12865 SW 107TH COURT 12865 SW 107TH COUNT
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City of Tigard Mechanical Permit 2 ! 9 3
New Installation 11 Replace 0 Relowi,�.,rJ Addition ❑ Alteration DATE:
HEATING - w
CONTRACTOR �--__�_— OWNER
ADDRESS—.-----_____ JOB ADDRESS_ �_--
PHONE_ --_—_ APPLICANT-
Heat Input Rating(BTU per Hwjr)�.—_ _ Vent Size Flue Size
FUEL OIL GAS [] ELECT OTHER
ITEM ITEM _ NO. _ FEE
For Issuance of Permit SEE BELOW Each Air_Handlinq Unit or Duct S stem _ .50�
New uP to & incl. 1001000 BTU 6.U0 Commercial Hood System
7.50
New 100,1700 BUT's & over _ 7.50 Other Equipment - Each 4.50
Woodburning Stove 4.50 1 Trip Inspection _4.50
Wall-Floor- Suspended — 6.00 — Air Condition Compressor - up to& incl.3 H.P. 6.00 _
Ven+ S stern w_Fan 4.50 Air Condition Compressor-3 1 to 15.H.P. 11.00
�E—__.
Repair-Heat Cooling 6.00 � -
CITY BUSINESS LICENSE. REQUIRED BY ALL CONTRACTORS OR SUB-CONTRACTORS ! !
PERMIT ISSUANCE 10.00 Comments:
E --
FE ES -------
.SU B-TOTAL___ -- — —
% STATE _ Isiu+ed By-- - ---—
2WPLAN CHECK
TOTAL — - REC. __ _
Signature of Applicent ���
Wye
ADDRESS i ��d� .��;_1� f* PERMIT NO.
neo -
PERMIT CHARGE _ none
OWNER 4 c*-/���, I •,.� CONNECTION FEE
_ PAID BY
TYPE OF BUILDING DATE CONNECTED
SERVICE RATE INSPECTIONFt.t
CONTRACTOR PAID BY _ DATE _
SIZE OF CONNECTION V iF`'SMENT _ PAID
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City Of Tigard
INSPECTION R QUEST
for
INSPECTION TIME '. PERMIT NO. : . '
DATE: /216/l6 DATE ISSUED'.- --,' L.
OWNERS NAME : . u Uc t�►-� _
ADDRESS : 10 ,7 -4 17 — —
CONTRAC GR :
TEST. Air O, 'Hater [&!Visual m.f<aboratory C)
RESULT. Approved 10,-, Disapproved U Pending (]
SKETCH'.^� z �
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INSPECTOR DATE
IC0TE Attach supplemental test Baro here lc1
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CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE_ �� ,1s 709 8 0
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
idon Hoare,;. ; �1g65 1,07th
OWNER ADDRESS BUILDER PHONE
ENGINEER
BUILDER Donald E� fit"j'��QK 1n r"ARCHI TELT -------DESIGNER
STRUCTURE MEW ❑REMODEL ❑ADDIT100 ❑REPAI R ❑RENEWAL [:]FIRE DAMAGE []DEMOLITION
[ RESIDENCI-: ❑COMIA ❑EDUCATIONAL ❑GOWT ❑RELIGI 1S❑PATIO ❑CARPORT C1GARAGE ❑STORAGE❑SLAB []FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY�� LAND USC ZONE. BLDG.TYPE_ FIRE ZONE- PLAN CHECK BY HEAT _...
M Const. one 2 Wtory dwelling unit per plane 163 A
38edroom 2 beth Tax Mop 21_�1—UD Tax Lest x{2900
8soement d74 sq.rt --
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES 2 AREA VALUE
BUILDING DEPARTMENT SET BACKS FRONT 70 Rf AR LEFT SIDE 20 RIGHT SIDE
Permit l;i�Q(�
THIS PERMIT !G 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 ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALI. 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 j*31 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING,
Total
ev -
- -----� ---- APP ANT OR AGENT
Approves! Receipt No
ADDRESS PHONE
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
n Contractor _
/D- C.�LO>tiJ d Permit No, c' t;
i t k-J
Rough-in
Fixture _
.a, Final
HEATING
67- Contractor
_ Permit No.
Gas or Oil _
Rough-in..
Final
— -- SEWER/m G-76
Final
DRIVEWAY
Final
_ Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach _
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
7 CERTIFICATE OCCUPANCY
�� �' •�/ �� Landscaping
�, C ��.�=-'-" ` — � Zoning Final
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UNIFIED SF-MERAGE AGENCY NO. 10603 _ -
WASI_.IING"' _-ON COUNTY DATE . 1976
x'.17 Y OF. Tigard
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APPLICATION FOR SEWER CONNE_C HON PERMIT
6ridon Homes Inc.
OWNER: .—.... ..
OWNER'S ADDRESS: _
STREET
- -----CITY-------------���_. STATE ZIP
r
BUILDING SITE: LOT._--- BLOCK . _ _ _ ADDITION
Tax flap 251-3AD _
TAX LOT NO. -_ ?qOn-_._ TYPE OF OCCUPANCY residence
ADDRESS
DWELLING UNITS-.--.------.1 FIXTURE UNITS
SURCHARGE IF APPLICABLE --------50._00____..Derry__Dell...
575. 00 25. 00 600.00
PERMIT FEE -
_.___ INSPECTION FEE TOTAL DEPOSITED
(NEW) (EXISTING) BUILDING SEWER SYSTEM
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICAN-f�
SEWER PERMIT
THIS PERMIT AUTHORIIES CONNECT ION TO THE SEWER SYSTEM,
LINE SIZE _ _ _ INSTALLER
RECEIVED BY.
(AGENCY Op ITS AGENT(,'
COMMENTS: .. Hldo, ('9B0
This Application and permit expires in one hundred and twenty (17.0) days.
The amount paid will be forfeited should expiration occur.
�_� - MIN
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CITY OF
BUILDING PERMIT APPLICATION i*10-- ARD DATE �&U�-� �P',�° 91'D
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED ��((�� 2306
OR AS SHOWN AND APPROVED IN THE ACCOMPA ,' P NS D CIPICATIONS. OWNEH PHONEZ�i'� �-��SJ
,1� �ss�c.�`�75' ►�Irlee.� _
_ i___ BUILDER PHONE�,�j.'_�JCJIp
ENGINEER StUp10 S" DQ616N
BLII.IZF$ t�iTl jj - r-7DESIGNER 11 Q0JZTC*J
STRUCTURE NEW 17 REMODEL -OADDITION [ 1;+r;PAIR UPS.-r: ^-I. OFIRE DAMAGE—QOFMOLIT'I-)N
RESIDENCE ❑COMM IJFDUCAI'IONAL ❑GOV'T ❑I,ELIGIOUSI "ATIO ]CARPORT ❑GARAGE [3 STORAGE0SLAB 13Ff-NCE
QSONDJr ❑MOVING= ^�nCONDITIONAL USE C DESIGN REVIEW - ❑COUNCIL APPROVED _ ❑SIGNS -`-
OCCUPANCY-.LAND USE ZONE. __BLDG.TYPE ___FIRE ZONE__ PLAN CHECK BY�T HEAT
OCC,LnAD _-FLQOR LOAD---- -- -----_..---HEIGHT _ - NO.ST,AIES AREA /D.x�Q VALUF�`
- _ y --
8611-DING DEPARTMENT- __ .. SET BACKS ..FRONT REAR LEFT SIDE 240 - RIGHT SIDE /72-
Permit 2Permit
THIS PERMIT IS ISSUED SORJECT TO THE REGULATIONS CONTAINED IN THE BUILDIN. ; CODE, ZONING
Plan Check �SREGULATIONS AND ALL APPLICABLE CODES AND ORDINANCFS, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCOHOANCF. WITH THE PLANS ANDSPECIFICATION'S AND IN COMPLIANCE WITH
Recording ALL APPLICABLE COOTS AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE C0VfNAN1S. CONTRACIOR AND SUB CONIRACIORS TO HAVE CURRENT CITY BUSINESS
State I.ICFNSE. Si:PA11A'rf: PERMITS HEOUIRFD FOR SEWI_R, PLUMBING AND HEATIN(3.
Total 3 horn) its
By
Ac'PI..IC.ANT o AGENT
Approved.* __—— Receipt No. .-AZ . _p,_. _Z9 s 330 h
—- -- - - ADDHt 55 � PI II)rJF
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME PERMIT NO. :
DATE : J DATE ISSUED:
OWNERS NAME : _ -
ADDRESS
CONTRACTOR :
TEST". Air ❑, Water j , Visual Cl , Laboratory ❑
RESULT: Approved,01, Disapproved ❑ Pending U
SKETCH: `\ /V D L- �,¢,vr fvi_� N)L;e )S
CLEI-14A-4NAl L 5G� SNr� (aj
)?t ren>scat AK tS �3t1 c>w C�xr�c
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INSPECTOR DATE
UOTF At loch +upple.nontnl toot ,foto horeto�
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EXHIBIT "B"
CITY OF TIGA]Irj 17532
CERTIFICATE OF OCCUPANCY AND REL: E OF RE:ITRICI'ION
The City of Tigard hereby certll•le:, that the occupancy of
the folloving described structure or premlae: with respect to Which
a restriction of occupancy Was, on !july 17 ll�y
recorded in Book 984 , stage 294 , Deed Recons of Wanhtngton
County, Oregon, ic: hereiry authorized ana nliruvea.
DMCRIi'TI0N OF PRo IUM:
lot 19, Pathfinder Subdivislon, Tax Map 251 3AO
OWNER: Clonutti Loi at. Co.
BUI LJ 1 NC P6:fUt1'i NUM 0i: 74-15b
BUILUIX ADDRE,;it 12065 S.W. 107th Lt.
Thii i,; to certify the 3a1a structure uxet With thv: requi.re-
mer.ts of the 9;.ilding Code of the City ;X Tigard and the above
referenced restriction i. hereby released and terminated.
1N WITNL13 W11F.REuF, the undernlgned authorized ufficer of the
City of T:gard haL; eau,ied thi^ certificate arm relea:.e of rentricLiun
to be executed this day Cf , 1)
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Title Y FL
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iTATE OF URWON ) r,;.e ra ws�ao...i-._7..........►�'l.S. ��`-�
AS. Hoar!fNOMbRII.We"M 140'..•. % , ...
Cowaty of Washington ) A
On this 4th day of March , 19_.75, personally
appeared before we the above named _Doris Ha r t i g whu:;e
uigruture appears hereon and who a^kn,,)Wledgea to me that tie executed
the same in his offs;-il. capacity on oehalf of the City of Tigard.
Notary IA sic of Oreton
My Commlanion expires:
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14OS3
EXHIBIT "A"
CITY OF TICARD
Residential Structure Occupancy Restriction I
KNOW ALL MEN BY THESE PRESENT, that. occupancy of residential
structure (s) on the foliouing described lands prior to the record-
ing of an occupancy permit relrasing the restriction in the Deed �
Records of Washington County, Oregon, is prohibited by the ordinance
of the City of Tigard, Oregon: (The City ui:,l issue a release as
soon as a final inspection determines that the construction is j !
1
satisfactorily completed)
DESCRIPTION OF PROPERTY:
lot 19, Pathfinder Subdivisions Tax Map 231 3A0
i
ADDRESS OF PROPERTY: 128655 S.W. 1107th Ct.
NAME OF OWNER: Monetti Conet. Co.
ADDRESS OF OWNER' 27390 3.W. BarlowRoad, Canby
U
rorty
IN WITNESS WHCREOF , the undersigned has caused this restriction
C� to be RXec.Uted this__day or
OWNER:
\ b~
l
s a Name
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t c — r... . �.._
Ily: s ci->,_�- r,� rte_-'� ��XaL1t�nWMRSLN.
U ing 0 icia
City of Tigard
M STATE OF OREGON ,s
- .a 7 Y r 19
County of Washington ; ___._...� E
Wf Porsonally appeared before me the above named=;'
and acknowledged the foregoing instrum,,ot
to bn 1, , ___voluntary act and deed. ry'
r-{ +� r2,,
Notary u.► i, for Dr gon
My Cu: m►:+5 on EKpidreo:'
BOOR W294
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14083
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EXHIBIT "All
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL IGEN By THESE PRESENT, that occupancy of residential
structure (s) on the followi.,g 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 :
lot 19, Pathfinder Subdivision , Tax Map 2S1 3A0
ADDRESS OF PROPERTY ; 12865 S.W. 107th Ct.
NAME OF OWNER: Monetti Const. Co.
ADDRESS OF OWNER : 27390 S.W. Barlow Road, Canby
IN WITNESS WHEREOF , the undersigned has caused this restriction
.to be executed thi 5�- _day of ,- Z4 19
OWNER :
Name
APPROVED
B y: i 1 Lr 9Zs 4 'L C _ — F Ue, Im rocr+td.,..(..�.��...........l0 7y et.� ..Il!�.
BL F.M
'�L
d i n g Official i c i a B X 3IQ64 niom RBN. thr"ar of hoaoM. & tjou* s
City of Tigard
STATE OF OREGON )
County of Washington ) ss _
� s 7� 19
Personally appeared before me the above named,—ti,
and acknowledged the foregoing instrument
to be h, , ,___r_voluntary act and deed.
Notary Pubic for Or gon �"--
My Commiss on Expi es:
BOOK 984 RAW
w �wwww w ■ rr
"ArE OF OR
EGp
Counh, of Was
hirgtan
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ve o EiecRorneroj}�rnssefj p,
shot lhq for sold coi01Rcio�rRector of Records
received within t ntY, order of
/o. °^`� recurd d r'nento fh�eby ceCof,
soid` book of ng was
Cotw r ' Acord:
Witness m
Y h°nd o
R CGF THOM offbxed.
ecpd d E/ect$�N, Airector
VP
.,JUL
.,JUL I T 12 24
e
�-""' CITY OF
BUILDING PERMIT APPLICATION TIGARD DATE_( �r19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN I�,APPR�QyED IN TiE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE_ — -
OWNER ADDRESSBUILDER PHONE
f J ENGINEER
BUILDER (� CLr fr ARC ETIH t ---
DESIGNER
fRUCTURE , NEW ❑REMODEL ❑ADDITION ❑REPAIR ❑RENEW ❑'IREDAMAGE QpEMOLITION
SIDENCE—❑COMM ❑EDUCATIONAL ❑GOV'T ❑R LIGIOUS ATIO ❑CAR POR LJ GAR E ❑STORAGE❑SLAB ❑FENCE
MOND ❑MOVING ❑ ONDITIONAL USE DES GN REVI _ ❑COUNCIL APPROVED ❑SIGNS
CCUPANCYLAND USE ZONE BL _P F E E PLAN CHECK BY 7" l
HEAT
.c"• � r r
n r -
OAD FLOOR LOAD HEIGHT '� NO.STORIES AREA VALUE - � t=�
BUILDING DEPARTMENL`
ermit SET BACI;S FRONT
^ REAR _ LEFT SIDE RIGHT SIDE
f — — — -- —
THIS PERMIT iS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Ion Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND:PECIFICATIONS AND IN COMPLIANCE WITH
ecording ALL APPLICABLE CJDES AND ORDINANCES. THE ISSUANCE OF 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 REMARKS PLUMBING ()AIE
Contractor___
Permit No.
Rough-in
Fixture
Final _
HEATING
Contractor
-- --- --- --_--_ _.___—_---_—_--- Permit No.
Gas or On
Rough-in
Final
— _ SEWER
Final
DRIVEWAY
Final
Storm Drainage_
(Rain Drain) Final
I
Sidewalk
Curb &Street Final
0 yo
UNIFIED SEWERAGE AGENCY NO. 4994
WASHINGTON COUNTY DA1-E
CITY OF
APPLICATION F R SEWER CO NECTION PERMIT
OWNER: 22L�2f--„ . -
OWNER'S ADDRESS: 7 e
STREET
CI
- - ZIP
BUILDING SITE: LUT -- BLOCK ----- -- - ADDITION
TAX LOT NO. - _ _ TYPE OF OCCUPANCY
ADD ES'S,- -
DW -l_LING\` IT ' �/- FIXTURE UNITS
SURck+ ARGEIF APPLICABLE ----�_ZL 4 -_, , .c..
PERMIT HE �' INSPECTION FEE TOTAL DEPOSITED
(NEW) (EXISTING) BUILDING SEWER SYSTEM __ s:.• .�- f/� ____
The Applicant agrees to comply with all rules and ulations of the Unified Sewerage Agency.
APPLICANT _
n
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSIEM.
LINE SIZEINSTALLER -
RECEIVED BY
IA ENCY OR ITS AGENT) _ _ -- - ----- - - ---
COMMENTS: ;JS —
This Application and permit expires in ninety (90) days. The amount paid will he forfeited
should expiration occur.
I