� -
Signatuife r.r. Appli�-X;t �/
I
City of Tigard
iNSPECTION REQUEST
for
INSPECTION TIME: � _ PERMIT NO. :
DATE: A /62 / DATE ISSUED :___LL i
C-NNERS NAME '. 7- 0---C
: _ -Q T` cv .3 � � /4', C�ch N"�
ADDRESSLra4 I
c r
CONTRACTOR
TEST : Air i.D, Water❑ , V'Isual ❑ , I-aboratory r—
RESULT '. Apnroved K, Disapproved ❑ , Pending �\
SKETCH.'
)
I SPECTOR DATE
50TFAttach supplemental fest data her ef]
i
7ALL SPACES h1UST BE ENDORSED
O�7 TO APPROVAL 0.' TH"Sc PLANS
; DZPT. �W
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,��i ,,. , •ter �5 --�--- .._
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N. tv. NATUZAL GASF3 Y.
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City of Tigard
I NSP ECTION REQUEST
I
for
-' ISPECTION TIME: ��s:. . PERMIT NO. :—.--
DATE: If /.!7 DATE ISSUED:--" I
INERS NAME :
ADDRESS' _ - — ----- -------
)NTRACTOR : T_ �° - - ----- -- —
:ST '. Air u, Water El Visual ❑ , Laboratory []
SULT ' Apnroved o , Disapproved 0- Pending E]
(ETCH: I
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INSPECTOR DATE I
TE. A:i.,C'� supplemental test data beret I
� R �
t
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT N,) '. —
DATE://'
:) :DATE // X11 5 DATE ISSUED'_1--L
OWNERS NAME :ADDRESS :
CONTRACTOR :_-- ------ — -- -- --
TEST. A r D, Water ❑ , Visual ❑ . La' ,rotary P
RESULT: Approved\�Q Disapproved _1 , Pending ❑
SKETCH:
INSPECTOR DATE
E ' Attach supplemental test data beret]
�l s
7 City of Tigard
INSPECTION REOUE ST
for
INSPECTION TIME : 3tyo PERMIT NO. : .-.__.-_._-._._
j DATE: - //1 p� DATE_ ISSUED'_._LL_
!I OWNERS NAME :
ADDRESS :
-�_-�.�.-- — �------ -- —
CONTRACTOR :_—_-2"��, --
I
TEST . A r J, Wates VisuaIf, La'• ,ratory L-1
RESULT: Approved , Disapproved J , Pending ❑
I
SKETCH:
I
I
,INSPECTOR DATE
[OTE: Attach supplemen iI teat data heret-10
City of Tigard
INSPECTION REQUEST
for
'NSPECTIUN TIME : �, #;,ERMIT NO. . .
DATE:/O i15,/ _ DATE ISSUED'_..._-/1
OWNERS NAME '' , r
ADDRESS : �. 1
CN1 RA GTR
TES 1 Jv��ter 7 , �': �; } Ln r,,.
RESULT Nppru�edui;,rNprover+
I SKETCH:
I
INSPECTOR DATE
Et�40TE: Attach eupplementol !est ,sufr neret]
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No.
Permit fee
Water C1osPt�Toilets Permit. Issu _ _
/ Bath Tubs vfl Approved by
avato Wa:; asin Building Perm.it
Shower Receipt No. ey
ins Dishwashing
Sin!-z, i Lchen X00
Sink C%r i�nary �— Location of Bu din _�`_�
Sinks,-Bar 'ars _
Sinks, S o
_ _ -- - - - -�---
H- Aut-omatic DishwasFer
_ Dis G_al ,
LaundrTra s Namq N Address of Owner
Drains. Floor __�, .�1Lti. L- —•
ra:.ns Area .---
~ Drain-3,R e ri era or .r ---
^ _ Ra-n Drains /
AutaMM'C' 777r N O N Addreg of hj , bar
Fountains, .,r i n s-__gr.�/..= 1� 1
'ountai.ns, soda _- -.. --
Hot ►��ter ask �,^_r `/f
_ Wal.e:r Serv;re Size? -7dr
Ur ..nals _ Build' _ Old c.r ew Alter Re air or
a t,� -Sass is—Yar — ns _ ---- --r-
3w, .., l ir-ilini _e.r_ S �tell _ i —. .C_�L 4 ...�----
.�� Po,.
,rir�kieei
'System
_-- — - —� —•This r�rrriit becomes, null and void if work cr constracti^r, no--,h,.rized is not
ccmmen,-d within 60 days, or if construction or work . 3 suspended c.r abandoned.
for a period of 120 days at any time after work is c .mmenred.
All plumbing firms must be licensed by the City of Tigard and post a $19000 bon
I hereby certify that. I have read and examined this applicatton and know the sai
to be true and correct.. All provisions of laws and ordinances governing this t.
of work will be complied with whether specified herein cr not, the granting of
permit does riot presume to give authority to violate or cancel the provisions
of any other state or local law regulating construction or the performance of
construction.
1 .,
S gn ture'1T' App is~{ ant
f 4
i
�,ity of Tigard
INSPECTION REQUEST
for
NSPECTION TIME. PERMIT NC. .
DATE - 01 7 DATE ISSUED
OWNERS NAME : T D. �- -- -
A D D R E S 3: 601- 6 -3
nN fRArT)R : - - - ---
EST : ,-'.- Niter❑ , `v'' _ :qi � '.ab story r-j j
RESULY -,Ivroved; ;-eridioq u 11
SKETCH: I
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Wn
ECTOR DATE I
NOTE: Aftucn supplemental test nota beret 01
,Y
2596
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MUN BY THESE PRESENTS, That Occupancy of residential
:,tructure (s) on the following described lands pr..or to the recording
of an occupancy permit releasing the restriction in th• Dee6 Records
of W,achington County, Oregon, is prohibittd by the ordinance of the
City of Tieard, Oregon:
DESCRIPTION OF PROPERTY:
ADDRESS OF 111OPER'i'Y: G
NAME OF OWNER: .t r
ADDR&)j OF 06.NER:
IN WITNFzS WHEREOF, the undersigned has caused this restriction
to be executed this ^,� day of 19
OWNER,
/ Na
APPROVED: By,
T.tle
By:
Building Official
City of Tigard
STAT: OF OREGON
County of Washing:.on ) iMignbOr I8 , 19 '/j.
Personalay appeared before me the above named ROY Brown, Vie• ProoidOei
and acknowledged the foregoing instrument to be
volw..:ary act and deed.
Notary Public for Oregon
Hy Comm-'scion Expires: 1 16 7S
946 oM{A{ p 5 �. •..
ROGER TNOMAREM.Viroctor al S a ion
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EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MCN BY TIME PRESEM6, That occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restrict.on in the Deeu Records
of Washington County, Oregon, ie prohibi.ted by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY:
ADDRE:,;, OF I'ROPMTY:
NAM OF OWNER: 1 ♦t� h ti E C� �'
ADDRZ"3S OF OW14LR:
:N WITNESS WHEREOF, the undersigned has paused this restriction
to be executed this day of
•. ti ~-
Mot:
ate:
nnr
/ Name
AMOV90s _ by:
Tule
By: _
Building Ufficial � 4��v �3 /? d
City of Tigard ru"lee weed... _ t/........e�.......4;-r M
*pan"MUSLIN,Dleeetee W Nowtde s EI�Minn■
STATE OF OREGON ) G f?. rt_.....................................
. -,'*-1cID• .•
County of Washington ) September 18
Personally appeared before me the above named Roy Brown, Vice President
and a--nowledged the foregoing instrument to be
volur..,ary act and deed.
....
Nota�v Public fur Oregon
Ity Commission Expires:
:,� scar 045 oLE775
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$ 1oz
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EMBIT �'A"
CITY OF TIGARD
residential Structure Occupancy Restriction
I
KNOW ALL MCN BY TICi4E PRESENTS, That occupancy of residential
structure (s) on the following described lands prior to the recording
of an ocLlpancy permit releasing the restriction in the Deet. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY:
I
ADDRE:,:3 OF PROPERTY: - L_< rte\
MME OF OWNER:
ADD:iaia OF OWNER: +tom, , E gra:�,._,_�.•\ .c a ,r
IN 'JITNESS WHEREOF, the undersigned has caused this restriction
to be executed this C+,`= day of
T"NER,v -,�.v ��il,•,�,r � roc.
APPAOYI•;D: By
a
T.tle
By:
Building Official
City of Tigard
STATE OF OREGON
County of Washington ) 821tember 18 , 19 73.
Personal y appeared before we the above named R.1 Brawn, Visa Praaidaat
and acknowledged the foregoing instrument to be
volw::sry act and deed.
Notary Public for Oregon
t(y Commission Expires: 1/16/73
CITY OF TIGARD
12420 S. W. hUln f+roO
TIGARD, DRAGON "M
APPLICATION FOK BUILDING PERMIT
New Construction U Demolish ❑ Addition ❑ Remodel ❑ Move ❑
ZONING p,.p DATE ISSUED^ 9-18-73_ BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ '77.00 No. 73 . 22()
BY PLAN CHECK ---
OTHER $ --4.09 recording f®ALUATION $ 20.769.00
.97 one per cent
TOTAL $ 91.87 RECEIPT No.
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N 63 14AP 8 CENSUS TRACT W-8 JOB N 5063
Architect or Engineer Tualatin Development Company
Address 15300 S.W. 116th Ave. Phone
Owner Mr. & Mrs. Krouse
Address Phone
Builder Tualatin Development Company
Add ress_same IN as above_
BUILDING USE Single Res. 10 Multi Res ❑ v 4f--Comm. ❑ Industrial ❑
OCCUPANCY GROUP_ I No. of Storiesll Total Heigh t___ Area or Lot ^
Type of Construction XXXXXIEXXEYIXXXIXX V Floor Area B --- 1 1290 2 ----
Set Backs: Front--- 10 (lack 4' L.Side_518" __ R.Side 101
Private c-- pipe Size 4" Sewer Kin Cit Septic Tank ❑
Water Service Pipe Size_ 3/4" Storm Sewer 2 Ditch ❑ Drywell
Street and Curb Requirements ae rAgy_ired by Subdivision ordinances
Driveway width 181 _ _—No. of Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED 15990 S.W. Century Oak Drive
FIELD CHECK BY euc DATE 9-18-73
PERMIT APPROVED BY
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.
S gna ure of plicant
EXHIBIT "B"
1 5! 35
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AMID RELEASE OF RESTRICTION
T7he City of Tigard hereby certifies that the occupancy of
the fr-lloving -ascribed structure or premisee ith respect to which
a restriction of occupancy vas, on Ct. E 19 7 3,
recorded in Book 114ti , Page 7 Z.5 , Deed Record of Washington
County, Oregon, is hereby autl�;,..::ed and approved.
DESCR;LPTION Of PROPERTY: >/I
OWNER•
BUILDING PERMIT NUMBER: .' •�rJ
BUILDING ADDRESS:
1"his 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.
IN WITNESS WHEREOF, the undersigned authorized officer of the
City of Tigard has caueed this certificate and release of restriction
to be executed this i f day of =t , 19
�(i s
Title: u.,i
STATE OF OREGON )ss.
County of Washingtnn )
Un this y�1 day of ., , , 19.1`1, personally
appeared before me the above named _ V " _, whose
signs-%ure appears hereon and who acknowledg9d to me hat he executed
the same in his offica.l capacity on behalf of the City of Tigard.
Notary Publ of Oregon
My Commission expires:
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