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10395 SW HIGHLAND DRIVE
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City of Tigard
r� ASPECTION REOUEST
for
INSPECTION TIME ' K`> __ PERVoIT NO.: —
DATE: 21-:
O.: —DATE: 1� DArE ISSUED:--L..L
OWNERS NAME :
! ADDRESS :
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CONTRACTOR : rTt �v
i TEST: Ai► ❑, Water Ci Visuaik Laboratory
RESULT: Approved Disapproved
p � ❑ , Pending ❑
SKETCH: jt)
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INSPECTOR DATE
50TF . Attach supplemental t*et data horst]
EXHIBIT °B" 4666
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 premises with respect to which
a restriction of occupancy was, on June 7 _, lg 7k
recorded in Book _y� paibe - gg , Deed Record of Wa:,hington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF PROPERTY:
Summerfield lot #174
19 recorded in Book 34, Page 5, Plat
Records of Weahington County, Oregon
C:INER: Mr & Mrs. H. U. Nelson
BUILDING PERMIT NUMBER: 7A-B1
BUILDING ADDRESS:
This is to certify the said structure meets with the require.
ments of the Building Cuda of the City of Tigard and the above
referer,!ed restriction in hereby released and terminated.
IN WITNESS WHEREOF, ,he undersigned authorized officer of the
City of Tigard has cauued this certificate• and relea:.e of restriction
to be executed thiso2S day of �_
Tit1e�11Y kFf(tapE�
STATE OF OREGON ) s
County of Washington )S .
On this `4
7/ day of , 19�, personally
appsared before roe the above named �• , whose
signature appears hereon and who ackn wledged to me t t he executed
the same in his offical capacity on behalf of the City of Tigard.
�L
o ry ublic`o egos
My Co si expires:: 7
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City of Tigara
INSPECTION REQUEST
for I
INSPECTION TIME PERMIT NO. :
DATE: 1',;'174 DATE ISSUED :
OWNERS NAME :Z O
ADDRESS: /O-r
CONTRACTOR : 10-375-
TEST :
0375TEST : Air ❑, Water[] , Visual ❑ , Laboratory p
RESULT: Approved, Disapproved ❑ Pending [-j
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SKETCH: � N Ne�tC ��.�„� i-t se,
I //4 ?19
IN30tCTOR DATE
EOTQ: Attach supplemental test data bereta]
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,Z SPACES MUST BE ENDORSED PRIOR TO
{ ISSUANCE OF BUILDING PERMIT
PLANNING DEPT. -
B
PUBLIC WORKS DEPT. ----�Date
By
BUILDING DEPT.
By '
TUAI-ATIN RURAL £y
FILE DPT.
1,:)YttGY ,D PCS:
I CI`T'Y Ulf.
PER1:1 i T i
`i'ITLT1_- __ ________ DATE—__�_--
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City of Tigard
I INSPECTION REGI
u E ST
for
INSPECTION TIME : PERMIT NO.:
IDATE: DATE ISSUED:
OWNERS NAME : T-D' 6.. .
ADDRESS : z 'r ,12-44 iyl /tom/�I i� /.
CONTRACTOR '- ' ' �7T�
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"IrEST: Air ❑, Water ❑ , Visual Laboratory ❑
RESULT: Approved ❑ , Disapproved , Pending (]
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SKETCH:
I
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I INSPECTOR DATE
IOTE: Attach supplemental fait data heret�
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City of Tigard
I
INSPECTION REQUEST
I for
INSPECTION TIME : PERMIT N0. :
DATE: 21917"1 DATE ISSUED:_.L1_
OWNERS NAME : -;
ADDRESS :
CONTRACTOR : _-- —
TEST* Air ❑, mater ❑ , Visual O— Laboratory ❑
RESULT: Approved LTJ" Disapproved D , Pending ❑
FETCH: �-
I S
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INSPECTOR DATE
NOTE: Attach supplemental test data hero,]
1
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No.
Permit feeo� 3o9-s �sw�1a-y e.
Water ClosetsToilets Permit Issue .--
Bath Tubs Approved by _ L2
Lavatory Wash Basin . �'� Building Permit
Shower Receipt No. _I o a c,o
in_Ts Dishwashing
Sins Kitchen
Sinks Ordinal Location of Building /41 �J� �-✓
Sinks. Bar --- Al.--'per'=-- --------- --
SinSlo---- <%.fin., Lr- /'/s e,&2
A#It isis was iffier -Disposal
Laundry Trays Name & Address of Owner % ni
Drains FloorDrains, Area nnc-Tjj�
Drains Re ri erator
Rain Drains
Automatic Washer me & Address of PlumberV-6 Al 4_,
Fountains Drinking d /�✓/�Ae.�_7-
Fountains odd —
Hot Water Tank
Water Service (Size-i&D
Urinals" _ Old orrr Alter, Repair or
atc as ns - ark THs .ala
Lawn Sprinkler System �-
Swimming Pool _ Ther
Sprinkler System
Tiiis 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 application and know the same
to be true and correct. Al? provisions of laws and ordinances governing this typ
of work will be complied with whether specified herein or 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. -
3 Q Signature of Applicant
w w ear w w w w a
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City of Tigard
I
INSPECTION REQUEST
f o r
IINSPECTION TIME : L" _ PERMIT NO.: __
DATE: s" /��/ /`/ DATE ISSUED:_.._L_l_
OWNERS NAME:
ADDRESS : 124-
CONTRACTOR :---
TEST'.
-CONTRACTOR : __TEST: Air ❑, Water ❑ , O'ir'ual 0 , Laboratory ❑
RESULT: Approved Disapproved ❑ Pending p
SKETCH:
7f y �v
Ih�PECTOR DATE
[OTE: Attach supplemental feet data here►—01
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City of Tigard
INSPECTION REQUEST
for
4T, , j r _ -
INSPECTION TIME : !_ PERMIT NO.:
DATE: —�- A-'11?k. DATE ISSUED:_. . 1..
OWNERS NAME : Z- Z2• <f-
ADDRESS : 7-
CONTRACTOR :CONTRACTOR :
TEST: Air p, Water p , Visual ❑ , Laboratory p
RESULT: Approved , , Disapproved p Pending p
SKETCH:
r lam+ S
SPEC'i OR _ DATE
COTE : Attach supplemental tasr data herst:01
I
CITY OF TIGARD
12420 S. W, Miln Slr"t
TIGARD, OREGON 97227
APPLICATION FOR BUILDING PERMIT
New Construction , Demolish Addition Remodel Move L-1
ZONING DATE ISSUED _ BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ 1 No.
PLAN CHECK $
BY
- --- ------- - /1r.,.A.yr S y ".� VALUATT.ON $
OTHER iZ _
TOTAL /% S� %� $�, � RECEIPT No.�O
TWO SITS OF PLANS AND PLOT PLANS MUST BE rURNISHED WITH APPLICATION
LOT 01-012129'T__ HAP #` CENSUS TRACT .._- JOB # 5l 7
Architect or Engineer
Address-j-'2-k' v .S.I[/__t1b._r� -- art--� r '�...__-- Phone__&_30:-3jjC.)j_
Address—--- —Phone-----
Builder
Phone----_Builder `?c a -------------- ----- �.^ _
Address Phone--__
BUILDING USE Single Res. [o Multi. Res. ❑ Comm. TnduFtr-lal�
OCCUPANCY GROUPS - No. of Stories__----- Total I{eight- _ Area of Lot—
Type of Construction I II III IV C__)Floor Area B-
Set Backs: Front_ o _ Back�,_7-_ 1 Side__"_ _ R.Side-.:!5_--
Private Sewer Pipe Size`!5k Sewerl�; -C t Septic Tank LrJ
Water Service Pipe Size _ Storm Sewer u Ditch ❑ Drywel.l U
Street and Curb Requirements _X
Driveway Width- �V-)'—_— - 4 _ _No. of. Parking Spaces`_,-
SEPPIu%TE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED_—q .—__------,----------- ------�_r
FIELD CHECK BY
PERMIT AI PROVED BYIG,�� f (tom
It is understood that all work will conform with 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 of Occupancy has been issued by the City of
Tigard Building Inspector.
Signature of Applicafli
V
9864
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MEN BY THESE PRESENTS, That occupancy of residential
ntruct.ure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Deer. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIP TON OF PROPERTY:
5V
ADDRESS OF 1111OPERTY: �(�' 45��lr � A;w:
NAME OF OWNER: 1\
ADDRESS OF OWNER: y C \ti. b,r r _,. M uc\� T C
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be executed this }
�y day of C \��� 19�•
OWNER:
(� Name
APPROVED: BY; \�'�egc
Title
Building Official
City of Turd
STATE. OF OREGON
County of Washington ) hn y , 19?
liersonally appeared before me the above named
„ rrI _ and acknowledged the foregoing instrum n -to be
voluntary act and deed. -)
F f:2
/ Jiwoft tary Publl.c for 0gon
—i.a lue ewe�d,..._{F..:....�..'.:o,�y...,..eJie -r,• My Comm'.ssion Ex;ares: _
RnQL11 y110MeeEN,Dlrnalot�I�WOfA�6 EIMt{on� .., �, , D
_...........
... Clo.�,..
BOM 97S IALAS9
( STATE OF OREGON 19
J) is �✓
County of Washington
1, Roger Thomssen, Ditsct; of Recotds
and Flections and E.Offic io Recorder of Con-
veyances for said county, do hereby certify
thut ihh* within innssttrumeLntt of writing was
,fteived and recorded In book of raa&
No.,A sold sold County ._.�...•._......
Witness my hand and seal affixed.
ROGER THOMSSEN, Director of
Recars & El"kxw �7
t(
�lm+ ''4
12 31 �� '�
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MCN BY THESE PRESENTS, 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 P,ecords
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY: ` 7
1� ecc�k-cl
ADDRESS OF PROPERTY:
i
NAME OF OWNER: ��\.�. M,�. \a. L) ,h� c� j�>,�
ADDRESS OF O'vINER C\-1[-.,1a r
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be eyseuted this ��
�y day of c-\c,�, 19- .
OWNMI
Name
APPROVED: By:
Title
Bu li ding Official
City of Turd
STATE OF OREGON
County of Washington ) r y �9 7,
,----)Personally appeared before me the above named
_ and acknowledged the foregoing instrumex.`.o-be
vol�u,t.nry act and deed. - 1
Notary Public for :egon
My Comm. anion Expires: