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15650 SW OLD ORCHARD PLACE N w 15650 SW OLD ORCUARD PLACE 0 U 0 LLJ LJ ccr r. 0 U Zy �vl 4-- -4- 1-4 J E-1 (7) EA to44 PI u 4 BUILDING PERMIT APPLICATION TIGARD DATE 3/13 ,9. 1 3633 THE UNDERSIGNED HERECY APPLIES FOR A PERMIT FOR THE WORK HEREIN!INDICATED BUILDER PHONE tib4-3169 OR AS SHOWN AND APPROVED I"!THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE6a9-6H40 OWNER LaWronc8 Lawton JOBADLOT DRE3S l:Jtj:.,0 SW Orchard Plans -- -- ARCHITECT ---- ENGINEER BUILDER Ken Parker ADDR2SS 8901 SE_Causey_,Ptld. DESIGNER STRUCTURE -�❑ NEW ❑ REMODEL _ IX ADDITION_ U REPAIR ❑ RENEWAL ❑ FIRE DAMAGE +U DEMOLITION XIXRESIDENCE L1 COMM CJ EDUCATIONAL L GOV`;' ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE OCCUPANCY '"-3_LANE)USE ZONE -f-7 BLDG.TYPE -- SN FIRE ZONE_ " PLANCHECKBY Ir-W HEAT---- rep lAjQI EAT-__-__-pljQI ell pgr dratrina .._end bides codes._ _-- SEWER PERMIT# OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA N0.BEDROOMS VALU311ts8. BUILDING DEPARTMENT_ SETBACKS FRONT HEAR LEFT SIDE RIGHT SIDE Permit �a Q(J — THIS PERMIT IS ISSUED SUBJECT rO THE REGULATIONS CONTAINED IN THE BUILDING CODE ZONING REGULATIONS AND ALL APPI_ICABi.E CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE Plan Check _v WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH ALL APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE Subtotal RFSTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS 10 HAVE CURRENT CITY BUSINESS Slate Tar. 4,�, 40LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEA LING. _,� � Total — 'f 10.40 SDC— d ► �*.e - PDC# ALPP IGANTOR AGE T By - -- �� is `,('.- ,��1 !S�✓ <. Receipt No. fr •_ I Approved— sty ADDREn v PHONE v - -- i- s DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE - -- ----- -- --- -- ---- �^/p Contractor Permit No. —`— Rough-in Fixture — Final ----_..- HEATING _ Contractor + Permit No. — - Gas or Oil _'- -- Roush-In -- -- Final SEWER Final DRIVEWAY — Final Storm Drainage (Rein Drain)Final Sidewalk Curb&Street Final Approach BLDG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY CdrtTIFICATE OCCUPANCY Final Landscaping — --��— 1Zoning Final - — w BUILDING PERMIT APPLICATIONTiGr,1�r. DATE 1 __..19 � THE LINDERSIGNED HEREBY APPLIES FCR A PERMIT FORTH E WORK HEREIN INDICATED 9UILDER PHONE OR AS SHOWN AND APPROVED IN THE ACCOM,PANYING PLANS AND SPECIFICATIONS, OWNER.PH0NE� ' �G J'`' _ LOT NO.L).i,Li.�a«cu K OL4 C7;t JOB ADDRESS S •� U CL ,1��. -z./ ' - — ARCHITECT �s ENGINEER BUII_^EP _ Z-? ADDRESS_ cTgO S [�«. e — DESIGNER _ — STRUCTURE ❑ NEW ❑ REMODEL ADDITION REPAIR 71 RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITJON L FIESIDENCE, F-- COMM ❑ FDUCATIONAI- 1:1 GOWT u RELIGIOUS a PATIO ❑ CAO PORT C GARAGE i.j .STORAGE n SL-ASCI F"NCE '•i,'.-UFANCY L/gNC '—EZONE _l _BLDG.TYPE _ FIREZONF_—, PL4N CHECK BY It HEAT SEWER PERMIT OCC.LOAD_ FLOOR LOAD HEIGHT NO.STORIES AREA - NO.BEDROOMS-- --. VA.LUtr-,/k- r_ BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE Pgtmit AJ THIS PERMIT iS ISSUED SUBJECT TO THE REGULATIONS CONTAINFO IN THE BUILDING CODE, 70N'`40 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREEE3Y AGREED THAI THE PIetlChaCk WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CO.4PLIANCa WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PFR"'IT I>OES NOT WAIV_ pub-tote) RESTRICTIVE COVENANTS. CONTRACTOR A' 0 5I.13 CONTRACTCR3 TO HAVE CURRENT CITY BUSINESS LICENSE.SEPARATE PERMITS REQUIRED FO - SEWER,PLUMBING AND HEATING. State Tax -- Tot al APPLICANT OR AtiEr�T - - — — By T `� Receipt No- Approved ADDRESS — —__`--_-- — PHONE *EIJER CONNECTION SEWER INSPECTION $ SEWER SURCHARGE ■ 1 O � J a iia jl � I El rn 2 � l I IJ, 1D R FES RM IT � 3 SITE AMAE � n _ v n � _ Y x It ss v i J W } J lk h y Gb ��So_s �S^gib^ad 31.IS lu u U ---- ro 1 - ' CITYOFTIGAM WASHINGTON COUNTY,OREGON February 23, 1YO-1 PERMIT OWNER ADDRESS 166 0 SW old Orchard Place T ' OUR RECORDS SHOW THAT A BUILDING PERMIT WAS 'LC"J.l 'D TO THE (ABOVE ADDRESS FOR THE PURPOSE OF : constructing a masonry chimney, - fc,r ...,, ventinN wuod burning AS OF THIS DATE WE HAVE NO RECORD OF' THE FOLLOWING INSPECTIONS: FOOTING PLUMBING FOUNDATION HEN KING POST & BEAM INSULATION.__ FiNAL FRAMING THESE INSPECTIONS ARE REQUIRED BY THE STATE BUILDING CODE. PLEASE ADVISE US AS TO 'THE STATUS OF YIIUR PROJECT. THANK YOU. TIGARD BUILDING DEPARTMENT 11420S.W. MAIN P.O. BOX 23397 TIGARD, OREGON 97223 PH: 639-4171- BUILDING PERMIT Ar PLICATION TIGARD DATE- - 19. 3142 THE UNDERSIGNED HEREBY APPLIES FnR A PERMIT FORTH E WORK HEREIN INDICATED BUILDER PHONE _639-6840 OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OVINER PHONE LOT NO. OWNER LAW R. Le%kon JOBAD RESS U 15650 SW Old Orchard ,� ARCHITE ENGINEER BUILDER _ ADDRESS DESIG ER STRUCTURE ® W ❑ RtMODE L_1 DITION REPAIR RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION RESIDENCE ❑ COM ❑ EDUCATIONA ❑ GO ❑ RELIGIOUS ❑ TIO ❑ CA PORT ❑ GARA E ❑ STORAGE ❑ AB❑ FENCE OCCUPANCY R-3 --L ND USE ZONE '7 BLDG.TYPE 5-N FI ZONE—. 3 PLAN CHEC BY br. Y HEAT i.onstruc t our Gh gy fa Y*ntina wood b.jrni sta . SEWER PERMIT N OCC.LOAD FLOOR LOA HEIGHT NO.STORIES AREA NO.BEDR OMS LUE - - - -- -. --- -- -- __ - _ _BUILDING DEPARTMENT SET PACKS FR T RE L SIDE Permit_ 10.07 THIS PERMIT IS ISSUE UBJECT T HE REGULATIONS CONTAINED IN THE St ILDING C00r5, ZONING —_W REGULATIONS AND ALL A F CODES AND ORDINANCES. AND h' IS HER, BY AGREED THAT THE Plan ;neck WORK WILL BE DOME IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANT'[ 10.00 !WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES Nor V,'AIVE Srnb•lotal RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT t:irY BI!SINESS —_ LICENSE.SEPARATE PERMITS REOUIREr FOR SEWER.PLUMBING ANL HEATING. State Tax .40 -- SDC- Total 10.40OR Ad-04f - - � PDCN APPLICANT By Approved Receipt No. < — ----- w w PWj DATE INSP. TYPE INSPECTION RFMARKS-� PLUMBING DATE— __ Contractor Permit No. ��G911jL�7 D s Ti`V?7' Rough-in -- Fixture - Final HEATING y Contractor ^� Permit No. Q ', le) ,rf-��-Sl 21— Permit Gas or Oil 4 U Roulh-in Final -- 5r WER - Final DRIVEWAY r T Final Storrr. Drainage --- - (Rain Oiain)Final Sidewel k Curb&Street Fical _ Approach BLDG. DEPT,FINAL TEMPORARY CERTIFICATE OCCUPANCY i CERTIFICATE OCCUPANCY Final Lendsceping Zoning Final BUILDING PERMIT APPLICATION "''i.N' CITY THE UNDERSIGNED HEREBY APPLIES FOR APE RMIT FOR THE WORK HEREIN INDICATED BUILDER PHONr---.---- OR AS SHO'V'.'N AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS OWNER PHo,4rjgia,?-.:n-d-e!e� LOT NO APCHI rECT EN61'JFt R qI L gf-Ft ADDRESS rRUCTURE 'JEW 0 RI 1,10 OF I. ❑ADDI TION ❑REPAIR 0RENE),NAL OFIRE DAMAGE CIDEMOLI-, )N 0W.SiDENCE ClC,DV-M DEDilLA;:1. [16OV'T f-]1IFL1(;IOUS(]PATI0 (]CAR PQHT 1CQQPANCV - LAND USE ZONE- Bt.OGT'1PE ..FIRE ZONE I-` PLAN CtCP! BY—'� HEAT. 3- v) PF()RQ4mj—"'--VA"IE �o n o C L 0 A D f! -, --TIT-IG H 11 NO Sf0"tSS A-RE BUILD"- Y, -T REAR !3'-,! IS PERMIT 11, -,UhD qUSJECT TO THE REGULATIONS CONTAINED IN THE BLII I DING CQC i! Pl.n Check 11f6ULATIONS AKIO ALL APPLICABLE CODES AND r,)RDIN&NCES AND IT IS HEREBY AGREED THAI ilt Iv, I,I K WILL RE DONE IN ACCORDANCE WITH THE PLANS AND SPECI F iCATIONS ANu IN COMPLIANCE I it I H Sub total :"O L APPLICABLE CODES AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOEe. NOT VYAIVt 11: S114ICTIVE COVENANTS. CONTRACTOR AND SUR CONTRACIGAS TO HAVE CURRENT CITY BUSINESS Slate Tax SEPARATE Pt RMITS REOUIRED FOR SEWER, PLUNII.41NG AND HEA'rING. Total WPP L"i iWi'-O P ii-C i"4 t Approved Receipt No 5DC PDC 5 F W I-RCON-N F CT S E W L R 1 N,$4<( T.1 0 N SEWER SURCHARGE Comments: uuLi, u , Ljt4ulu uc� u CITY OF BUILDING PERMIT APPLICATION TIG►ARD DATE- 0369 THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIF QIP. OWNER PHONE _ OWNER MIS* LouiIN Bolan �d XXPXX _ ADDRESS _ GUILDER PHONE �,1set18rn lJaad Prodi ctp ENGINEER 9� I1 LDER ARCHITECT DESIGNER _ S TRUCTURE ANEW Q REMODEL _ ❑ADDITION ❑REPAIR -1 []RENEWAL FI�R1E DAMAGE r-� ❑DEMOLITION IJfR-E�S�IDENCE ❑COMM ❑EDUCATIONAL QGOV'T QREI_IGIOUSOPAT" ]CARPORT ❑GARAGE _1,_.ISTORAGEOSLAB ❑FENCE QBOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW `❑COLO CIL APPROVED ❑SIGNS OCCUPANCY.__ LAND USE ZONE---BLDG.TYPE_ __Fs9E ZONE, PLAN CHECK RY, HEAT x 10 ached ettachod tv dwell- OCC, well- _ _ _- _ CC LOAD —FLOUR LOAD` HEIGHT NO.STORIES AREA VALUE 200 BUILDING DEPARTMENT _ SET BACKS FRONT REAR LEFT SIDE RIGHT';IDE r, x:1133 ---_—.__._ - - ---- -- — — Permit — --- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE — WORK WILL BE DONE IN ACCnr7ANC.E WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE 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 _ .05 LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING Total 5.05 APPLICANT OR AGI NT — - Approved -- Receipt Ni) FEW DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE Conv actor Permit No. Rough-in Fixture Final -_--4 —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 CERTIFICATt OCCUPANCY -7U CERTIFICATE OCCUPANCY Final — � Landscaping i Zoning Final 1_._� 11• I! e I I s City of Tiger tl E INSPECTION REQ(� �h for INSPI.CTIAN TIME . - PERry;T NO. : , DATE: DATEUtz%lir . , OWNERS NAME . ADDRESS . CONTRACTOR TEST. Air D, " iter E3 , Visuai I_a�•)r�fr i "t'Z ILT: Approved A,, Disapproved Ll SKETCH: 1 ?s INSPECTof.l [NOTE : Aftech loPPle iantal taut dead }� ,.;,L � I I city of Tigard INSPECTION REQUEST for IINSPECTION TIME : PERMIT NO. : DATE: DATE I SSUED:._1...L..... OWNERS NAME : ADDRESS : II CONTRACTOR : TEST: Air O, water [] , Visual D , LaboratoryE] RESULT. Approved Disapproved 0 , Pe-ling I SKETC r 00 I r 1 SPECTOR DATE rNOTF Attach supplemental too, data haretu] 1 ?TL SPACES WTST BE ENDORSED PRIOR TO ISSUANCE OF BUILDI.Pi' PE MIT PLANNING DEPT. PUBLIC V',lOjZjly T), 1,S DEPT. BUILDING DEPT. J'y TUAT,ATTTT R',j-rZAI, FIRE DEPT. APPROVED CITY T BY� -----TITLE -DATE I City of Tigard INSPECTION REQUEST for INSPECTION TIME . ',( _ PIkRMIT NO. : DATE: S 1131 /V DATE ISSUED : 1_L_ I OWNERS NAME : ..---. � 2�-� _ ADDRESS: —'-) !�L C 0 N TRACTOR : .___ __._� � k TEST : Air 0, Woterp ,, Visual Laboratory p RESULT: Approved ` , Disapproved O , pending p I SKETCH. G-a..-t.' I I I I I i INSPECTOR~ bA► E I T NOTF. Attach fuppleTental tewt data bereta� I i City g of Tigard INSPECTION REQUEST i I for INSPECTION TIME: f 1 PERMIT NO. :—_ I DATE. DATE ISSUED :_._LL_ OIOWNERS NAME ' ADDRESS. 40-71, ( _`�`_...� i CONTRACTOR : TEST : Air ❑, Water❑ , v�eual ❑ Laboratory O i RESULT : Approved , Disapproved ❑ , PendingI SKETCH: U i I I I IN PECTOR DATE _ I NOTE: Attach supp;ementni test data hereto i f ' City �of Tigard I � INSPECTION REQUEST � for I OPECTION TIME; PERMIT NO. : DATE: '' DATE ISSUED :---Z-L_ )WNERS NAME : ADDRESS: S/ O N T R A C TO R : ____.4A �, BEST : Air ❑, Waterp , Visual O Labor I otory p RESULT: Approved Diss I f , pproved ❑ , Pending O KETCH; i l I i I I INSPECTOR DATE 01E: Attach supplemental test data beret] I I I w ! ! ! ! ! lw ! ! ! I I City of Tigard INSPECTION REQUEST I for INSPECTION TIME' PERMIT NO. . I DATE: �_.11212--� DATE ISSUED L - OWNERS NAME : ADDRESS: 41i I � CONTRACTOR : .________.____._ TEST : Air n, Water❑ , Visual [I , Laboratory ❑ I RESULT: Approved , Disapproved 0 , Fending SKETCH.' I I I I I IN ECTOR DATE NOTE I DP MOTS Attach supplemental test data beret a] I I I City of Tigard INSPECTION REQUEST I for NSPECTION TIME' _. -1 _ PERMIT NO. : DATE: _ '11�1_Lx� DATE ISSUED : — / JWNERS NAME ' -- --- A D D R E S S: 'ONTRACTOR : __--t— — TEST : Air ❑, Water❑ , Visual [1 , Laboratory ❑ RESULT: Approved ❑ , Disapproved ❑ , Pending ❑ I SKETCH: I I 13, —IVWPECTOR DATE I NOTE : Attach supplemental tett data bereta I W PLUMBING PERMIT A.PPI_•ICATION Jurisdiction of No. Type of Fixture Fee Permit No. Permit fee Water Closets Toilets Permit Issued_ �- 217y Bath Tubs Approved by Lavatory Wash_ Nasin _ Building Permit Shower _ Receipt No. q•w in R7,_ Dishwashing- Sinks Kitchen _ Sinks Ordinary_ — Location of Building ��� 4 - inks Aad r i Sinks.'S122 Automatic Dis ;i .as er Di s o s a1 -- Laundry Trays y---^ Name, & Address of Owrer _ _Drains, Floor ----_ Drains, Area Drains, Re frige-gator RainDrains r ----+ Automatic Washer - Namer '& Address of Plumber ountains, Dri- - Fnuntains, Soda FTot WateF Tank r — -- Water Service Size, - Urinals —� Building Old or New Alter, Repair or Cai F=t3asins - -�Fif =ns tElljj Lawn Sprinkler vstem� -- Swa.mming Pool +- Other _-- _._ _�rinkler System _ .� _._..__� __._�_ ----- _ __ -_� _-• .__.« This permit becomes null and void if work or construction authorized is not commenced within 60 days, or if construction or wort, is suspended or abandoned for a period of 120 days at any time after work is commenced. All plumbing 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 same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not, the granting of a pennit does not presume to give authority to violate orcancel the provisions of any other state or local law regulating construction or the performance of. construction. Signature of Applicant W 1 City of Tigard INSPECTION REQUEST for / INSPECTION TIME :-2; - PERMIT NO. : - — DATE: ,-:-:) DATE ISSUED: �, OWNERS NAME : - ------- ADDRESS : L� CONTRACTOR : TEST. A'r L-1, Water ;] , Visual )f, Lah ,ratorY C-I RESULT. Approved Disapproved _1 Pending I7 SKETCH: I INSPECTOR DATE COTE ; Attach supplemental test data hereto0 1 City of -Tigard INSPECTION REQUEST f o r INSPECTION TIME: PERMIT NO. : DATE: .' //i /7f DATE ISSUED :--LL- OWNERS NAME ' _ rve ADDRESS l�o7, el c wc�-ihN1:2 CONTRACTOR : i -VEST Woter[] , Visual ;�, I. aboratory 0 � RESULT . Apnroved N, , Disapproved 0 Pending ❑ SKETCH.* INSPECTOR DATE I CNOTE : Attach supplemental test data here t fl v i I 135'74 EXHIBIT "A" CITY OF TIGARO Residential Structure Occupany Rostriction KNOW ALL MEN BY THESE PRESETS, that occupancy of recidantial structure (a) on the following deacribod lands prior to the racordint o° an occupcncy permit releasing the rectrlct.ion in the Dead Racoroa of Washington County, Oregon, is prohibited by the ordinance of the City of Tigard, Oregon: (Tho City will Josue a release as soon ae a fia--1 inspection determines that the construction is satisfactorily conplotod) QCSCRIPTICN OF PROPERTY: a e . .a.\.1 - -.- c. �`i` a� '\2..k.C V `f�,A 5�..�.�yC a.r. C►O GOORESS OF PROPS-,TYt AODAESS_ OF OWNER: IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this -jj,-CN, day of OWNER: Noire APPROvED: Title 9y: I dirq O cya City of Tigard STATE Or OREGON County of Washington ss. January L7 19 _ Personally appeared before ns the above named , Roy Brown and acknowlodgad the foregoing instrument t0 be his voluntary act and dead. [ e_ Notary ol.c for Oregon %3,17-cOregon -,y Comaiocion Expires: 1/16i75 h !!nn{{ t V� a x 4 --_ $ EXH13IT "A" CITY OF TIGARO Rosidontial Structure OccupGny Roatriction SNOW ALL MEN 87 THCSE PRESENTS, that occupancy of residential otructurs (a) on the following deacribod lands prior to the rocording of an occupancy perait relsaoing the roctriction. in tho Dsed Rocordo of Washington County, Oregon, io prohibi`ad by the ordinance of the City of Tigord, Orogon: (Tho City will Josue a rolocoo as soon as a flail inapection determines that tho construction is satisfactorily cowplotod) LZSCRIPTION OF PROPERTY: v.,ti. �.... �... �cl! �.. �".��.e.�s. �►'�.►,�?e.•,�t.. `�`� , \ \mom OZESS Of PROP'RTY:OF OWNE R: T= AOORE53 Of OWER: .Q IN W;TNESS WhEREOF, the undersigned hoa caused this restriction to ba oxacutod this day of \.a e, , 19�•� OWNER: Nero` APPROVEO: "" "— Tide"` Syl 44 Building Of is a City of Tigard STATE OF OREGON County of Waahington ; as' Janwrr 29 lg 76 Personally appoorsd before ao tho aauvc ncaod Ilay Bro�•a _ and acknoulodgod t:.io for gaing instrument to to h1" voluntary act and cooc. / 01_ Notary Puoi:c for 0remon ry Cou:aiazlon Exa:;oa: 1116175 i ay s� CITY OF Ti IGARD 12120 s w. MbM krW 11GAR0. 0*640N "US APPLICATIO?i FOR BUILDING. PERMIT Construction Ful Demolish ❑ Addition ❑ Remn�el ❑ Move❑ SING, D DATE ISSUED__/- ag .L BUILDING PERMIT .)ATF. PI:CF:IVED BUILDING FEE S f�c's'' _ No. PLAN CHECK S �0 "°C; kt .'aF'° far ?'V- j Z I+Y --- _ OTHER 5 s/•C C) i*w e,.,,&.)&'VALUATION TOTAL 5- [-�ls �°� .51�it RECEIPT No. TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION MAP 1 _ CENSUS TRACT JOB 1 Arohitect or Engineer���y�as_� AddreR.^�� _ L.�a►_� � �� . � Phone�.�s.. y Address Phone Hui lderq_. Address BUILDING USE Single Res. UnA Multi Rea. ❑ Comm. ❑ Industrial❑ (+CCUPANCY GROUP 7X-- No. of Stories_ Total Height_' Area of Lot Tyle of Construction V Floor Area B — 1 2 � Set Hacks: FrontBack` L.Side Private Sewer Pipe Site _— y�• Sewer� +' ptir. Tank ❑ ,4atnr Service Pipe Size.-24,3 Storm Sewer Ditch ❑ DryweII❑ :,t.rpet. and Curb Requirements��:���._�_��,��s�,�y�__- �)rivewsy width _�►. a �No. of Parking Spaces SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING SPECIAL INFORIMATtON AtDPESS ASSIG'4ED f II:LD CHEC'r BY DATE PERMIT APPROVED It is understood that all work will conform with applicable codes and ordinances ­f the State of Oregon and the City of Tigard, Oregon, and that the building will not I,e occupied until a Certifica':'� �,F f+rcupancy has been issued by the City of I> Jrrd Ruildinq Inrspe-tor. tIL ;Aynatur ' Applicant. '� 4061 CITY OF TIGAND CERTIFICATE OF OCCUPANCY AND RF:IAUX OF MWRICTION The City of Tigard here`ly certifieu that the occupancy of the following described structure or premiseu with respect to which a restriction of occupancy was, oa _afiyerv1_ recorded in Ifook � �, 11alp rl , Deed Record of Wa%hington County, Uvegon, is heret.y nuttxrrized and approved. DESCRIITION OF 1,P4Vt:RTY: Summerfield - lot 141 As recorded in Book 33, Page 44, Plat records of Washington County, Oregon k Ownot Tualatin Oevelopment Co., Inc. WILDING MRMIT NUMLHI:R: 74-12 FUIL.DING ADDKEZ: 15650 S.W. Old Orchard Place This i+ to certify the said structure meets with the require- rests of the 9.,iiding Ccle of the City of Tigard and the above referenced re%trictiun is hereby released and terminated. IN WITNT•= 'FILET-010, the undersigned authorized officer of the City of T gard has cau,;ed this certiriaate and release of reutriction to be executed this !r day of Title; In JL STATE OF URWON County of Washington ) On this day of _, lye, personally appeared before we the above narodS—Ylr .�.. _, whose ;ignisture appears hereon and who Ackno edged to shat that to executed the nave in his officai rapacity on behalf uf the City of Tigard. Lary 1 tic gon My Ciocy*xpIrea: h:. b-4 H o... AN 1'R assts Tw.,MMsartl,b...r.� a.,.,w 1 tti..� soot 994 FkA52 a Cl t L.1 CITY OF TICAIta CERTIFICATE OF OCM.)IANCY AND MIFA39 OF RL"MICTION The City of T16nrd hei eby certifies that the occupnncy of the following described structure or premibet with rer.pect to which a restriction of occupancy van, on _�1111iuk_ 147d , 19,_,.,_# recorded in Rook —91,1 , J%f1e , Decd Record of Kar.hington County, OrcLon, is he.rut,y authorized and appruved. DESCRIITION OF 1'FU-?:CTY: Summorfinld - lot 141 As roc.ordod in Book 33, Pago 449 Plat records of Wrtshington County, Ornyon owNF:R: Tualatin Devoloment Co., Inc._ MID1NO 1,FIVGT NU FMt _._..24-12__.,._...__._._._._._.._ - BUILDING ADDAL;5: 15650 S.W. Old Orchard Place This is to certify the said structure meets with the require- worts of the Building C,-le of the City of Tigard and the above t t i referenced restriettun in herby released and termirwted. IN WITIM.IS M0,1 RDF, the undernigned authorized officer of the r City of Tigard has cau:,ed this certificate and relear,e of restriction to be ezeeuted this day of , 19 Title: County of Wa-,hington )ns on this _�___ _ day of , 19W, personally appeared before tx the above tared _, whose signature npprare hereon and wla acknowledged to me that he executed the same in his offical capacity on behalf of the City of Tigard. Notary Public of Oregon My Commission expires: