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12175 SW 127TH AVENUE-1 t 1^ 11 t 1 / I t '1' 12175 SW 127TH AVENUE E I l II 1 ^i M E-4 FA ? to W R' \� y m t" H Fi1 d ^ fzr Q W 1 ro vj. Ift� 0mp � m n ^' <� mIN to cr c' k ti) rn H _ r 1� r1 w r ,� 4U f _ N i 011 -`��, Y,ry '-` v V ii��,,' ��:'.r1 •"SI "I 4 - In lip. .•„ c` .'e1�N+`' �f r� "'y ►n. .A` t i b+�F�p�r r I �� '�s4 i� a '�t {({ ``r�' 't 1• yi C i y •,J'� 4 1 w. 'iii y �.T ,t�.w a• 'i s � �, u� +�,� � /�/ r ,,, �~ %1tIM'�'�i���'Aplq•'7i{•�lplr�fi�,I�IIAS �a11U►„'+'�'�s't � i f► �`•�•�',::`�p��'+,�=�`}j1Sy n��"'��ah���'��".'(n y.;�-,�ia� �s'�'r„c",�n�`��tyr��:�fia���,�try,�,�,. �rr1 � .� a`` �; ; co cq cu En u b, N1, WE Ln bj) bo.� — oa o I • , i c d bn vii cLn �'•f;' 1 N Gf v �i ' IPA, �� y . F-IIII 4) :tom• � N � •�0 CLr �.;.� NTI 41 Lr N Ln en ICU - {cn �. r•'.iff , (-�` J4 CA Cd T v, Fr• r� ��• '1N If ; yul 1i •r.7S 'T..�- •,r '%..A! -' �•••�!i.' w "w, i► APPLICATION - STREET IMPROVEMENT/EXCAVATION COPY TO: ORDINANCE NO. 74-14 L7� (WHITE)-FILE -IN (3 (YELLOW)-INSP. (INSTPUCTIO1"'S ON SEPARATF_SHEET) (PINK)-OTHER AGENCY-bldg (BLUE)-APPLICANT APPROVED APPLICATION NO.: 434 NOT APPROVED ❑ CF Y OF TIGARD, OREGONFEC AMT. a $16.00 _ PENDING FEE. PMT. ❑ CITY HALL RECEIPT NO.!.. jo-zo oz+ PENDING SECURITY ❑ PUBLiCWORKS DEPARTMENT BY :.`.�' DATE 2 / Z�'/ 9G PENDING AGENCY "OK" ❑ .Application and Progress Record � — — — — — — — -- — — — MAINTENANCE BOND S- PENDING INFORMATION ❑ OR STREET IMPROVEMENT/EXCAVATION A% RLQUIHLD ANNUAL PENDING VARIANCE ❑ EXPIRATION DATE. PERMIT NO 389-90_ _ DATE ISSUED: ___ :.'..�- �- -- BY. (1) APPLICATION 15 HERE-T5�X� R AND INSTALL __J�ity Strd Conti rete Drivewa A _�_� AS DESCRIBED HEREIN, INTM--L-_A,CCORDANCE WITH CITY REQUIREMENTS. APPLICANT Pham _12175 S.W. 127th Ave., Tig OR 97223 8 684-5223 NAM! ADDRESS CITU CONTkAC TOR ___ (aPQ NAMEf. _ ADDRESS CITY PLANS BY Per City Standard (Detail At ac rte} NAME ADDRESS CITY -----_-- PHONE ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST). $ _-400.00 DOLLARS (2) EXCAVATION DATA: FOR OFFIC E� 16.00 MIN, 0.04 x S ' = f STREET _ DESCRIPTION _ PROGRESS & INSPECTION STATUS NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY TYPE LENGTH WIDTH DEPTH ITEM & QUANTITY STREET 127th Ave. (SoE Attached) I INSPEC- J R TION E - Q ESTIMATED STREET OPENING DATE:___--_._--_/ / E S ESTIMATED STREET CLOSING DATE: / / T -.- E 4�.�Q� STREET (3) SECURITY NO. — _- SECURITY AMT.: $ — kLOSED SURETY CO. _ _ FINAL __ _ —OirR1�{RIiM CHELK rASH 8ON0 INSPEC. (4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS: FEATURES. EXCAVATION LOCATION AND EXTENT. 1. Notify Mc. CarlyiewR_ G] (City Inspector) 8639-4171 Prior to initiating any work. All work shall conform to URB �„ _ _ _ _ _ - _ _ _ _ _ �„- - City st&Nlards & specifications. 3. Excavator shall comply with Avle�. __ ---- — ORS 757.541 to 757.571. +� n _ _ 4. Traffic & c>edestrian controls ks I• - - _ shall be provided for by the Ifi� I I applicant/contractor. 1 1 rFJ I I 5. rocm(s) inspection is required h pr or to pour v; concrete. (S) NOTE THE CITY OF TIGARD DOES NOT. HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE RIGH-i-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY AND EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS, APPLICANTSSIGNATURE __-_ DATE / J r O If 4 X rte•8 arnyy A ai Z_o Q m a 0 U + M Q W H W In U N N Q M a _ J►i1r �N i(��/60/(� �Q' r7!. , `tiw�� da8 0o20C GZ�Z�IT� C9w1 3O Z► d0 N Og H# i O Wt` sIt Qv Nw • I +' w po � • Oi) Tt LQ — orQ - g f0 -9O 1 M CD 0 ~ Po ow O � J l O ►n i Ob { �M w oow OW .r, z M • i N !t Zol 1 1 r99�F 4, Pp n Os VZ W 3�ZCeflO 9p J N Q� r �•'L19C 000L - 9►'19 � {{---- co f �../ • co ` �b ^ co N 3 O V n rr • M �V 419Z1 11.► VJ O , N 0 •o F� M II��3.0z,11'10 N N m r w� 3„Ot holp N n M YC,Z• r0___ 001 ),02, I O r V^ 00 S 9 00 G 6 Q O to ♦ J4� V Q �S 6$ 3 , 01 3i n H Q r M O L • O lJJ /�`J1 o h Z f�� NOyIM ` W M M a N ar m O M '9 _3„OZ.Z►eION /y = no 001 001 )„Ot,II 010 N It =# ; N s a _ Q C G OI 1 {J W rd N 0 '' O g � - D- a atL p Z + l� 1 ' p rJ 3„Oz 9 p-001 O U • O,, Q� O COD W �o 0) 0 o Io. Q W 6L 4 S �' 001 {U z 1' CIDA Q ,� or N �Q OL Dl 90 L fL'9G C r r 0 O 3.,02 ,11010 N ►O 682.y ^CL OO_1 O1 0 Q1 0 . O t 3~CY'zp_•eI1� N ^_ Q .' 0 1 v} O s Iv n �f 001---- � �y,J Q ,N 1 W r S 09 90 G may► �, bry .OL,21 otl ly OO t L Dy.. of n n O XYH CYE _j- r00 06 O Q C O w JO O •_, � eo _ 302 II el0 N Q ad 001 ool 4 it O 00, L / - ----- -Is Qor (7 rLIJ T m �h� o O CD 09 CK,21ot1 i GL {j 'WIy ) 03 (R II QIO N � OIXl a Oil U ` No=o 00 2°trIV # tL °O �• CO � 2t1 3-oz C) m 0 m °pror —1e MOSr- 24 — _ ir) 001 001 Z1r- °.- rr,L1/w- _ to n. �� (D a • O >< Q O 104.03 0 J •zP r O O - O O Ll M rp a `�D. J N O W try T o r - K_ ^ 01) Q1 O !^C Nb ti �!P Or to ELI n O s F 8 Qo t IR 001 - lND .�° ; 's - yhy •� o is, _ \bg 0 y� N b O OD 113 to p b et O 0 ^ n Od'. N Ori•°° 3O r (07 m M #•'i ti P O Z )„OZ,II010N 3.02,11010N no'{zi _ V 'FjO,n V�' LL t► 001 001 2L 9p M..02 210 _ o O 1'r) 0C►1, l 96 21 g : m Q (D r, S O S t 1i o a O S M ^ V _ 9 O N _ 10 O N o Mos; w'r lND p J Y01 d•' O Nen n • o n O ► 06 car „ -�r) C��n .T C) �l 1-►r Fr -- r, N , MAX. 12' - 0" MIN. DRIVEWAY R/W LINE w --CONTRACTION JOINT OPTIONAL ac SIDEWALK a LOCATION i B SIDEWALK EXPANSION JOINT u / EXPANSION JOINT —s CURB JOINT — IS pn A 3 O 6' -0" MIN. qpkoW' MAX. 6' - O" MIN. I&OWMAX. 3'-0 I FACE OF CURB / SIDEWALK ADJACENT TO CURB SIDEWALK AWAY FROM CURB PLAN 1-'/2" EXPOSURE r I USE EX1;3TING EXPANSION B-8 JOINT OR SAWCUT AND E3 ELEVATION _B PLACE COLD JOINT. _. SEE DWG. NO. CS-306. STREET COMPACTED SUBGRADE 2" OF 3/4" MINUS SECTION A-A NOTES I. CONCRETE SHALL HAVE A MINIMUM BREAKING STRENGTH OF 3000 PS I. AFTER 28 DAYS , 6 SACK MIX. 2. CURB JOINT SHALL BE A TROWELED JOIN' WITH A MINIMUM 1/2" RADIUS ALONG BACK OF CURB. 3. EXPANSION JOINTS SHALL BE 1/2" PREMOLDED ASPHALT IMPREGNATED MATERIAL OR EQUAL , EXTENDING FROM SUBGRADE TO FINISHED GRADE . 4. SEE DWG. NO. CS-300 AND NO. CS-305. WASHINGTON COUNTY i DEPARTMENT OF LAND USE RES"► DENTIAL DRIVEWAY AND TRANSPORTATION DATE CIVIL EW?INEER DRAWN APWA NO WASK COUNTY NQ �T • ..--.�` '_� AEA 6 NONE DW-- 200 9 Wfib'' W w ��3 _L v eo 'y�G I ( ib i NOR 11 INSPEC'rION NOTICE City of Tigard Building Department 12420 S.W. Main St. Tigard, Oregon 9722.3 Phone 639.4171 Address --..—..... Permit #► Type of Inspection —_- __-- -- The fallowing Building Code deficiencies are required to he corrected: Presented to Inspector Date --- u •'` CALL FOR REINWECTION ❑ VEs U NO BUILDING PERMIT APPLICATION T'CARD DATE___ �s n0 3423 THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT'-OR IHE WORK HEREIN INDICATED BUILDER PHONE _639-691 OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE LOT NO. 0U-HE3IIW000T- OWNER Oays Gott JOB ADDRESS 1217�3 SL, lc 1 Lh Avenue ARCHITECT ENGINEER BUILDER Classic Hone_Tmpr. ADDRESS 1233b^SLI Ann I*ourt DESIGNER bluore -- STRUCTURE _ 3 NEW ❑ REMODEL. [I ADDITION Cl REPAIR C RENEWAL U FIRE DAMAGE ❑ DEMOLITION E RESIDENCE U COMM ❑ EDUCATIONAL O GOVT ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE ❑ SLAB❑ FENCE OCCUPANCY K"3 _LAND USE ZONE F`-�-BLDG.TYPE i FIRE ZONE_—PLAN CHECK BY_ W_ HEAT - "onstruct family room n Closet% addition—to existing _siflwl8 family dWGllinQ. 5EE COPPECTION SHEET ATTACHEII _ SEWERPERMITM -- OCC.LOAD FLOOR LOAD 40 HEIGHT 12 NO.STORIES 1 AREA 4.31 N0.BEDROOMS _ "-° VALUEY 14 t e 0 0. BUILDING DEPARTMENT SETBACKS FRONT_- ti 0 REAR g_ LEFT SIDE 16 RIGHT SIDE -- Permit $7i-00 _ THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING l7Q REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED 1HAT IHE �� Plan Check • WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE Q�101i• WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE 3ub•total RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONI RACTORS TO HAVE CURRENT CITY BUSINESS LICENSE.SEPARATE PERMITS REOUIRED FOR SEWER,PLUMBING AND HEATING. State Tax 4; 2.00 i — SDC- rote) ;.110.8E; _.-----.--- ___ PDC# APPLICAN 0 �ENT By P1 ' — _ -- Receipt No. O �. Approved_ duh ADJR gS PH- 0 E IivA DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE `O-Y-tro �► ' _ Contractor --- /� Permit No. Rough-in ,-., _ / �( ' Fixture -- - -3 Final i HEATING Contractor Permit No. h Gas or or Oil Roughmin Final i# — SE`wR Final DRIVEWAY Final Storm Drainage (Rain Drain)Final Sidewalk Curb&Street r-inal ---ttt--- _ Approach i ROG.SEPT.FINAL YEMPORARY CIh CY Final CERTIFICATE OCCUPANC,'fCKRTITA7OC _ I i - Landscaping —� Zoning Final }E.:. '�.�I•; .. T "ial i����:.+..'...----'*--^.^.....-.-.^��+r•-ter-• �_.-'_.. __..._.. _.. 1�'tx •`� I .'js^:4.j1r,,� 't yl�# `�M.b; ... t. ..,. r (i l I BUILDING PERMIT APPLICATION TIGARD DAT . t9 THE UNDERSIGNED HE 4;=BY APPLIES FOR A PERMIT FOR THE WORK HEREIN IN ICATED BUILDER PHONE G� �-`/� I nR AS SHOWN AND APP�IOVEO IN THE:ACCOMPANYING PLA'-NS AND SPECIFICATIONS. OWNERI ONEA711 j JOB ADDRESS I ,217,��.-�_I���'_ - LOT r.0., — -AA6�I+FE6'T BUILCERIG - V tAODRESS IZ-33 �tJ%JYI DESIGNER STRUCTURE ❑ NF+,N ❑ REYMOOEL ' ADDITION ❑ REPAIR ❑ RENEWAL ❑ FIRE DAMAGE ❑ DEMOLITION RESIDENCE G COMM ❑ EDUCATIONAL :1 GOV'T ❑ RELIGIOUS G PATIO ❑ CAR POPT ❑ GARAGE_❑ STOR GE G SLAB❑ FENCE C�i:uPANCY R- --LAND USEZONE �BLOG.TYPE FIRE ZONE � PLA�[N CHE,CpK BY -HEAT own SEWER PERMIT# OCC.LOAC FLUOR_LO.AD O HEIGHT I� NO.STORIES r AREA ,Z NO.BEDROOMS VAL UE�80 _ —_ BUIICI�I�,�LPAFTP.1Eh i SETS.'--KS FRONT ZO REAR � LEFT SIDE � RIGHT SIDE Lpr THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE ZON'NG i REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED T e.AT THE IPInnCheck _ 00 WORK WILL BE DONE IN ACCOP.CANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE ~ WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVe !Su btotal Q 0 RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY SUSIN r^ 1U ESSt SDC LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING. t Stitm Tax • - Tota! �(�, POC# APPLICANT OR AGENT By Receipt No. Approved ADDRESS i PHONE 30C - Z 'Dy s 1�3t 33.4a SEWER CONNECTION ;EWER INSPECTION S O D HEWER SURCHARGE 5 -nmriC3 • 34YYn`/ ll�- y�•bNll7.p� �1 4'Y��y�'a ,� � l (�a .r` 1�. Lv11 'TI'�'�`.i ,�°� /°"'�. r", ;,�,��. I ,T +v�I � /��v•� int 1`'� / '� / �� �4 . �•rte. / n T,.a �� �1RD �C OF oce � . c CITY OF TIOA OREGON l ♦ I ...9 .dz................... .Permit No. 1. -.21.1 ...... 1.`.a� ......................................... y:. Building Address..............12.. Certificate is hereby given this.....40.....day of...p.�.�� mb.er. , 19 �4 ' building may be occupied and E C that said g Y • t that it complies with all requirements of the Building Code for the City of Tigard, j y as approved by the Tigard City Council. (,, <• ... .L.d..�.'.f.!:�.: ........ .... ....rte-:'............................. 'V Building Inspector •:4,c 4.,k i EXHIBIT "B° 15523 CITY OF TIGARD CERTIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION The City of Tigard hereby certifies that the occupancy of the following described structure or p.zmises with respect to which a restriction of -)ccupancy was, on 12-5 recorded in Book ggrPage a�q , Deed Record of Warhington County, Oregon, is hereby authorized and approved. DESCRIMION OF PROPERTY: Tax Map 251 4AA, lot 86, Bellwood II Subidviaion OWNER: J. W. Brayton Builder. Inc. BUILDING PERMIT NUMBER: 73-271 BUILDING ADDRE33:12175 S.W. 127th Ave. This in to certify the said structure meets with the require. ments of tae Building Code V the City of Tigard and the above referenced restriction in hereby released and terminated. IN WITNESS WHEREUF, the undersigned authorized officer of the City of Tigard has caused this certificate and release of restriction to be executed this ,-2 day of r Title: STATE OF ORMON ) n County of Washington ) On thiscil _ day of ✓ , ?97✓ , personally appeared before me the above named �L�., whore uignature appears hereon and who acknowledged to me tt:6t he executed the same in his offical capacity on behalf of the City of Tigard. /V o ar� i—� o re on y B My Cu 6 391i•en: �y �� a� ru.n it ward,.... 1lotitll TMO�ttt�e«Mer d f1«bMr ti tt�n..•n. R�O� JOU PAb[��9 -6641 � sY o a� i o W g c-•-> u1 1 7 1 N 0 O z m x m m o ch ca --! 00 1 v ❑ O m D z v 4 `- o A . o m n =� M C7 3rn �► ❑ ❑ v < v -t, 00 G r Q z rn 0 10 u C� nl o k a v CL t v °0 w C. z 21 m W Ll v � � Mq ` I I ALL SPACES MUST BE ENDORSED PRIOR TO APPROVAL 04- F`AMS PUBLIC WORKS C'"T. COUNTY H-- CITY •I-CITY O.Dt.tl D ---- ---- I ,� Iti • . r1GC,^D YL' r,l• .i�i: GENERAL TLL I P. G. C. T. R. -F` D. _11 it d! 1� City of Tigard INSPECTION REQUEST for to INSPECTION TIME: / � _ PERMIT NO. :— DATE: 0. ;DATE: 2 4�1 DATE ISSUED : OWN ERS NAME : ADDRE3S: z ¢� ar- �7 CONTRACTOR : -- TEST ONTRACTOR . __TEST . Air [3, Water❑ , visual Laboratory p RESULT* Approved �, Disapproved ❑ , Pending ❑ SKETCH. I INSPECTOR DATE i VOTE Attach suPPlemental tett doto bereto] i I City of Tigard INSPECTION REQUEST for L INSPECTION TIME : PERMIT NO.: DATE: ` %` DATE ISSUED:_1L OWNERS NAME : __3,L?a�sa� A D D R E S S : CONTRACTOR : 4' TEST: Air p, Water ❑ , Visual ji', Laboratory p RESULT: Approved i', Disapproved 0 , Pending p SKETCH: SPECTOR DATE [OTE : Attach supplemental test data hersto0 i I City of Tigard I INSPECTION REQUEST � for I INSPECTION TIME ' PERMIT NO. : DATE: 91 ,1�[ DATE ISSUED :-- Z OWNERS NAME :Vii-1 _ ADDRESS: / '2f -SW CONTRACTOR : TEST : Air f7 Water Vi euall , laboratory p RESULT: Approved Dieapproved O Pending p I SKETCH: I I i I INSPECTOR DATE NOTE Attach fuppiementa I tett data harlt� w O FILE COPY,*� City of Tigard INSPECTION REQUEST for INSPECTION TIME: _ PERMIT NO. : -- DATE: DATE ISSUED :--L.L— OWNERS NAME : ot)'L/� �`sO S: � r — ; —r ADDRESub i��7 CONTRACTOR : TEST : Air C7, Wotsr0 , Visual , Laboratory I] RESULT: Approved Q , Disapproved Pending p SKETCH: I Co INSPECTOR DATE I I [NOTE Attach supplementol test data beret] City of Tigard INSPECTION REQUEST for 4.( xIc '� INSPECTION TIME: PERMIT NO. : DATE: DATE ISSUED :-1-2— OWNERS SSUED : / /OWNERS NAME : ADDRESS: _1.IL1 S +ti� — CONTRACTOR : — 1__'_t_n�,;�-^- � TEST : Air 0, Woter p , Visual ,, ; Laboratory p RESULT: Approved , Disapproved p Pending p SKETCH. INSPECTOR DATE CNOTE . Attach supplementnl test data hereto] City of Tigard INSPECTION REQUEST for INSPECTION TIME: PERMIT NO. : DATE: 3DATE ISSUED : OWNERS NAME :_ ADDRESS: a l -7 S s'w I a -7 , CONTRACTOR : — TEST ONTRACTOR : _TEST : Air ❑, Water❑ , Visual C] , Laboratory ❑ RESULT: Approved 0 Disapproved 0 , Pending ❑ SKETCH. INSPECTOR DATE F—MOTE Attach supplemental tefr data beret 01 I I City of Tigard INSPECTION REQUEST for INSPECTION TIME: PERMIT NO. : _ DATE: ---16-114 DATE ISSUED : I Z I OWNERS NAME : _ ADDRESS:CONTRACTOR : - TEST : ONTRACTOR : _TEST : Air ❑, Water[] , Visual ❑ , Laboratory ❑ I RESULT' Approved .! , Disapproved 0 , Pending � SKETCH. %tee 1.21.F,e1. e,�f 4... P 4 Cvv Gem v S 7INSPECTOR DATE 5OTE' Attach supplemental feet data beret] ar � s � � ■r I City of Tigard INSPECTION REQUEST for INSPECTION TIME :_.._ � �'� • PERMIT NO. : _ — j DATE . DATE I SS'IIED'__�' OWNERS NAME : ADDRESS : 1 CONTRACTOR :— ti11- TEST . A r :3, Waterx, st;al�, La'- ,rotary h RESULT'. Approve Disapproved 1 , Pending El I SKETCH: I I I I I SPECTOR DATE �N:0TE Attach supplemental fest data herefld 1 ItIff f ® ■/ City of Tigard INSPECTION REQUEST for INSPECTION TIME : ��' PERMIT NO. : - DATE : DATE ISSUED:_._L_L OWNERS DAME ADDRESS : / IS" S �L� � -7 CONTRACTOR : TEST . A r L] , Water X, Visl,al ;�, La` .ratorj (l RESULT: Approved,, , Disapproved 1 Ppriding SKETCH: I � r lal � c I INSPECTOR DATE ICOTEAttach supplemental test Jata heret:01 1 kddre-.s L a—1 Permit No. 1_3 Permit charge Owier j- Ccunection fee 67- Paid by Type )A" t,.�a Date connected c�ervlce rate Inspection foe Paid by Da t e. size )f Assessment PLUMBING PERMIT APPLICATION Jurisdiction of No. Tyre ,.;f Fixture Fee Permit No. Permit fee 3c Water Closets Tcilets 6'-60 Permit IssuedAy- - -n Bath Tubs °-V Approved by = I. -_ 3vat.or n Wash_BasiY _ o?� Building Fermis p -^ Shower sa Receipt No. Sinks Dishwas- ing�_ _Llnks Kitchen Sinks Crdinar -. _, —_ Location of Building 6, S,Bai,------------------ Sinks� Slo -_--- - !:3_i?r�_s ? aZ-.' -- -_---- V� _Au t! ma tic D SFWasher p °� --_..-------- --•--- -----�---- _ -___- ___ _Laundry Tragi -- Name & ddress of Owner --- D ,ins, loor ------------ ?U --- -5-rains, Area __ -- _----- _--� e s _ n •tlGZ;� �_ --------- Drains,_Re rl eratui'_� ._,�� Z- _ Rain Drains -` _ --- —._ Automatic Washer ° Name & Address of Plumber oun'r:a i Else Drinkl r_i Fountains i tPfitid-Th'�UR�flf�-R 4 �r-r4,--lt�C-------- _ _ Hot Water TaSoda _ ° 4 t3 2 c3 jT- ------ c --- � '=- -1 ifs---------- Water Service ( Size- � ��------- __ -, _-- -•---- -Urinals ry Buiidin Old or New �Alter, Repair_ or t,�tai-$asz ns - r�r3_`_r �' Inaa3�' ____--__. ------------- ----- - _I.�wn S p r i nk l rSy�-snom - --- ---•---- ---.—__—.� _.____—_r_--- _ _ Swimming Pool +1: _ UFier ----- -----------S ,r„�--This permit 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 fur 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 -,ad 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 per ni t- does not presume to give authority to violate or cancel the provisions of any ether state or local law regulating construction or the performance of construction. � D AmMmUm I I City of Tigard INSPECTION REQUEST for ` INSPECTION TIME : Z2.t" PERMI NO. : --- D AT E: �jL .1�,aK- DATE I SS U E D - OWNERS NAME : - I A D D R E SS : CONTRACTOR :____ •W Ial- .ratory [l TEST: Air ❑ , Water CJ , �!is::al ❑ , L I RESULT: gpprovecJ,,,JKJ Disapproved _1 Pending [I, l SKETCH: I I I I I I I SPECT0R DATE [UTF Attach , pplemental teat data hernt] 1 i ' City of Tigard gand INSPECTION REOUEST for INSPECTION TIME : PERMIT NO. : DATE: DATE ISSUED'—L-OWNERS NAME : I ADDRESS : CONTRACTOR :- i TEST. Air r,7, Water [] , /isuol , Lot ,ratory [l RESULT: Approved . , Disapproved -a , Pending J I SKETCH: I � I I I INSPECTOR DATE I [NOTE Attach supplemental teat data hereto] 1 UNIFIED SEWERAGE AGENCY NO. X933 WASHINGTON COUNTY DATE 1-13-73 Tigsrd CITY OF APPLICATION FOR SEWER CONNLCTION PERMIT OWNER: -_—.-------1.W. Rray_son F31,dr. , Inc. I OWNER'S ADDRESS: ___7603 _1YIL_S.E.___piwrell. _ STREET Portland -------- --- -- ------- CITY — STATE LIP BUILDING SITE: LOT 86__ BLOCK ADDITION Bellwood_l.i TAX LOT NO. _ _ TYPE OF OCCUPANCY Residence -_ ADDRESS _ 12175 S.W. 127th Ave. DWELLING UNITS --___ 1 __ FIXTUI,lE UNITS SURCHARGE IF APPLICABLE PERMIT FEE 4511 -_ -_ _ INSPECTION FEE 25 TOTAL DEPOSITED _ 475 - (NEW (EXISTING) BUILDING SEWER SYSTEM Tigard_ _ The Applicant agrves to comply with all rules and regulations of t1w Unified Sewerage Agency. APPLICANT - 4 SEWER PERMIT THIS PERM11 AUTHORIZES CONNECTION TO THE SEWER SYSTEM. LINE SIZE 411 �_ . . INSTALLER RECEIVED BY . Qtt4,41 1 IA ENCY OR ITS AGENT) COMMENTS -73-421- Wets -; t"1.•-r This Application and permit expires in ninety (AO) days. The amount paid will he forfeited should expiration occur. CITY OF TIGARD 12420 S. W. MainStreet TIGARD, OREGON 97223 APPLICATION FOP. BUILDING PERMIT New Construction l_J Demolish ❑ Addition ❑ Remodel Move ❑ ZONING p 0 DATE ISSUED 1t_13_73 BUILDING PERMIT BUILDING FEE $ 89.00 No. DATE RECEIVED - 73-271 PLAN CHECK $ 1XI110,00 ❑ BY-` OTHER $ EISFSOALUATION $ 24,311 TOTAL $ RECEIPT No. 221%' TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION Ln'i' k pF MAP N �An CENSUS TRACT JOB A Architect or Engineer _ Address 7603 S.E. Powell _ Phone Owner J.W. Brayson Bldr., Inc. Address 7603 S.W. Powell _ Phone 777-3954_ Builder Address _ Phone________ BUILDING USE Sinole nes. n. Multi Res. ❑ Comm. ❑ 1nc?ustrial❑ OCCUPANCY GROUP` _ No. of Stories 2_ Total Height-,---- Area of Lot Type of Construction ZXXIZXXMXXIRX V Floor Area B`--_ 1�� 2 500 _ Set Backs: Ftont 20 Back 30 _ L.Side 51-6 — R.Side-�5-6 Private Sewer Pipe Size 411 Sewer use TigardSeptic Tank ❑ Water Service Pipe Size 3/4" Storm Sewer © Ditch ❑ DryweII ❑ Street and Curb Requirements sxieiing Driveway Width 171 No. of Parking Spaces__ _2 _ � _ SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING SPECIAL, INFORMATION ADDRESS ASSIGNED 12175 9.W. 127th Aup_�_._— -- F I ELD CHECK BY 78 _-----_—_—v _-__.—DATE.��_17. PERMIT APPROVED BY ,, gped work will conform with It is understood that all or applicable codes and ordinances of the State of Oregon and the City of Tigard, Oregon, and that the building will not be occupied until a Certificate ofOccupanc has been issued by the City of Tigard Building Inspector. Inatu a of A lican 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 re:ording of an occupancy permit releasing the restriction in the Deed Ricor.ds of Washington County, Oregon, is prohibited by the ordinance of the City of Tigard, Oregon: (The City will issue a release i me soon an a final inspection determines that the construction is satisfactorily completed) DESCRIPTION OF PROPERTY: Tax flap 251 4AA, lot 86, Bellwood II Subdivision b i ADDRESS OF PROPERTY: 12175 S.W. 127th Ave,_ NAME OF OWNERt J. W. Hrayson Builder, Inc. ADORESS OF OWNER: /603 S.E. Powell Blvd, I IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this day of , 19____ OWNER: Name APPROVED: Title By - . ,, u n g c aT City of Tigard STATE OF OREGON County of Washington °°' M,, 19 Personally appeared before me the above named and acknowledged the foregoing instrument to be _ voluntary act and deed. n Notary Pt@blic orrego�— my Commiettion Expires: ,6 V000 THGM°etd.thto-gym of riA,t,d,b .w,mm• M, .. ��...�.'[-i•Y'Ct k. !Y.��..:........Dwp icy { Porn X55 rn�F 439 l t7� M 1 c, STATE OF OREGON County of Washington *ss I Roper Thomism Olrector of Records and E�ectlons and Ear-Offldo Recorder of Con- veyonces for rild county, do hereby certify ,hot the wllhln Instrument of writing was received and recorded In book of records No of said County -� Witness my hand and seol affixed. ROGER THOMSSEN, Director of Records & Elections j �e S IZ 38 3 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 raccrding 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: (Thq City will issue a release as soon as a final inspection determines that the constr,. tion is satisfactorily completed) DESCRIPTION OF PROPERTY: 7,1- "Ian "' I 1i1", lot Bt,, Oellwood II 5ubdiv1::16 j 1217! S.IJ. 127th Ave. ADDRESS OF PROPERTY: NAME OF OWNER: J. W. Hraysun Builder, Dnc. i593 S.E. Powell Blvd. ADDRESS OF OWNER: IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this _ day of 14_ OWNERS Name APPROVED: By: J ?ilding Official City of Tigard STATE OF OREGON County of Washington °°' _. , l9 Personally appeared before me the above named and acknowledged the foregoing instrument to be voluntary act and dead. Natery ublic for Oregon My Commission �xpiress � 13 1�