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12115 SW 124TH AVENUE _ 12115 SW 124TH AVENUE i w � r r o He �n Ra � ct r i'' (12 � o � 0 m � ►� �n '� i - to a i rn x � h w �7 7 �� �I I ` \ � • �. N N r� N r♦ Ili i I I BUILDING P 11MIT APPLICATION 1IT TIGARD DATEOF THE s-- THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHC,N!Z—_ OR AS SHOWN PND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNERPHONt LOT NO. — ;agrl�e Svay7F• >.:d3.1j 5W io44W rtvs. OWNER JOB ADDRESS ,r HOME ADDRESS ARC IT CT ENGINEER ADDRESS DESIGNER BUILDER CftlWl, rLertita �J.1r,1.1..__ STRUCTURE ❑NEW ❑RE1,1171DEL •40%DDITION ❑REPAIR [:]RENEWAL ❑FIRE DA %kGE ❑DEMOLITION QESIDENCE ❑COMM ❑EDUCATIONAL. ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE ❑BONG ❑MOVING []CONDITIONAL USE ❑DESIG14 REVIEW ❑COUNCI'_APPROVED [:]SIGNS OCCUPANCY LAND USE ZONE.— —BLDG.TYPE-_FIRE ZONE— PLAN CHECK BY -- LI: t.. swimmyw., Poul aliper pl-Aita ac d-ssiyrted Uy fjuj is ;3. LjguLjhan PF r, tir/app:ovoid Qate to be il: place before peal is I;'illidd. To be hwatwd Vat) u".'. Q© QG^,LOA1Z— _Ham' _---_- Np.STORIE$ .—AREA_­. NO,@.E�p44MS VALUE G r�r BUILDING DEPARTMENT SET BACKS_ )NT _ REAP_ _ ——LEFT SIDE RIGHT SIDE Permit 411.01) PERMI i 53UED SUBJECT TO -IIE REGUI ATIONi CONTAINED IN THE 13UILDING CODE, ZONING Plan Check REGIJLATION. AND ALL APPLICABLE :ODES ANI) ORDINANCES, AND IT IS HEREBY AGRFED THAI 1H —— — WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE W1 II Subtotal ALL APPLICABLE CODES AND ORDINANCES. 7HE ISSU.ANCF OF THIS PERMIT DOES NOT WAiVI RESTRICTIVE COVENANTS, CONTRACTOR AND SUB CONTnACTORS TO HAVE CURRENT CITY FUSWF'';5 State Tax J. i-)i) LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING ANtt HEATING. TotalBv q .LIl1 ��-_--�- APPLICANT OR AGENT Aonrnvftd Rerelpt No. I DATE INSP. TYPr INSPECTION REMARKS PLUMBING DATE —zfa y. C ontractor - -v� �� _: - _ _ No — Roughdn Fixture Final HEATING — — Contractor d — - — --- Permit No. a62 Gas or Oil �� —__ — Roughen `---- SEWER Final— ------ DRIVEWAY-- — ---.-_i 1 —., — --------— -- Final --------- -- -_ Stom Drainage (Rain Drain)Final a --- Sidewalk Curb a Street Fir,al — — — Approach - - BLC i D[PT.F'INAL— TEMPORARY CERTIFICATE OrCUPANCY Final — CERTIFICATE OCCUPANCY L andscaping Zoning Final �r T 11' , y�ll fi Irl)Sl1 I'115, 'r`� ''R�71sv'ir � 'R^ 1, . 'R :;)a• I {r} ,.ibai 11�{'� �.-r•R City of Tigard INSPECTION REOUEST fow Jk INSPECTION TIME : /� A ��l_ PERMIT NO. : —__- DATE: DATE ISSUED'.__Z_1 OWNERS NAME : 4-9a _,t �����., ---____-- ADDRESS CONTRACTOR :_ TEST: Air ❑, Watcr ❑ , Visual `F� , Laboratory p RESULT: Approved A , [Disapproved ❑ Pending p SKETCH: f INSPECTOR DATE EN OTE Attach eupplemenf0l foal data horst] i l I City of Tigard INSPECTION REQUEST for INSPECTION TIME : 4 .Al, PERMIT N0. ' DATE: ��^�. ��� DATE ISSUED:—.L_L O�NNERS NAME : ADDRESS * CONTRACTORJ:.� TEST: Air 0, Water p VieuoI)( La aratory p RESULT: Approved ' , Disapproved p Pending ❑ SKETCH: IPA— 40LI-lL . Z. A INSPECTOR DATE NOTE : Attach supplemental tett dote he►�t� r FILE COPY City of Tigard INSPECTION REQUIFiST for INSPECTION TIME' _ itis PERMIT N0. DATE: DATE ISSUED :_.1 / _ OWNERS NAME : -- ADDRESS' —ADDRESS:CONTRACTOR '. .- TEST : ONTRACTOR '. ._TEST : Air p, iWnter p , Visual�Labo7tory p RESULT: Approved ❑ mmupproved , Pending J SKETCH: fjc* J R0 C1�Y. �T *_ s 3 7 INSPECTOR DATE HOTF. Attcch 1Upp1eme001 test data beret] no� oS Ave- � 1� i City of Tigard INSPECTION REQUEST for IINSPECTION TIME . PERMIT NO. . i DATE : 111J 3- DATE ISSUED:—LL— OWNERS NAME . -- I ADDRESS : CONTRACTOR :- TE ST . ONTRACTOR :TEST. A:r 0, Water p , Visual 0 , La', ,rotary Et RESULT. Approved : ', Disapproved _1 Pending p I I SKETCH: I I I i I INSPECTOR DATE ICOTE : Attach supplemental fest darn hnrnod 1 I ' I City of -Tigard INSPECTION REQUEST for IINSPECTION TIME : PERMIT NO. : . + DATE:12 r;ZL22 DATE ISSUED•_.,__Lr I OWNERS NAME : I ADDRESS ' _ CONTRACTOR :__ ITE T A r J , Water [] , ��islcar� , La' ,rotary p RESULT. Approved):' , Disapproved 1 Fending ❑ I f SKETCH: 1 I I I I I INSPECTOR DATE ICNTE Attach supplemental test data heret] � 9 y0 l ADDRESS I "11► '� ► .� I �, ,_� - PERMIT NO. �� lb 1) PERMIT CHARGE _ OWNER CUNNCCTION FEE �I � ' , PAID BY TYPE OF BUILDING DALE CONNECTED _ II 1 `1 ._.._ ' SERVICE RATE A rLj i INSPCLTION FEE CONTRACTOR r` PAID BY )n DATE _— SIZE OF CONNECTION ASSESSMENT _ PAID ]0 I< City of Tigard INSPECTION REQUEST for INSPECTION TIME :_.._ PERMIT NO. : . DATE: // /P?/73-' DATE ISSU -:D'_..LL_ OWNERS NAME ; ADDRESS : �_— -- TEST'. A:r 1.7, Water [1 , �!isual�;, La'.- ,ratory n RESULT" Approved, Disapproved Pending O SKETCH: it 1 � 111 t i INSPECTOR DATE OTE: Attach supplementol feel datn hereto] ,TairiaQi�u Of Ai Type of Fixture Fre Permit No. ?y31 P Permit fee Water Closets (Toilets)- Permit I5suej- 1 Bath - 7� a tz Approved by a o a as nVw Building Perm Y a bower, _ Receipt No. Zar— r s Diahwas�iin a s c eiA n s r ne Location of Building Sinks. Bar —Sinks. Slop- Automatic Ou oma . C 3 iwaener 9 Osa r a Name & Addre s of Owner •sins F -Cor — S a ns rea --- — ns -'fir era ,or ---- Rain oiaraCnsas er F-8 g Name & Address of Plumber i Fountains,-Drinking—_ --� Fountains. bo s ater a c — ' -e- ater ervice Siz rina s BuildingOld or New (Alter, Repair GT a c - fl 9 - _ ^.9 a 1 ---- awnrin 'ler 5 sem Swimming Pool Other --+ 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. " 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 Epplication and know the ass to be true and correct. All provision£, of laws andd ordinances governing this t. 9 of work will be complied with whether specified herein or not, the granting of i 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. '2 �� Signature of Applicant C- r 3 i I City of Tigard INSPECTION REQUEST i for I 'NSPECTION TIME : %� �'I PERMIT NO DATE: !/ L 'SATE ISSUED '—/ OWNERS NAME ' _ f_�= ' I ADDRESS ' 1.2Z,/ s C'ON1 RA CT's R : ITES] \ , .� , W(iter 7 , ��;� .;I u , Lo r(,,f , '.7 RESULT : Approved �� Dkri)proved 1 I NSPECTOR DATE 59TE ' Attach supplemental test JOr: keret] I i amity of Tigard INSPECTION RE"QUES 'r for NSPECTION TIME . PERMS ! NC t DATE : ��1s '?3 DATE 1SSUE:D _z_ ,� � OWNERS ivAME 7r : _ _�•_ � ADDRESS: Z� ,'nN,rFtArTOR : ---- ------ - -- 4 -EST * , Neter Q , J' _ ct . '.0 be►at.�r„ :� k R,ESUL` * gyp. roved uppr�).ad G L] SKETCH. INSPECTOR DATE CNOTE : Altacn ®uppiemental test uata heret�] w wT of 71gard INSPECTION REQUEST for NSPECTION TIME . PERMIT NC. . DATE.' 23 DATE ISSUED .—, 04VNERS NAME , -D. A D D R E S S: - `ON TRArYr) R : _ EST ' . ye,terp , V' '.ab-►ct-)r, —j RESUL_" raved :upproved G eridhltf L] SKETCH.' r Q. I INSF'ECTGR DATE [NOTE . Httacti SLIP;, emental test Lj t! i,Nr -t1 w v� 1 UNIFIED SEWERAGE AGENCY NO. 4895 WASHINGTON COUNTY DATE _ 9-26-75 CITY OF Tioard APPLICATION FOR SEWER CONNECTION PERMIT OWNER: _.__0 nK.-_Llzx_y__ OWNER'S ADDRESS: _J&%,Z A.Y. iloensi FarrY ltd. STREET �`- -- Tualatin Oregon 97062 cil Y -- - --- ---STTATE-- -- - --- ZIP BUILDING SITE: LOTS._-___ _ BLOCK _�_ _ ADDITION TAX LOT NO. ____-___ TYPE OF OCCUPANCY Residence ACDRESS _ 12115 9.Y. 124th Ave. DWELLING UNITS ___�_ FIXTURE UNITS SURCHARGE IF APPLICABL.E _—._ --------- ----- 3 PERMIT FEE 150________ INSPECTION FEE 2b __ TOTA-,. rEPOSITED 475 _ 1� (EXISTING) BUILDING SEWER SYSTEM Tigard The Applicant agrees to comply with all rule-, and regulations of the Unified Sewerage Agency. APPLICANT._1�� -- SEWER PERMIT THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM. LINE SIZE 1." -__ --___ j LLER ___ _.--Et-Fl-jr-rtll RECEIVED BY --__ AD i/- ENCY OR ITS AGENT) COMA,ENTS: _ This Application and permit expires in ninety (90) days. The amount paid will be forfeited should CITY OF TIGARD TIGARD, ORIGON f721i APPLICATION FOR BUILDING PERMIT New Construction Demolish ❑ Addition ❑ Remodel ❑ Move❑ ZONING,-_ DATE ISSUED9=26-73 BUILDI,1�l','PE*Sj DATE RECEIVED BUILDING FEE $��a.ao No. f`S PLAN CHECK $ BY -_ OTHER $ �'5r recording VALUATION surcharge TOTAL kECEIPT No.-till— TWO ,t`)53 S 161.56 � TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICA"ION LOT N brookAWMAP i_2,5.1 3BB CENSUS TRACT W-19 JOB ! — Architect or Engineer L. M. Bruinier h Associate _ Address Phone-- Owner- honeOwner__A, Ferry ­ Address___jj540_4,R., Soonea Ferry- Rd.LTuslatin —Phone-- Builder D.K. Ferry _— Address __ —Phone— BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Indistrial❑ OCCUPANCY GROUP_— No. of Stories 2 -- 'rotal Heiqht--- Area of Lot. Type of Construct iunXXXXXXXXXXXXXXXXX V Floor Area e` 1_ 648_ 2-- 1243 Set Backs: Front 25� Back 4r L.Side-- 14c R.Side 1A! Private Sewer Pipe Size 4P Sewer_ua• TioardSeptic Tank Ll Water Service Pipe Size__" Storm Sewer Q aitch ❑ arywell E l :street and Curb Requirements___ EXjAj g_ Priveway Width_ 181_ No. of Parkinq Spaces--_ SEPARATE PERMITS REQUIRE') FOR SEWER AND PLUMBING SPECIAL 1AFORMATION ADDRESS ASSIGNED_ — 12115 q-N. FTF:LD CHECK BY� — - DATE 9-2fi-73— i PERMIT APPROVED B �.•. Lt is understood that ell work will conform with applicable odes grill ordinances of the State of Oregon and the City of Tigard, Oregon, and that the building will not be occupied until a Certificate of Occupa cy has P"n issued by the City of Tigard Building Inspector. ,tom S gnatute of Applicant/ v 833 a EXHIBIT "A" CITY OF TIGARD Residential Structure Occupany Restriction KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential structure (a) on the following described lands prior to the recording of an occupancy permit releasing the restriction in the Dead 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) DESCHIPTION OF PROPERTY: Tax Map 231 388, Tax Lot 2500, Lot 25 Brookway Subdivision ADDRESS OF PROPERT'r : 12115 S.W. 124th Ave.,_ Ligard, Oreann NAME 01' OWNER: D.K. Ferry ADDRESS OF OWNER: 18540 5.W. Boon©a [ rry Rd.. Tualatin. Or. 97062 IN WITNESS WHEREOF, the undersigned hes caused this restriction to be executed this �_ day of OWNER: i rase APPROVED: Title —f-i- Aftilding Official ,ity of Tigard I a ATE nr nRrGnN County of Washington ; 8°' q ,7� 19 Persorally appeared before me the above named i '-1) jj� . f1 /--p 9nd arknowledged the foregoing instrument to be voluntary ect and dead./ Notary Public for Olegon ' My Commission Expires: rn.e ke'ema...../,:...... nncrn T�oMen[N,d�«,�.of hed"'W' 1._ f. w �unti 948 r,._643 ; 3833 y V U y G IN � � o d u. E 1, EXHIBIT "A" CITY OF TIGARD Residential Structure Occupany Restriction KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential structure (a) on the following describ4d lands prior to the recording of an occupancy permit releasing the res;.riction in the DRed Records of Warhington County, Oregon, is prohibited by the ordinancy of the City of Tigerd, Oregon: (The laity will issue a release as soon as a final inspection determines that the construction is satisfact,.rtly completed) DESCRIPTION OF PROPERTY: Tax Lot 2500, Lot 25 ';runk,,,,•v ;,ul diviaiun ADDRESS OF PROPERTY: j.2115 S.W. 124th Avc.., Tigard, Oregon NAME OF OWNER: I ADDRESS OE OWNER: 10545 5.1j. P.00nes arry Rd., Tu,•Istin, 7r. j7nt,2 IN WITNESS WHEREOF, the undersigned hes caused this restriction to be executed this day of 19 OWNER: Nana APPROVED: Title gui lding 07'i t'al--_ City of Tigard STATE OF nREGON ) County of Washington ) so. 19 Personally appeared before me the above named _ and acknowledged the foregoing instrument to ha _ voluntary act and dead. Notary Pub 1c oTDr Oregon My r'0mmission Expires: >wr s w► 1�1 s-JU� 1: 'Portland 'federal Savings HOME OFFICE: 444 B.W.Fifth Ave. a Portland,Oregon 8780,1 • Telephone 224-4444 -- -- --- September 20, 1973 Mr. Dallas Ferry 18540 SW Boones Ferry Rd. Tualatin, Oregon Dear, Mr. Ferry, We are pleased to inform you that your application for a loan has been approved. Date Approved — 9_40_73 Cnterviewer Gordon ROckweit Loan Number �4.,�[�';5(, Lean Closer _ Phyllis Waller Property Address —� 12 1 IS U 1241:11 _-_ 'Fv�ard Seller sAmv Broker or Attorney Escrow Agent When the necessary title information is obtained and the support- ing documents are prepared for signature, you will be contacted by your loan closer. We are enclosing the Disclosure Statement required by the Federal Truth in Lending Act. You will notice that the 8h% interest rate of your loan may differ from the annual percentage rate as stated in Item 7. The annual percentage rate con3ists of the in- terest on the declining balance of your loan, as pvovided for in your note, as well as the total prepaid finance chat?es as expressed in Item 2 of the Disclosure Statement. So as not to slow the processing of your loan, please sign the white copy of the Disclosure Statement as indicated and return it to the sender in the enclosed envelope. Sincerely, Joani Leedom Loan Closing Department Home Office Corner 6th&Washington Other officer Gateway,Lloyd Center,Raleigh liins.Standard f'lazn.82nd h Division L-390 Beaverton,Lake trove,Mllwnukie,Oregon City,Snirm Eugene,Valley River,Springfield. Rockwood, INinintin .., ,�... y.� �.. ,,...W..,.. a�..�:..r.W........�. �... »...� Mw -r 14��� 1 I City of Tigard INSPECTION REQUEST I for I INSPECTION TIME : 2,*615) P"I PERMIT NO.: 73 5-3 I DATE: 1 /41/ 7,4 DATE ISSUED: IM OWNERS NAME : ADDRESS : �J _ I CONTRACTOR :--D-Ll-L---.---F--Z—l?—/? -- ITEST. Air O, Water Ej , VVisual "-,--'Laboratory p RESULT. Approved B—, Disapproved ❑ , Pending p I I SKETCH: c I I I I I INSPECTOR DATE E:Ni OTE : Attach supplemental lett data heret:01 1