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12173 SW 125TH AVENUE-1 s 1217:.3 SW 125TH AVENUE -- Oj p z � -HI a p �I Po tilz tot- I I e• � +a r 'n Ey Ci �� V14 CCC3111 O 14 ry M N .-1 N .-1 (Ay of i igarld INSPECTION for S; crz) INSPECTION TIME:&WTMS- PE.r-,,rv!'-T NO. ', DATE: D-4-11r Tq OWNERS NAME: ADDRESS : LO i K A C ri V i SV! r: nw 4� 7.3 1,25 r I N S F T Y-1. It,jkjjnj. #j s f of n 7 7 8579 EXHIBIT "B" CITY OF TIGARD CERTIFICATE OF OCCUPANCY AND RELEASE OF RLSTRICTION The ^ity of V card hereby certifies that the occupancy of the following d,�5cribed structure or premises with respect to which a restriction of occupancy was, on 12-5 , 1914 recorded in Book 955 , Page 427 , Deed Record of Washington County, Oregon, is hereby authorized and approved. DESCRIPTION OF PROPERTYi Tax Map 2S1 3BB, lot 36, Brookway Subdivision OWNVR• John Loewer BUILDING PERMIT NUMIDER• ��� BUILDING ADDRESS: 12173 S.W. 125th Ave. This is to certify the said structure meets with the require- ments of the Building Cc of the City of Tigard and the above referenced restriction it-, hereby released and terminated. IN WITNESS WHEREOF, the undersigned authorized officer of the City of Tigard has cauied this certificate and relea:;e of restriction to be executed thisda, of } _ , ,,; i,,, , 19�i. i Title: — STATE STATE OF OREGON )ss County of Washington ) On this _ day of 19 7 , personally appeared before me the above named jA ►tip , whose signature appea.s hereon and who acknowledged to me flat he executed the same in his offical capacity on behalf of the City of Tigard. Notary PublIc of Oregon May Commission expirea: r' AM rx n 1166tH T MMU M,NnmW M k X0 a 4,tlw ,.ft, PO(1R ��, I,'b(139 nr a 4 I II f I U�t C y7 u WST, SPACES MUST EE PR'!'0?3 TO IS�iJAiC-E l.. �.�)II•:1',..0 'i' _:i.:?.`i PtA2U I'ls D—'-2T. PUELIC V.O.RKS D!,PT. BUILDING DEPT. f T11!,7A'rTN RTIMAL FIEE DEPT. CT T1 C' , BY, TITLE--- DATE 1 �.. n W ON o ui z D �- � x o a Q 0 � W � o cpw wO J O F--- 1 - o' U o �I Q W �9n t n 4-- ` 1 ' v vi b sZ 0 0 %+-A- F- +- -' ♦- W 4J o C) W �. D o n a Q W O a 4 z zm �- ❑ n O z H to c] Q a F- � U � Q fr J U - " w W F- H F- a z 3 O w W x W 0 U fitS w_ W-1NAMw iX qF w City of Tigard INSPECTION REOUEST for c9L- INSPFCTION TIME : PERMIT NO. : DATE: 2 LS Y 24 DATE ISSUED:—/ OWNERS NAME : Loc A13DRESS : IZ / -73 /ZS_ CONTRACTOR : ie)Ael L ad-w r- TEST: Air Cl, Water ❑ , Viaual�, Laboratory ❑ RESULT: Approvedl� , Disapproved ❑ , Pending U SKETCH: _T ars 1 INcPECTOR DATE NOTE Attach supplemental toot data heret] �'i1 w[ !� ®! W fAi sR City of Tigard INSPECTION REQUEST for INSPECTION TIME : -/'U Aria PERMIT NO. : ._. r DATE: 'V A . DATF ISSUED:- ' L OWNERS NAME : - Jahn ADDRESS : �•� �� /� .S Com( r _ CONTRACTOR TEST. Air ❑, Water ❑ , visual , laboratory ❑ RESULT. Approved , Disapproved 0 Pending [] SKETCH. I ' INSPECTOR DATE CNOTE . Attach supplemental test data hereto I 1 f i g � o ADDRESS i I u"��� PERMIT NO. �y/7 PERMIT CHARGE OWNER V �' CONNECTION FEE X) PAID BY TYPE OF BUILDING _ DATE CONNECTED SERVICE RATE :,,�1Vh. _ _ INSPECTION FEE ) CONTRACTOR ( �r PAID BY �o ti A. — DATE _ _.... PAID SIZE OF CONN CTION �x � ASSESSMENT of Tigard and City 9 INSPECTION REOUEST for IINSPECTION TIME :_.:_____._ PERMIT NO. : .__.--. I DATE: ___L.....L--- DATE ISSUED:__L OWNERS LAME * - ADDRESS ' CONTRACTOR :-------- TEST:Air0, Water [3 , Visual jX,, Laboratory ❑ RESULT: Approved, Disapproved L] Pending ❑ I SKETCH: I I I I I INSPECTOR DATE / I COTE Attoch supplemental test date h$W:D J I i City of Tigard i INSPECTION REQUEST I for INSPECTION TIME' _ PERMIT DATE: PE / DATE ISSUED :___1._____ OWNERS NAME :_. '2'ADDRESS: --- - —�_ ----- CONTRACTOR ' ___. - - - -- - ----TEST : Air O, Woter O , Visual Laboratory p RESULT: Approvedg , Disapproved O Pending L] SKETCH. i I I I INSPI_CTOR DATE [0?E: Attach supplemental teff d pte herstoj i 1 PLUMLING PERMIT APPLICATION Jurisdiction of No. Type of Fixture Fee Permit No. �e Permit fee Water Closets Toilets `5-- Permit Issued Bath Tubs Approved by _y "- Lavatory Wash Basin Y =' Building Perini _ / Shower Receipt No. _J_2 L4 7 in s Di shwa.shing—_ Sinks Kitchen _SinRs Ordinary_ Location of Building __ 5��L) SinsAar _ ______.__�__.__M�--•__�—_��_----------.-- _ Sinks, Slob-- Automatic D--ishwa�ier _W - - - ---------------------- ------- Di:�posa�M _— ._.._-- Laudry Name & Address of Owrier Drains, Floor _ __ _-___-----�_------•-•-------.--___—�_._. -Drains Area -- - -------------_.Y--------------------- Drains, Refri era or -- -- ----_---__ ----- ------------------------ - Rain Drains - AuTomatic Washer �;"�-== Name & Address f Plumber. __------ Fountains, r n in -- ountains, Soda --- ----- Hot Wa-cer Tank— Water Service Size _- Urinals Buildin Old or New jAlters Repair or Catch-basins-Y�ar7_ Tnsa�i�ts1 ►^ 5 _..—_ Lawn j�Rrinkler System SJ___ _�_�__-__.�___.______� ._-_---•- --- Swimming Pool UERer_..��_ - ---•--__---_.,.. - -_. �rinkler 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. All plumbing firms ,Auat 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. A1.1 provisions of laws and ordinances governing this type of work will be complied with whether specified herein er 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 AFplicantL 1 I I City of Tigard INSPECTION REQUEST for INtPECTION TIME:_��, PERMIT NO. :_ _ DATE.- DATE ISSUED : Z OWNERS NAME : Zola )tlL1eY .___--_ _ ADDRESS: CONTRACTOR : TEST : Air E), Water[] , Visual 0 , Laboratory p RESULT : Approved, Disapproved G , Pending p SKETCH; i SPECTOR DATE NO1F Attach suvniemental test data bereto� I ii city of Tigard ! NS ►0.r-.-lCTl0N REQUEST for INSPECTION TIME : PERMIT NO. : DATE: I � DATE ISSUED:_..L_L OWNERS NAME : '—� *//. ADDRESS : CONTRACTOR TEST: Air ❑ , Wat®r [] Vieuol ❑ Laboratory C3 RESULT: Approved , Disapproved ❑ Pending SKETCH: �'��.c-,,/' r ,ti F-• r /, '.�C, /'�, �1:,2`�_ 7c! C Pere, IMSPECTOR DATE `NOTE : Alloch ] oupplementoI trot d 01 here l `I f r I AMEN' illi�ill I City of Tigard INSPECTION REQUEST for INSPECTION 7.1 ME : PERMIT NO.: _.__ DATE : VL3/' `Z DATE ISSUED:--Z—/._ O W N E R S NAME : A, ADDRESS : �- � � 3 S w • /�S t�' CONTRACTOR : TEST' Air ❑ , Water � , Visuals , Laboritory 11 RESULT: Aporoved�W Disapproved ❑ , Pending p SKETCH: y,� :.� �G'�L.�_�- a�9 yr- Xj 7� i 7,� ,r'�c.tl L INSPECTOR DATE COTE : Attach supplemental test dato heretJ W l� a p-# 9.2 sr UNIFIED SEWERAGE AGENCY NO. _ 4917__ WASHINGTON COUNTY DATE - 11-13-73 CITY OF APPLICATION FOR SEWER CONNECTION PERMIT � j OWNER ----_ -4U- Jahn- Laauar -- - OWNER'S ADDRESS. -3921, S.U.___Dakota STREET - Partland __- CITY STATE - - - - _�._ - Z!P I I BUILDING SITE: LOT _36_. ____ BLOCK ---.-- ADDITION Brookway _ I TAX LOT N0. TYPE OF OCCUPANCY residence ADDRESS - 12-17 5.1d. 125th Ave, _ DWELLING UNITS - 1 !- - _ FIXTURE UNITS i SURCHARGE IF APPLICABLE PERMIT FEE 450 - INSPECTIO►" FEE ___-25_� TOTAL DEPOSITED f INE (EXISTING) BUILDING SEWER SYSTEM . __ _ Tigan! The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency. APDL ICAN T ___.. (�• _�_.�� G` s�`Z� SEWER PERMIT THIS PERMIT AUTHORIZES CONNECTION 1'0 THE SEWER SYSTEM. LINE SIZE NSTALLER RECEIVED BYJaw NCr OR ITS AGENT) COMMENTS: This P.pplication and permit expires in ninety (90) Days. The arrukint Laid will he forfeited should expiration occur. CITY OF TIGARD 11440 S. W. Mein Street TIGARD, OREGON 97113 APPLICATION FOR BUILDING PERMIT New Construction ❑ Demolish U Addition ❑ Remodel ❑ Move❑ 7.ONING R-7 DATE ISSUED 11-13-73 BUILDING PERMIT BUILDING FEE $ No. DATE RECEIVED ---7 4•ZA--- PLAN CHECK $ 10•QQ` BY OTHER $_ 4. recording feVLUATION $ .19,674.00 RECEIPT No. e � TOTAL $ 88.34 /-�3 7 3 TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION LOT M 36 MAP N 251 BFB_ CENSUS TRACT W-19-- JOB N Architect or Engineer L.M. 8ruiner — Address 1304 S.W. bertha Phone Owner John KANNNAXX Loewar _-- Address 2921 S.W. Dakota St. Phone Builder Address _ — __- Phonei BUILDING USE Sinqle Res. ® Multi Res. ❑ Comm. ❑ Industrials OCCUPANCY GROUP__ No. of Stories 1 Total Height_ 161_ Area of Lot Type of Construction RXXRRXXRRRXXRXX V Floor Area B� Set Backs: Front 22r Back! L.Side_ 7 ____ R.Side- 131_ Private Sewer Pipe Size 411 Sewer use Tigergeptic Tank ❑ Water Service Pipe Size_ Qn Storm Sewer © Ditch ❑ Urywell❑ Street and Curb Requirements pY1Af_�ng No. of Parking Spaces Driveway Width 1n1 - SEPARATE PERMITS RFpUIRED FOR SEWER AND PLUMBING SPECIAL INFORMATION ADDRESS AGSIGNED 12173 S.W. 125th Ave. FIELD CHECK BY� 38 — ------DATE-.11-13-73 � � I PERMIT APPROVED BY c It is undcr%tood that all work will conform with applicable codes and o finances of the Stage of Oregon and the City of Tigard, Oregon, and that the building wil not be occupied until a Certificate of Occupancy has b;.,�n issued by the City of Tigard Building Inspector. L gnature of Applicant I EXHIBIT ^A^ CITY OF TIGARD Residential Structure Occupany Restriction KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential structure (e) on the following described lands prior to the recording 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 tie construction is satisfactorily completed) DESCRIPTION OF PROPERTY: Tax flap 251 3BB, IMk lot 36, Brookway Subdivision ADDRESS OF PROPERTY: 12173 S.W. 125th Ave. NAME OF OWNER: Jahn Loewer ADDRESS OF OWNER: 3921 S.W. Dakuta Struut IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this day of �, 19_. OWNER: — ami APPROVED: Title By ,Muit— _ iding ;1 City of Tigard STATE OF ORCGON ) County of Washington ) Be 19 I� Personally appeared before me the above named Ir.�._ ,' , and acknowledged the forsgoi-:g instrumen` to be L 4 voluntary act and dead. Notary Public for nregon Ry Commission Expires: ;^ o� LP T)IoM DuMe1 d%& ori % R,.- ho,, U'55 -.4?7 C2 G"1 STATE OF OREGON ,r► 1 to Courcy of Woahinytan 1 I, Roger Thomsen Director of Reenrds and Electluns and EK-01IIclo Recorder of Con- veyances far sold county, do hereby kertlfv that the within Instrument of writing was received and recorded in book of records No. of sold County Witness my hand and Beal affixed. ROGER THOMSSEN, Director of Records & Eleetloro DepuN DEC 5 12 OF Ph r73 EXHIBIT "A" CITY OF TIGARD Residential Structure Occupany Restriction KNOU ALL MEN BY THESE PRESENTS, that occupancy of residential structure (s) on the following described lands prior to the recording of an o:cupancy permit releasing the restriction in the Deed Records of Washington Count/, Oregon, is prohibited by the ordinance of the City of Tigard, Oregon: (The City will issue a release as soon as a ffaal inspection determines that the construction is satisfactorily completed) DESCRIPTION OF PROPERTY: 7-4 Mnr ?^? '1[" , TNX 1^1- 369 Orookway Subdiviaiun ADDRESS OF PROPERTY: 12173 c,1-1. 1251h NAME Cr OWNED: .10 n I nousar ADORE.`iS OF OWNER: 3921 S_1.1_ 1laLn+n St mf IW WITNESS WHEREOF, the undersigned has caused this restriction to be executed this day of � , 19— OWNERi Name i APPROVED: Title B y s y c A City of Tigard STATC OF OREGON Coun-y of Washington °°' _ , 19 Personally sVpeared before me the above named _ and acknowledged the foregoing inst,-ument to be !r voluntary act and deed. o ary Putlic for Oregon My Commission Expires: Y