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BUILDINGPERMIT APPLICATION TIGARD DATE- April .24c�Z' 1905 _ 5335
THE-UNDERi;IGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HERFIN INDICATED BUILDER PHONE 4dQ9
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND S^ECIFICATIONS. OWNER PHQNFa
LOT NO.--
OWNER Uorothy Stewart JOB ADDRESS 13240 SW Burnham 251-2AC
550 SW 90th ARCITECT ENGINEER ENGINNEEREER
BUILDER Stant0% $yw��1t :DDRESS I'ortlatW, QR_ 9722 ---,_ DESIGNER 8�p��pQ�Y p --- ---
STRUCTUR_E_ ❑ NEW ❑ REMODEL _ n ADDITION C] REPAIR ❑ RENEWAL ❑ FIRE DAMAGE D nEMOLITION
XkRESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE Cl SLAD❑ FENCE
OCCUPANCY __A'l—LAND USE ZONE .—BnkJ--BLDG.TYPE 5A____—FIRE ZONE PLAN CHECK BYX_—_HEAT _
Construct single story addition to existing single family dwelling
i
SEWER PERMIT M
OCC.LOAD FLOOR LOAD 40 —HEIGHT 12' NO.STORIES 1 AREA 144 NO.BEDROOMS — VA.UE5.100 I
BUILDING DEPARTMENT —' SET BACKS FRONT -- REAR 40• _LEFT SIDE -•- -. RIGHT SIDE
Permit 56*50 — THIS PERMIT IS ISSUED SUBJECT TO THE r4EG,:I-ATIONS CONTAINED IN THE P_UILDING CODE, ZOWNG
REGULATIONS AND ALL APPLICABLE CODES ANI. ORDINANCES, AND IT IS HEREBY AGREED THAT THE
Plan Check 36.73 WORK WILL BE DONE IN ACCORDANCE WITH THE 'LANS AND SPECIFICATIONS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. 1,1E ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Subtotal 93.23 RESTRICTIVE COVENANTS, CONTRACTOR AND SUB C )NTRACTORS TO HAVE CURRENT CITY BUSINESS
Z LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax 4 1 2• 6 _
Total 95,.49 5DC— :
- 'DCN t��LICANT OH AGEN�
By 12 6
Receipt No
Approved BCRsb jd . j f�.(j ADDRE®8i ' — PHONE
Pp
1
DATE INSP. YYPZ INSPECTION RXM4RKS -- PLUMBING I U/►TE
yrs_ _ _.
�elev.[1 Contractor —�
_ _ S, --- -- - P(!rmil No,
Fixlura
Final
HCA71NG
— -_._ —�.�_. _---- --------• Permit No...—_..�.—.. _
—' -- -'---- — -- Oat or 011 .�•'.
Final
SEWLrt
Final
--...-DRIVEWAY
Final
Storm Drainage —
i
(Rain Dr
eln)Final
__.. Sldewelk
Curb&Street Final
Approve h
_ RLDC:. UflPT, '1':'q' TEMPORARY C�TII It'ATE OCCUPhNCY —
�rl !If1hlC.AY'COCCU1'ANCV rival
1-widtcaping
Zoning Final
1
ADDRESS PERMIT NO.
PERMIT CHARGE
OWNERic, �,1�,-�, ,.�.c1 _ CONNECTION FEE
PAID BY
TYPE OF BUILDING DATE CONNECT�LO
SERVICE RATE ,�/,.r„�„�. INSPECTION FEE _,�
CONTRACTOR _ PAID BY DATE _
SIZE OF CONN7c , N �� ASSESSMENT PAID
—.--
EXHIBIT "B"
4U6�+ CITY OF TIGARD
^T%rIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard ' -i, ,r certifies that the occupancy of
the following describe tructure or premises with respect to which
a restriction of occupancy was, on � w l? 19 ,
recorded in Book 980 , Page 33 , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRIFTION-OF PROPERTY:
Tax flap 251 2DB, Lot 16, Burnham Park Subdivision
OWNER: Ken Stem t
BUILDING PERMIT NUMBER: 71,_1n';
BUILDING A:7DRF5S: 13240 S.W. 8t,r them Court
This is to certify the said structure meets with the require-
merts of the Building Code of the City of Tigard and the above
referenced restriction is hereby released and terminated.
IN WIT*Z3S WHEREOF) the undersigned authorized officer of the'
City of Tigard has caused this certificate and release of restriction
to be executed this ^�,s day of 5 .� 19 ;P.O..
Title: CIII IiE.CORDEA �
'T7
STATE OF URP)GON )
County of Washington )�
On chis day of 19 ; personally
appeared before me the above named r -' whose
signature r.ypeHrs hereon and who ack6owledged to me that he executed
the same in his offical capacity on behalf of the City of Tigard.
NAary bl1c T Or on 4~
My CC as e as:
� s9
NAA br"Word................jv.,_1�7 Y�I 9..AM.�MIF
Flom THOM OK Duedw d swe"6 6 11 Mloes
goa►
991 PALE6503 91...._ ....
sssr iv stv xNssss ssw ss ew
4062
STATE OF OREGON
County of Washington as
I, Roger Thomssen, Director o1 Records
and Elections and Ex-Officio Reeewder of Con- r =�
veyances for said county, do hereby certify
,hot the within Instrument of writing was
received and recorded In book of records
No.
of said County
Witness my hand and seal jffixed.
ROGER THOMSSEN, Director of
Records 3 Ekxtk,ns
r ,
e
I
City of Tigard
INSPECTION REQUEST
EST
for
IINSPECTION TIME :--- PERMIT NO.: —
DATE: UJI.7 DATE ISSUED:�. L
OWNERS NAME
ADDRESS : --
gCONTRACT 0 R : ---_ --
ITEST' Air O, Water Q , Visuc l ❑ , Laboratory
RESULT: Approved Disapproved Cl , PendlnQ U
IS K E 7'�.M �.� _.._.
I
I
IN CTOR DAT
I [OTE Attnch supplemental test data hard]
1
i
ALT, SPACES MUST BE EBTDppSED
ISSUANCE Ur biJIIDII-- �'RIOR TO
LM _
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : /L06-gat,. PERMIT NO. : —.—
DATE:
O. : _._DATE: k/9 1 9Y DATE ISSUED: I
OWNERS NAME :
ADDRESS : 22 y
CONTRACTOR :_____ �_
TEST. Air O, Water ❑ , Visual [] , Loboratrry
RESULT: Approved'34 Disapproved 0 , Pending L7
SKETCH:
I
I
I
I
'INSPECTOR ^ DATE
CN07E : Attach supplemental feet data hereto—]
1
i
i
Cite of Tigard
INSPECTION REQUEST
for
INSPEC1 iON TIME :?.. PERMIT NO. : --.
DATE' Z4312ATE ISSUED:__/_:
OWNERS NAME
ADDRESS
I
CONTRACTOR :
TEST. Air 0, Water p , visual ❑ , Laboratory ❑
I RESULT: Approved , Disapproved p , Pending L]
K E TCli:
I S � v
I
I
I
' PECTOR DATE
I
COTE : Attoch euppltnmeatal test deta here 1]
I
City of Tigard
INSPECTION BEQUEST
for
i
IN�'PECTION TIME : PERMIT NO. : _
i DATE: . --L1DATE ISSUED:—.L_o.
OWNERS NAME : _ . �'' . �'�rp �r Z-1,At -»ADDRESS :
I
TEST: Air U, Water [j , Visual ❑ , Laboratory ❑
RESULT. Approved ( ` , Disapproved [I , Pending []
SKETCH:
I
O
i
I
INSPECTOR DATE
! r OTE Attach supplemental toast data hersf01
I
City Of Tigard
INSPEC110N REQUEST
for
INSPECTION TIME: PERMIT NO. :
DATE: iZ.0 7 Y DATE ISSUED :--_1 -L._
OWNERS NAME : - _
ADDRESS' /3��fC� C:cu �.�� ►, {�.�,,, CZ
CONTRACTOR : . 'P a ----
TEST : Air L'1, Water[] , Visual Laboratory p
RESULT: Approved , Disapproved O , Pending D
SKETCH:
E74/
NSPECTOR DA'C'E
FO'tE Attach suppiementel test data bereta7
i �
i
P:,uMB1 NUJ PERMIT APPLICATION
Jul-.isdiction of
No. Type of Fixture Fee Permit No .5 1
I Permit fee
J- Water Closets Toiletst Issued
Permi -
Bath Tubs �d'"o Approved by
2 Lavatory_(Wash Basin A Building Permit V
Shower _-- Receipt No. 1,',3/,e1
Sin s-, Dlshwashirl� _
Sinks Kitchen - _ •a
_— S.i.nks�_Ordinary ____ Location of Building
Sink st Bar------------- ----- _1. ?`F O .S C,�J Lie. -►► �� A_-----------
S i n::s,z_Sl op—r.—_ -----
_Automatic Dishwasher-
- -Disposal _"-----�_--- --- -----__�—_,�_----__--_._------
La.undrTrays____--_ ---- N, ie & Ad s f Owner
Drains, Floor--._Drains Area _
Drains, Refr�igee rat•:)r —~-- --"-------`—
_ Rain Drains
AutomaticWasher N me & Addre,s of P1umbcr
oun-tains,-morin in_g - e- 7 �'
Fouritains, Soda &J4�� F=7 L
�Hot Water Tank �o -
Water Service Size �_�_ ----------1-- --
Urinals Buildin r,Old or New) alteRepair
— titch-Basins - aard--_ �ns_�a7 � -- or
-- _._
Lawn_SprinklerSySte.m- - — �— -- -
-- Swimming Pool_-- _ ----_- Other
_— ._Sinkler 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.
A1]_ plumbing firms must be licensed by the City of Tigard and port a 51,000 bond
I hereby certify that I have road and examined this application and know the sam
to be true and correct. All 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.
Signature of Applicant
\J I
1
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME* 4r,'\ii PERMIT N0. :M
DATE: G /iiL'7t DATE ISSUED :__L_L_ I
OWNERS NAME :
ADDRESS: 4-t/
-t/
CONTRACTCR :
TEST : Air ❑, Water[] , Visual ❑ , Laboratory ❑
RESULT: Approved ❑ , Disapproved ❑ , Pending []
w �
SKETCH!: I
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INSPECTOR DTE
rl-.!07V Attoch supplem:ntol test data hereto]
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UNIFIED SEWERAGE AGENCY NO. - 4974 _
WASHINGTON COUNTY DATE
CITY OF---
APPLICATION FOR SEWER CONNECTION PERIVi T
OWNER:
OWNER'S ADDRESS
STHI ET
CITY STATE
BUILDING SITE: 1.OT—I',o BLOCK—. — ADDITION
TAX LOT NO. TYFEnn OF OCCUPANCY
A D D R E SS ----.._L3L1 --
DWELLING UNITS__ _ FIXTURE UNITS
SURCHARGE IF APPLICABLE
J"
PERMIT FEE- SCS_. ____ INSPECT!ON FEE _ TOTAL DEPOSITEDS-._—_._
NEW (EXISTING) BUILDING SEWER SYSTEM
The Applicant aarses to comply with all rules and regula 'ons of th�ifiad S r-,.a Agency.
APPLICANT-- IL. - --____ .--
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE _—_--. _ _.__ ___ INSTALLER
RECEIVED BY.
it.4LNCU OR ITS AOENTI
COMMENTS:
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
i
209108
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Res *iction
KNOW ALL MEN BY THESE PRESENT, that occupancy of residential
structure (a) on the following describe� lands prior to the record-
ing of an occupancy permit releasing the restriction in the Deed
Records of Washington County, Oregon, is prohibited by the ordinance
of the City of Tigard, Oregon: (The City will issue a release as
soon as a final inspection determines that the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY:
Tar. r-ap 251 20n, lot 16, aurnham Park Subdivision
ADDRESS OF PROPERTY: is An S_1.1_ n,--h— I"1._
NAME OF OWNER: e,n ;tai.hart
ADDRESS OF OWNER; 11,1 11117_ setae I;ranhamt nrnynn
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be executed this _1 ,2 day of , 197.
OWNER;
r
_ i�4 c-19 ij,pA,, /1 Name
Tit 9
APPROVED r
Y
u ng Official
city of Tigard
STATE OF OREGON
County of Washington ; as 4 - is V �, 19
Personally appeared before me the above nr.med
/? and acknowledged the foregoing instrument
to be /Its voluntary act and deed.
STATE of ORMN Notary Pb ic T r er e
1 "
County of Washington My Commis f o r E):p 1 r e s;
I, Roger Tharnsiten, Dirscrpn of R cords~
andElections and Es Officio Recorder of Con
yeyancet for told county, do hereby certify 980P,,Ii� 33
tlhat the within Instrument of wilting was q(r
received and recorded In book of records
No. _.. —. �...
of said PourMy
Witness my hand and seal offl"d.
R(X;ER THOMSSEN, Director of
kecords & Elections
Ju�� 17 11 26
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW All. MEN BY THESE PRESENT, that occupancy of residential
structure (s) on the following described lands prior to the record-
ing of an occupancy permit releasing the restriction in the Deed
Records of Washington County, Oregon, is prohibited by the ordinance,.
of the City of Tigard, Oregon: (The City will issue a release as
soon as a final inspection determines that the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY:
Tax Map 251 2DB, lot 16, Burnham Park Subdivision
ADDRESS OF PROPERTY: 1374n q-,,- Q+irnhnn r+
NAME OF OWNER: I'rn Stnunri
ADDRESS OF OWNER: 1 K? r'r Inc), Uranha=r Or o"
IN WITNESS WHEREOF, the undersigned has caused thi3 restrictior'
to be executed this1 ,7_day of Ja , 191L.
OWNER:
Name
Title
APPROUED/� /+ /
t'Jilding Official.
City of Tigard
STATE OF OREGON as 19
Cou .*y of Washington 6 - �C
Personally appeared before me the above namedr
:T and acknowledged the foregoing instrument
to be ��, � voluntary act and deed.
Notary Public For Oregon
civ Iffy Eommissio Expires`:
r30� 35 ,/Y S
-
_a
CITY OF TIGARD
12420 S. W. Main Street
TIGARD, OREGON 97213
APPLICATION FOR BUILDING PERMIT
Now Construction 1 Demolish ❑ Addition ❑ Remodel ❑ Move❑
7,c:N1NG DATE ISSUED BUILDING PERMIT
BUILDING FEE $ Q� No.
DATE RECEIVED "' ._
—"� PLAN CHECK $__1p�-
67-5
BY _ VALUATION $ 1
---- - OTHER $ ?��`✓
p,4RECEIPT No. Oa
TOTAL $ "
'PWO SETOF PLANSAAND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT p4- i(j MAP CENSUS TRACT JOB N
Architect-o-r Engineer
Address Phone
Owner—
Address
1w n e r__
Address //�'Z, �}; _p' �� ���"- _ Phone
Builder
Address Phone 60(6-67-
BUILDING
o 6-67-BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Indn:,trial❑
OCCUPANCY GROUP__ No. of Stories_ Total Height / Area of Lot
Type of Construction I 11 III IV �'VD Floor Area B 11¢S6 2�^
Set Fucks: Front 2")' _ Backe L.Side_L_ R.Side 7 -
r�
Private Sewer Pipe Size Sewer Septic Tank ❑
water Service Pipe Size_ Storm Sewer 91 Ditch ❑ Drywe11❑
street and Curb Requirements
Driveway width_ _ /� I -,-----No. of Parking Spaces Z-
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
AUURF:SS ASSIGNED
F11C1,I) CHECK BY ^` DATE �A)
PERMIT APPROVED BY, . tz, 17
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 Occup cy has ee issued by the City of
Tiqard Building Inspector,
Signatur&V of Applicant
o � WjFffXX
CITY OF TTGARD MECIiANICAL PERMIT
DATE ���_ � PERMIT N0. � � �(F���� _ RECEIPT NO.
BY _ �I _�_ FEE �--
1. Permit shall be obtained prior to cormnencemen of installation.
a. Permit shall be obtained for all appliances which are to become
a' fixture to the building.
3. Relocation, replacements, alterations, or changes to burners and
duct work require permits.
4. All work to be concealed must be inspected before cover up.
on l`X Replace ❑- Relocation �� Addition Alteration
OWNER
A,nRE,SS WORK ADDRESS / s:yo W v�:,vim:
APPLICANT
TELEPHONE NO.
FURNACE - ,1ANUFACTURER ���,►�o�lt _ TELEPHONE NO.
HEAT Input ra.ti ng (Dtu PerHour) fg?e? Vent Size Flue Size el
FUEL OILEI GAS P? ELECT U OTHER
ICTAL SQ, FT. Top Floor _ Main Floor Basement
-- GEIv'FRAL
ITEM NO. FEE ITEM NO. FEf
For Issuance of Permit _
t00 _ Boilers Over 50 Hp
New - Under 100,000 Btu _ 4.00 _ - Air__Handling 1.0 000 CFM
New - Over 100,000 Btu Handling Over 10000 CPM
Floor Furnace .00 .- Ey-�!Rorative Cooler .(
VF811 -Floor - Suspended 4.00 ^ Vent Fan
Tnstall Vents �� •�� Vent System T � _
P�ai�r - Heat &_Cooling _ 4.00 Hood _ -�-
Hoi.lers Under 3 HP 4.00_ -DomestIc Incinerator ,_ (
boilers 3-To 15H 10.(
Boilers 15 to 30 Hp _ -10,O0
Toilers 3�—0-50 Hp _ _. X5.00
I14SPECTORIS COMMENTS
APPROVED BY� 15�t _ -_ DATE Y:-21-2V ISSUED BYXV' (( DATE
Si ature of A - 13crt
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� _ P