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uity of Tigard
INSPECTION REQUEST
for
INSPECTION TP.E: PERMIT NO. :--
DATE:
O. :DATE: 'L'1_ DATE ISSUED :
OWNERS NAME :
ADDRESS:
CONTRACTOR :
TEST : Air p, Water❑ , Visual 0 , Laboratory c-j
RESULT: Approve D:sapprovef'lv- Pending p
SKETCH.
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I 9PECTOR DATE I
50TE: Attach iupplemenfal feet data hereto '
esa 4er eg � ser seer rsr en e>.
City of Tigard
INSPECTION REOUEST
for
INSPECTION TIME : PERM!T NO.:
DATE; ��''� DATE ISSUED:. I
OWNERS NAME :
ADDRESS : a'
CONTRACTOR : ?� '�
TEST: Air ❑, Water ❑ , Visualk Laboratory ❑
RESULT: ApprovedO , Disapprovedx , Pending ❑
I SKETCH:
I -70
I
i INSPECTOR DATE
ICOTE : Attach supplemental fest data hereto]
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City of Tigard I
,'INSPECTION REQUEST
for
S&Uee- do�--Jlj ,
INSPECTION TIME: PERMIT N7. :
DATE: DATE ISSUED :.Ll_ I�
OWNERS NAME :
ADDRESS. ----
C O N T R A C TO R : _
TEST : Air p, Woter p , Visual X, Laboratory ❑
RESULT: Apar,-vada Disa proved U. Pending
SKETCH: ,,tt
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INSPECTOR DATE
[NOTE: Attach aupplomentai 464 data beret
s ,r
'. -IL ,R(!TLDER
FEC yoG D A T E__,�, /P!y
LOCATIOtJ Ioago .2�,
P L U�1 r""' -----L u ;T a s r- T Y P E
— �c
v�4 Gr P E n'-1 I T �__ F[E 3`
SEWER PERr1IT �; _ FEE MECHIIf�!ICAL PCRf1IT �'
SATE _ _ by� DATE
Excavat i on F . 1 Ir Air cond - F by
Footino,� '3Tf '� --- 1 _ t.ionino
un, n i 'J entilati9n
Forms S r.inl<1er +
Slabs -P_.-_ s „em
Fleinforcino ('�ason^y�ues
-. - {Slee! -
Structural 5tee1 __ — - Fire doors exits
r / Plumbing I-- _ Garage Floor.1,.1 yeW8
Sewer
La ,n �Ja1J.bcard - _ Starm Drain _ ----
Heatinq
-- -- ( ar!<inr
Laterna'- - - 1-!'nco screen
—Cr ___
.� cinIl
�Lr�ays rvo? Por) :;,TE
07 LI r� n7- 0tA-0 12
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CITY OF TIGARD
12120 S. W. Main SfrN►
71GARD, OREGON 97227
APPLICATION FUR BUILDING PERMIT
New Construction ® Demolish 0 Addition ❑ Remodel ❑ Move❑
------------------
ZONING DATE ISSUED �y 7v 13UILDING PERMIT
BUILDING FEE $ [' Vii_ No.
DATE RECEIVED__j-,bj —s ' _ 'J V-11
PLAN CHECK $ /".oc)
BY - OTTTER�rz..a�`$_, �/� c ,� VALUATION
/%•S/o!� $ J RECEIPT No.
TOTAL
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N Z,'L5� MAP N _ CENSUP TRACT _ JOB
Architect or Engineer0o\a -L.-'
1fc,TH /�J `C� TCY _Phone_(,, 1=�1Q�
Address
Owner ----
Address_ — ----- -___. - __ Phone_— -
Builder,, ,, - --- ---- --- --- -
Address ---- --��Phone---------._
BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Industrial
OCCUPANCY GROUP:1.7 No. of Stories — Total Height_ _ Area of Lot_____
Type of Construction I II III IV Floor Area B__.___ 1 1Zj?- 2!___
Set Backs: Front—toBack-L(}j_ L.Side_ I�_ R.Side^ �f�(re"
Private Sewer Pipe Size—„-- Sewer 1C;���' _ Septic Tank
Water Service Pipe Size—'I Storm Sewer LTJ Ditch ❑ Drywell❑
I
Street and Curb Requirements
Driveway Width_]�j No. of Parking Spaces—Z,
_—�--------- - --------- ------ - --
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNEDCir c� _
FIELD CHECK BY _JDATE
i
PERMIT APPROVED BY
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of Tigard, Cregon, and that the building wil
not be occupied until a Certificate of occupancy has been issued by the City of.
Tigard Building Inspector.
Sign��;pP'=cant
EXHIBIT "A" 11915
CITY OF TICARD
Residential Structure Occupancy Rentrictiou
KNOW ALL 14EN BY TIESE PRESEN'T'S, That occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Deec. Records
of WsehinGton County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY: Summerfield - Lot —5
As recorded in Book , Paga _� , Plat records of Washington
County, Oregon.
ADDRESS OF I'ROPERTYs 11[)7
NAME OF OWPIER:71-L.?r,l a+,rC ��.'�/r��7t_ �;:tic>r�
ADDRESS OF OWNER:
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be executed thisl`1
0/ day ofit-11,r' 19
MMR:
APPROM: By:
Title
By: c ., c �ru �
Building Official EOORII of P-145ti rl-ltl—
City of TigardPy
�,..
STA`",E OF OREGON ss.
County of Washin„ton ) C „� ��! 19 7,0(
rrsona14 appeared before me the above ruWed
and acknowledged the foregoing in: trum-r to be
vo)untnry act and deed,
13,,
!.'ot4ry Public fU 0:cgon
17
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STATF OF OREGON
County of Woshingtor ss
and El. Dar x�srand Ev-Of He of ""OR@Corde, Records
onces lot sold county, do her, Can,
tvhey
the Mlthin Irnrnunant of v -ertl
Wl* fy
d and reeardN In book d A was
Neo..
of sold Coayy •--- -.....
Wltness my hand and seal o/fhted.
R are &EkKtk,,, Director al
�etf
Deputy
JUN 26 10 sl AN'71!
4
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EXHIBIT "A" 11315
� I
CITY OV TIGAX)
Residential Structure Occul-,incy Rcstrictioa
KNOW ALL I,2N BY TIMSE PiMEbiS, That occupnncy of residential
/
ctructurs (s) on the following described lands prior ':o the recording
C of an occupancy permit releasing the rcetriction in the Deed Records
of WaahinGton County, Oregon, is prohibited by the ordiiance of the
City of Ti,ard, Oregon:
DESCRIPTION 07 PROPE.ZTY: Summerfield - Lot
As iecorded in Bock -3 y , Page 2L Plat records of Wauhington
County, Oregon.
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ADDRESS 0: PROPERTY:117
„ ADDP.cSS OF 01-MM"i: \"'j x�/+j�
v 7 f
1�
Yl,N WITNESS VUEREOF, the undersigned has caused this restriction
V to be executed this /�' any of e 19
OWI RI {
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Tool.�ti.n l:c+rlo�.r,�ixf Crnr,r,gm . Jrc.�
�T 1 APPROYEDt
�-- Title
i
I LI..n.wi.sem.
13tillding Official p�+�InSCH.I�4+n�M OI pam1ds ti Eji11°„N
City of Tigar3 '
STAT) OF OREGON ? so.
County of Washington ) 7nammod
lly rppeared before me the abova
and aclunowlcdScd the forcCoing inetrumt-r to bao
ya1 Lary act and decd.
2.../ 11�
z.o ry vublio fo 0 wGon
li+ \.VWW.Mt+�N•f V%..i1Y:.u. Y_-�-�� �
}:XHIBIT "A"
CITY OF TIOARD
Residential Structure Occulkincy 1(c.o riction
KNOW UL 1,E-N BY TI{:SE PRESENTS, That oc,:upnncy of residential
structure (s) on the following described lends prior to the recording
of an occupancy permit releasing the rt•striction in the Deet: Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DF:,SCR'LPT.ION 0 PROPERTY: Swsmerfield - Lot
Ao recorded in Book -2�Ll , Paye ;" , Plat records of Washington.
County, Orf?Kon.
ADDRESS OF PROPERTY: leg�7.C10 lL G •/11u(� 11 y
NA14E OF 0VNLR
ADMSS OF OWidF.:Z: c� p1{
IN 14ITNESS MUERF.OF, the undersigned has caused this restriction
to be executed this / day of �ii,re
04+iNE1R i
r
Tuel.atin Do �,loome ( rnr,nam . 7r.c.
APPROVED: Byi 7'i'7 C—t_
33y: _
Building Official
City of Turd
STATE Or OREGON
County of Washington )
ernonally, appeared before me the above na-m ,1
and aeYnowledLed the foregoing�71-strum t to be
voluntnry net and decd.
Nota y rublie fo rogon