12855 SW 107TH COURT 1.2855 6w 107TH COURT
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ADDRESS PERMIT NO.
PERMIT CHARGE none
OWNER CONNECTION FEE
.� _ PAID BY
L
TYPE OF BUILDING 'a. DATE CONNECTE ____
SERVICE RATE ��/Q�, INSPECTION FEE
CONTRACTOR j,'TLd PAID BY DATE
SIZE OF CONNECTTN � '
ASSESSMENT PAID
r r r r r r
City of Tigard sus=
INSPECTION REQUEST �
for
INSPECTION TIME: PERMIT
DATE: 2 .6��/��' DATE ISSUED --"_. _ �
OWNERS NAME :
CONTRACTOR :
TEST : Air p, WoterQ Vieual'
0 , Luborotory C
kESIJ'—T.' Approved Di
eapprovPd r7 , PPr•ding C.]
SKETCH:
I
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-7"TV,4 DATE _ I
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City of Ti and
I NSPEC , ION REQUEST
for
INSPECTION TIME: oPE
DATE: RMIT NO. :
5 , I
RATE ISSUED :--L—/
OWNERS NAME :
ADDRESS:
CONTRACTOR :
TEST : Air U, Woterp , Visual Laboratory
I I
RESULT approved Disapproved O Pending
D
SKETCH: 01
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� 7, I
INSPECTOR DATE
[OTE: Attoch Suppl�mentel test doto berets]
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b CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE._______ 19N2 0364
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE____.__—____.-
OW _NER marry Cohr,r _ ADDRESS 121155 5,W* 107th C"I"'IBUILDER PHONE
ENL;: c E R
BUILDER QW11jPX' ARCHIL, 7T DESIGNER
STRUCTURE L_JNEW 3REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑REL.IGIOUS❑PATiO ❑CAR PORT ❑GARAGE [:]STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE_ SLUG.TYPE __FIRE ZONE __ PLAN CHECK 8Y HEAT
conritruct 1 a Qq reins dw, 4ing wtfi gersgla .in basement
,_. Permit usur.sd nuuject to new corrected drawing 3 bedroom
OCC LOAD FLOOR LOAD e01b HEIGHT NO.STORIES 1 AREA 2816 VALUED*000
BUILDING DEPARTMENT SET BACKS FRONT 209 REAR 221 LEFT SIDE 20f RIGHT SIDE 1E,
Permit i.27.061 'X+ _-- --
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 T14AT THE
WORK WILL. BE DONE. IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RES rRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State 1.27 LICENSE SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 19177 A
By rte
APPLICANT OR AGENT __._..------- ---_—___- _ --
Approved ri'N Receilil No
AD .�a� r�inr�r
i
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DA If
1Contractor
Permit No
HOugh in
FiXtLIre-----
Final
HEATING
Contractorku,t,
Permit No. 2 n 6.
Gas or Oil
Rough-in
Final
SEWER cJC LLIC, 'F-/8-'25
Final
DRIVEWAY Cook f-/,j- 7 6-
Final
Storm Drainage
(Rain Drain) Final
Sidewalk 7:,'
Curb&Street Final
Approach
SLOG. DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
Final
CERTIFICATE OCCUPANCY
/7 I-*-� I Landscaping
Zoning Final
kMIBIT "B"
17593
CITY OF TIGARD
MiTIFICATE OF i)CCIJ]'ANCY AND RELEASE OF RE:3TRICTION
The City of Tigard hereby certifies that the ucrupvar.cy of
the following described structure or premisei, with respect to which
a restriction of occupancy was;, oh July 17 , lj 74,
recorded in Book qga Page 291 , Deed Record of Wa;,hington
County, Oregon, is hereby authorized and approved.
DIZiCRIITION OF PP"'ERTY:
lot 18, Pathfinder Subdivision, Tax Map 251 3Q
OWNER: Monetti Const. Co
BUILDING ]i;iiMIT NUMBER: 2A-1=,r,_ V.
BUIL').?IG ADDRI�j: 12855 S.W. 107th Court
Thi:l Ill to certify the ;aid structure meets with the require-
inert,,-, of the Building Cude of the City -f Tigard and the above
referenced restriction i. herety released and terminated.
IN WITMIS 'wHERE0, the undersigned authorized officer of the
City of T gurd ha:; caused thi-; certit'ieate anti relea:.e of restriction
to be executed this �..f ] _ uay of /41",4 !i 1) i
�i, ice_ _ _ ,� ♦Lir.
Titl4 INO
STATE OF uREGON
County of Wa:;hington ) Mxt11 tNOMs•..1i.IM»wr d MwW /1M1M�
On this 4th day of March , ly 74 personally
nppeami before me the above namedpor a usr�i , who:•e
signature appears hereon and who acknowledgeu to .ie
9 that tie executed
the varve in his office]. capacity on behalf of the City of Tigard.
r
rtotar; : regon
My Commineion exilrea:
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14CS0
EXHIBIT "A"
CITY OF TIf_ARD
• I � Restdn.ntial Structure cOccu?that oncy ccupancyof residential
KNOW ALL MEN BY THESE
PRESENT,
structure (s) on the follouing described lands Frier to the record-
ing of an occupancy permit re,lea3ing the restriction intthe
oOrdonance
Records of Washington County, Oregon, is prohibited a
release
1 of the City of Tigard, Oregon: (The City uill issue a is
soon as a final inspection determines that the constructionn as
►
e
satisfactorily �ompletr,d)
D a OE SCRIPT ION OF PROPLRTY:
m Lot 111, pathfinder Subdivision, ANXftfOftlfltliMV Tex Map 251 3A0
.,y
$" 12USS S.W. 107th Court
N ADDRESS OF PROPFRTY._
r ` NAME Of OWNER: .LGA
4 27390 9. Barlai� Road Cenb
o AnDRESS OF
rM
OWNER:
c V p �.
IN WITNESS WHEREOF , the undersigned has rained th13 re3ttiction
on to be executed this f-_�daY Of
V4�' c.. OWNER:
Nems
Ii e
.79f
,R
/7—
APPROVEDR �
�.«.o._Z=.,/...Z.....ro 7..�e.........1►M rye.
By; / !, a• ' "��-`" p0;[fl YIIUMA"L41.M��^N M��b 6 tiwe,wnra
u d ny
City of Tigard M Ut��.... ..
5TATC OF OREGON ss
County of Wanhingt.on )
pernonrilly appeared before me the Above named
end acknowledged the foregoing lnstrumont
to bvoluntary art and deed.
r /
In ary Pu is for r gon
i30� f! [Gv+ My Commission EvR►reet_ �_
i aao�
f !
i
f
' 14U�8o
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL IGEN BY THESE PRESENT , that occupancy of residential.
structure (s) on the following described lands prior ;, the record-
ing of an occupancy permit releasing the restriction, in the Deed
Records of Washington County , Oregon, is proh.ibite.i by the ordinance
of the City of Tigard, Oregon: ( The City will issuo a release as
soon as a final inspection determines that the construction is
satisfactorily completed)
DF5CR «TION OF PROPERTY !
Lot 18, Pathfinder Subdivision , AAX1th1f010AN Tax "lap 151 3AD
ADDRESS OF PROPERTY . 1855 S.W. 107th Court
NAME OF OWNER : mt,Cjo t t ; ��aa-t•._t�.-_-- --___N.�__ ____---_----------
ADDiitSS OF OWNER : 27390 S. Barlow Road, Canb
IN WITNESS WHEREOF , the und�3r�itgned has cau,3ed this restriction
to be executed this_ day of , 19
OWNER .
Name
Tit1R
APPROVE 7 J �y
By: f 1,.. f_� L/a,` rumd int fornid...r�,,,t —1..�y l....,......19 /,,(, tlt./....A M. P M.
u i d it n g Of ficial ROAR THUMRSCN. Q►to,"ot nt Ronotds & r1orhon•
City of Tigard
N.1
STATE OF OREGON ss
County of Washington
PerSOnall ; appeared before me the above named �—
j ' and acknowledged the foregoing instrument ..__
t •..•.•'tb ba h, voluntary act and deed.
k _
,'. Notary Public for Or gon
�'• •••• '' , 600K 984 me 291 Icy Commission Exp1rR9
STATE OF OREGON
County of Woslringtcn ss
I, Roger Thomssen, Direetpr of Records
and Elections and Ex-Officio Recorder of Con-
veyonces for said county, do hereby certih
that the within Instrument of writing wo:
received and recorded in book of records
No. ..._._..................
,f said Courcy
Witness my hand and seal offbced.
ROGER THOMSSEN, Director of
Records & Eiectiory H
Do" ^'
JUL 11 12 214 PH '74 "/
I
LLT-L JF
BUILDING PL11MIT APPLICATION TIGARD DATE --�.� �y __,,g � `~
TFIF UNDERSIGNED HEREBY APPLIES FO.1 APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN A PPR VED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE -- - --
OWNER =' ADDRESS �} g ^)� .J w7�� BUILDER PHONE _
f) ENGINEER
RUji ZER /LveN t`f' ARCHITECT DESIGNER
'RUCTURE &NEW ❑REMODEL ❑ADDITION OREPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
,) ESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUSOPATIO ❑CARPORT ❑GARAGE ❑STORAGEOSLAB—❑FENCE
_❑BOND ❑MOVING OCONDITIONAL USE ODESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
CCUPANCYLLAND USE ZONEBLDG.TYPE--_FIRE ZONE_ PLAN CHECK BY. 4 11 -2id - HEAT - _
ALL,
Al
Of 01
_C,LOAD _FLOOR 1=0AD _ HEIGHT � NO.STORIES AREA VALUE
BUILDING DEPARIMEN T SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
ermit
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTIONED IN THE BUILDING CODE, ZONING
Ian Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND II' IS HEREBY AGREED THAT THE
-- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
ecording ALL APPLICA9LE CODES AND ORDINANCES. THE ISSUANCI: CF THIS PERMIT DOES NOT WAIVE
— RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
otal
APPLICANT OR AGENT
pproved Receipt No. PHONE
DATE INSP. TYPE INSPECTION REMARKSFFIxturs
BING I 1 f
— -
_—_--V
TINOA — -
-- ----- ---------._-_ -�`-- —- Contractor
—_---__ -- - --- -- -- Permit No. -- -
Gas o• Oil -
- —- - --- Rough-in
---- --
i
UNIFIED SEWERAGE AGENCY NO. ___ - 4997
WASH I NGT ON COUNTY DATE
CI I OF IX
i
APPLICATION FOR SEWER CONNECTION PERMIT
0 %N L R: L,I1 4_—- ---- --------
_OWNER'S ADDRESS:
�ZLL?..-- ---,amu=L�rc - -' —.--.---- -------
STREET
CIT STATE -- ------- ----------�._._.. �_--ZIP -_
BUILDING SITE: I.OT—..�._ BLOCK __.-_.._-_____- ADDITION WrrI���L�__�_
TAX LOT N0. __._..— -- TYPE OF OCCUPANCY
ADDRESS
DWELLING UNITSFIXTURE UNITS
SURCHARGE IF
PERMIT FEE ���--- INSPECTION FEE . �.yl__ TOTAL/DEPOSITED
` (NEW�J (EXISTING) BUILDING; SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE `� IN13 LLER
RECEIVED BY..
IA i
ENCU OR I1S AGENT)
I.:OMMFN f S: q
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
C:I1-Y OF TIGAF:D
12420 S. W. Main Sfraaf
TIGARD, OREGON 97223
APPLICATION FOR BUILDTNG PERMIT
New Construction _ Demolish Additi-in Remodel--__ Move
ZONING_ �- DATE T';SUED._& -_jfr-171P' BUILDING PERMIT
DATE RECEIVE:D � •f{'
BUTLniNG FEE s „� '-- Nn.
By PLAN CHECK .-
----- r.„ L.-y S y VALUATIOti
OTHER/� ----
TOTAL /) yr,rr $ RECEIPT No.
TWO SETS OF PLA14S AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT 1_L� r MAP 1 - CENSUS TRACT ►-h t—ifl LJULJOB
Architect or
Address Phone
UanerM n�Orvl-i�(_
Address .' rL�__�_�S�TlI _I 1aRl alp_y a����1s/,rliy.r�.____Phone
_ -
Bailder �►±.�.�^ ___.______._-._____�.___._.___..._____-�____ __
Address _ _ _ Phone
BUILDING USE Single Res. Multi Res. C] -- Comm. r U Industrial;
OCCUPANCY GROUP_ No. of Stories 1 Total Height__ -, Area of Lot'741J t'
Type of Construction I II III IV V Floor Area B-_� r 1,- _- 2
'et Backs: front 2 U Back �- L.Side S R.Side _
1'rivate Sewur Pipe Size _�[-� _ Sewer co Septic Tank L_.J
water Service pipe size---�l _ Storm Sewer Hitch ❑ nrywell��
Street and Curb Requirements--11'i
Drivewey width 2 ,�� - `-� V - �No. of Parking Spaces-?— __--
SLPAPATE P(:RMITS RF.(?UTRED FOR SEWER AND PLUMBING
SPECIAL INFOILMATION
pDDPC:'5 A"S IGtlf.t)�!�.�_ �_�� ..� l`r /t rA (i•...-r _ .
pIEL0 C111-Cr ::Y
PERMIT APPROVED BYr,l�!=C
It is unleratood that all work will conform with applicalale codes and ordinances
of the StAtc of Oregon and theCity of Tigard, Oregon, and that the building will
not be occupled until a C,rtificate of O uparley has been issued by the City of
Tigard 11uf ldiny Inr.he(:tor. _.
1.-
S' gnature doAp—p�inA
1
CITY 71:O -TIGARD
main ><1rNl
TIGARD, OREGON M23
APPLICATION FOR BUILDING PERMIT
Construction a
_ DemolishEl Aaaition11Remodel 11 Move
ZONING
DATE ISSUED 7��
DATE RECEIVED / -;dS- y BIIILOING FEF—S BUILDING PERMIT
OTHEy?n..J
$
/ - VALUATIOfi 5--4
TOTAL I%. ��, 'rn,
RECEIPT No._fDYl1_
LOT
Two SETS OF PLAITS AND PIAT PLANS %IUST BE FURNISHED WITH APPLICATION
� 1
HAP 0 CENSUS TRACT,
Architect JOB
or F.n9lneer
4ddress ------._ --
')wner ----- - -- --- _ _Phone
IJ
d
'address -----
+ui lder— S ow��� NI11�4AN^_Phona`�_ 2.7 0 g
,Jdress
UILbING lt;E Singla Res. _---�'-`-_---Phone
Multi Res. D __
�'CUPANCY GROUP No. Stories_
Com• Industrial
Of Stories
_�_ Total Height
Me Of Construction III -- Area of Lot7d.)J
III IV V Floor Area B
,t nacksi Front Z,-) --- 1___ 2
Back -� -- L.Side 7 _ R.Side ZL� --- �_
-ivate Sewer Pipe Siza e� — `
Sewer_ Septic Tank
iter Service Pipe rizer ~ -- v,
_ ._(- _. Storm Sewer NJ Ditch
ireet and Curb ne, DI'ywel l
iu i rer,ents I u
iveway width 7p ---- - - --- _
of Parking Spaces 7
SI:PARATF. PEP141TS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
5 ASSIGNED_���
CHECK oil
"__----•--------.__.._- ---------DATE_ �.�t'�J
PERMIT APPROV
5 understood that all work will t:D HY
_•_vim.'_ _�._�___
;e State Oregconform w
on and the City of Tigard,
apPlicable codes and ordinances
e occupied od until a k:ertificate of Occupancy
and that the building will
;d Butldinq !n f ,,,-tor, fancy has been issued by the City of
si��-.��
9nd ' !`App c nf -------- ---