9553 SW LAKESIDE DRIVE AAf A� A'! Alf!.AL4w-JWlw PW PM PM
— 9553 SW Lakeside Dcive -
w000t 11
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U'1
CERTIFICATE OF
CIC
TYOFTIFARD �crr.-or- w OrCLJPqN! ',
CCMMUNFTY DEVELOPMENT DEPARTMENT ON ki'l I I #. . . . . . . A M 10-01382
13T's 6WHWlBard P.0.Fw23Wj*d,0mg0n Mo(8*0*476
SITE ADDRESS. . . : 1�5ii-rSW LAKESIDE DR PARCEL- 2"3111CA-11400
SUB01VI510N. . . . .- LAKESIDE PLACE ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .Z5
CLASF, OF WORK. :NEW
TYPE. OF ' 'RE. . . 3SF
OCC(JPP!4C Y GRP. e R3
OU.11PANCY LOAD: 118 A
TENANT NA14L. . .
NOSTALGIC HOMES
PU BOX �'016
LAKE GROVE OR 97035
Phune *o !.5036E05666
NOSTAUDIC 110MES
PO BOX 8016
1441%.' GROVE OR 97035
Phune #z 5j %,.`-:?0"5666
Rep it. . s 5 563.1
Ocultparr-y (of the above referenced buildinq is hereby given, and certifive
t!-if. cumplianrnwith the state of nregon ',ipectalty Codes for the WrOlApq
ijCUIJlar'c'.'Y, and use 'Lindov. whish the referenced permit was iss, pti.
riRr. nrmn"rMENT BUIL ING'
176.,jr.
M.
P L I I L DIN
POST TN CONSPICUOUS PLACE
w ei ear w t M
INC-PECTION NOTICE �1lb 0irk C' ,
]1? City of Tigard Building Department
G� P O. Box 23397
Tigard, Oregon 97223
Phone 639-4175
Type of Inspection z7l"�e 0 /___
—
Date Requested�7 ? Time A.M._ P.M.
Ad0ress __—� ~� `��,! S/' Permit #• 'w c .3
Owner S Lot # .
Builder ,.
The following Building Code defi iencies are required to be corrected:
Presented to --_- - Approtiad
11
Inspector __ _----
Disapproved
Date Z __
CA! FOR REINSPECTION
CA.VrFO
El YEa C; NO
INSPECTION NOTICE
City of Tigard Building Depar+--. t.
13125 M Ball Blvd. Tigard, Oregon 97'23
Inspection Line (Rec-O-.Phone)t 639-4175 Business Phone: C39-4171
Inspection: —_ _—.—�--------— -- (—
Footing
Plby. Underelab Mec.t. R,)cgh-in Appr/Sdwlk
Pound. Plbg. Top Out Cas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Ba i Moch. Rain Drain Insulation -Plumb.
Plbg. - Iloot pater Line Gyp. Bd. -Koch.
Date Requentedt17
_f— __Time: __,�-AM _ PM
Address: Permit f
Builder:.
THE FOLLOWINO CORRECTIONS ARE RdQIIIRED:
Inspector:---- 70— ----�-- -- ------- Date:
APPROVED —�_ DISAPPROVED -_ APPROVED 5118JECT TO ABOVE
Call. For Reinsp.
;Y PECjIO[I NOTICE
City of Tigard Building Department
13125 BW hall. Blvd. Tigard, Oregon 972 3
Inspe,:tion Line (Rec-O-Phone): 639-4175 Business Pho..-- 630 4171
1, actions — ------ �— _ --
Plbg. Underelab Mech. Rouqh-in Appr/Sdwlk
Found. P1 Top Out ` Gas Lino 'INAI.c
Poet/Beam Struct. San. Sewer Framing -Aldg.
Post/Ream Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Leine Gyp. Bd. -Mech.
Datm Requested:_�� a --Times AM X.. PM
7 c
Address:-__ I � ! res it fs���
Builder:_THE FOLLOWING CORREC"IO'AS ARE REQUIRED:
Inspector: /� _ nate:
APPROVED -_ DtSAPPROVRD APPROVRD SUBJRCT TO ABOVIF
Call For Reinep.
:
j 1 NOTICE
city of Tigardgard Building Depart-Ment
13125 BW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec`O-PPJhoone)t 639-4.75 Bue!neeo Phone: 639-4171
Inspect ion I__111111'111L_'�-Y�r__�-__—
looting Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Cas Lire FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Ream Mech. Rain Drain Inoulatlon -Plumb.
P1bg. Underfloor Hater Line Gyp. Bd. -Mach.
Date Requested: Times ! _,AM - _PM
Address: � armit f:
Ruildar: -- —
TAE FO*.LOWING CARREGTIONF ARE I.EQUIRED:
s.
-`- J
I
Inspectors _ Data: --�
L— APPROVED DI8APPRkWzD APPROVED SUBJECT TO ABOVE
Call /or Rainep.
as wia est eas er e>tr war �
xKBPLCTI �
Obi_NO'_ICF
City of Tigard building Detartmont
13125 SII Hall Blvd. Tiy- d, Orc,gon 47223`
Inspection Line (Rea-O-Phone): 639-4.75 Business Phone: 639-4171
Inspection:
Footing P1lxI. Underslab Mach. Rough-in Appt/Sdwlk
Found. Plhq. Top out Can Line FINAL:
Post/Beam Struct. Sen. Sewer Framing -aldq,
Poet/Beam Mach, Rain Drain Insulation -Plumb.
Plbq. Underfloor Kuter Line Gyp, Bd. _gev-!.
Date Requestoddtt I/ Time: --AM PN
Acldt•,:es t b Permit . ->
Buildart
THE F)LLOWINo ODRRLCT'IOHS ARE RBQUIRED:
F
Inspector: - 1►�
— —�� Date:
PROVED DISAPPRJVED APPROVED SUBJECT To ADM
Call For Relnep.
,rte ao .. .■ v � asf �
r
INSPE
City of Tigard Building Departowwt
13125 9W Hall Blwl. Tigard, Oregon 5\on 97223 I
Inspection Line (Rec-O-Phone): 637-4175 Business Phone: 6241(
Inapection t_T_�_
Footinq Plbg Underslab ech. Rough- n Appr/Sdwlk
Found. Plbq. Top Out Gas L.ne FINALt
Poet/Beam Struct. San. Sewer Preening j -Bldg.
Poet./Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor WaterLina Gyp. Bd. -Meeh.
Date Requested t �� Timst _ AM PN
AddreeetJ'3 � 6LfeC-a'ce�� Permit #t
J M v3oc-.Z
Builders j
TBE Ff)LIA)WING CORRECT MS ARE REQUIRED:
Inepectort_ Date•.
PROVED DIBAPPRDVED APPROVED SUBJECT TO ABOVE,
--Call /or Rei.nep.
MPBCPION NOTICE
City of Tigard Building Department
13125 Sq Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec--O-Phone): 539-4175 Business Phones 9-4 7
Inspections`_
Rooting Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line FINALS
Poet/Bears Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulacion -Plumb.
Plbg, Underfloor Water LineGyp. Bd. -Mech.
- pl1
Date Requested: - '�j
Time: AAi•-
Adclresl�9 " __ Permit #:11_2
Builder: ✓ C'
THS PO OORRSCTIONR ARE REDS
APPROVED DISAPPROVED T� APPROVED SUBJEG'T TO ABOVE
Call For Reinsp.
iNSPrscrzoN .�oTice �
City of Tigard Building Department
13'25 SW Ball Blvd. Tx• krd, Orw mn 97213
Inspection Line (Rec-O-Phone)s 611;-.175 Business Phone: 639-4171
Inspection=--
Footing Plbg, Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALc
Post/Beam struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. 1.sir, Drain Insulation -Plumb.
onderfloo Water Line Gyp. Bd. -Mech.
Date Requested: � _ �Times _AM _PM
Address:_ L Permit /s �JF�
L
Builders��
THE FOLLOWING CORRECT NS ARE REQU':RED:
Inepectors2�� -- Date!
__�LAPPROVND DICAPPROVED APPROVED SUBJECT TO AROVF.
--Call For Rei.nsp.
r
t
i
INS E�T�ti,_NOTICE ��,
City of Tigard Building OeFartment +` ,--
13125 810 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639--4175 BusineBH Phone: 639-4171
Inspectirn,,_ _�------------ --.--
Footirg Plbg. Underalab Hoch. Rough-in Appr/Sdwlk
Foun7. Pl.bg. Top Out Cas Line FINAL:
4 rUC5,) San. Sewer Framing -Bldg.
oat/Beam-M Rvin Drain Insulation -Plumb.
Pibg. Underfloor hater Lina Gyp. Bd. -Koch.
Date Requesteds ' ` — _Time: _ _AK _ PN
Addresas C � Permit fs
9v o
Builder: ' �1 __�� .�L— —•
THE FOLLOWING CORREGTIO ARE REQUIRED:
Inspectors —_ Date:
PROD DISAPPROVED APPROVED SUBJECT To ABOVE
Call For Reinap.
S BCTLON_j70TICE
City Of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 9'1223
Inupection Line (Rec-O•-Phone): 634-4115 Rueineee Fhonet Q4
Inupection:
(F=—ting H.bg. Underelab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Cas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beane Hach. Rain Drain Insulation .-Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: Times ,AN pN
Addr.ees ` / �•L_ Permit fs .
Builder:
TNM FOLIAWIN0 CORRECTIONe dREQuIRED1
Inspectou_ _
APPROVED DISAPPROVED APPROVED SUBJECT TO AUOVE
__Call For Reinep.
� PL.UMN I Nf:r PERMIT
CITYOFTIFARD _. PERMIT M. . . . . --
C17YCVTWAR! . a MST�0 03a�$
COMMUNITY DEVELOPMENT DEPARTMENT � ORMI- 1
13126 SW Flail Bwd. P.O.Box 23:197,Tigard,Oregon 97229(603)839-4176 / DATE ISSUEDt 02/04/9,1
SITE ADDRESS. . . s 9553 SW LAKESIDE DR PARCEL: 2S 1 1 ICA--11 V1
SUBDIVISION. . . . t LAKESIDE PLACE.
ZOMINOe R•-7
SLOCK. . . . . . . . . . e LOT. . . . . . . . . . . . . y4.�
^
CLASS OF WORK. . ANEW GARBAGE DISPOSAL3.4. : .1.._____.________...__.__.___...__._____...__._.._
TYPE OF USE. . . . 1SF WASHING MACH. . . . . . . ... 1 BACKFLOW PkEVNTR5. . 10
OCCUPANCY GRP. . sR3 FLOOR DRAINS. . . . . . . :'D TRAPS. . . . . . . . . . . . . . t0
STORIES. . . . . . . . P1 WATER HE:AVERS. . . . . . a 1 CATCH BASINS. . . . . . . r0
F T X.TURES-.- _----- --. - LAUNDRY TRAYS. . . . . . :0 SF' RAIN DRAINS. t 1
SINKS. . . . . . . . . . : 1 GREASE IRAPS. . . . . . . so
LAVATORIES. . . . . sc OTHER FIXTURES. . . . . so
TUB/SHOWERS. . . . t SEWER LINE (ft ) . . . . :0
WATER CLOSETS. . t2 WATER LINE (ft) . . . . : 100
DISHWASHERS. . . . al RAIN DRAIN (ft ) . . . . :0
Remarks:
OWNER t
NOSTALGIC HOMES PAYM $ 100. 00 JLH 10/19/90 206084
PO BOX 2016 HPRT ! 400. 00
BPLC ! 260. 0+ / !
LAKE GROVE OR 97035 85PC t 20. 00 / 1
Phone #s 5036205666 STDC f 600. 00 / !
S'IDC $ 375. 00 ! /
Plumbing PARK t 300. 00
MPRT $ 36. 00 ! r
Name: MPLC $ 9. 00 / !
Address ��- _ M5PC t 1. 80
ritys -�:tatea _ PPRT $ 117. 50
7.1p:___ ---Phone#sP5PC t 5. H8
Peg Rs _ PAYM -1 2225. 18 JLH 02/04/91
-- REQUIRED INSPECTION8 --- -_
This permit is issued subject to the req _
ulations contained in the Tigard Municipal Foot/found Insp Rain drain Insp
Code, State of Orta. Specialty Codes and all Post/Beam Struct Water Line Insp
other, app.l icmble laws. All work will he done pant/Beam Mechan Appr/Sdwlk Insp
in accordance with approved plans. 1-his Film/l.andslab Insp Mechanical Final
pPrmit will expire if work is not st.%rted PLM/Underfloor Plumb Final
within 180 day% of issuance, or if wor-k is Merf-anir_al Insp Building Final
suspended for more than 180 days. Plumb Top Out Erosio;, Control
Framing Tnsp
Fi ep:ace Insp
X(/
Gas Line Insp
` / Insulation Insp
Gyp Board Insp
Authorized Plumbing Contractor Signat Ire ��---- -
Call For inspection - 639--4175
Contractor Natest
ws
-wxmw-x
CITYOFTIGARD MASTER PERMIT
CITYOF TIGA ..ERM T #. . , . . . . MST90-038
COMMUNITY DEVELOPMENT DEPARTMENT ORWOON
13125 SW FW1 Blvd. P.O.Box 2331)7,Tigard,Oregon 97223(603)6394175 DATE. YGFUED: 02/04/91
t5
'7" PARCEL: 2S111Cn--t
ADDRESS. . .
5U,kl)I V I S I ON. . . . . L(4KE6 i DE PLHLE ZONING: R-7
BLOCK. . . . . . . . . . LOT.. . . . . . . . . . . .
BUILDINL:
IRE I SSUE: DWELLING UNITS: 1 13ASEtiENI.. . . . . . . . :0 S F
CLASS OF WORK. :NLW BEDHMS:2 BATHS.-c'? GARAGE. . . . . . . . . . :483 Sf
TYPE OF USE. . . :SF FLOOP ARE i)5—----. REQUIRED GE1'BA(_'KS-----_.__.__
TVPE OF CONS!. -.5N FIRST. . . . : 1704 Sf LEFT. . :0 ft R I GHT. 0 ft
()CCJP0I\I(."Y GRF,. :R 2' (:-'E CCND. . . :0 S f PRON'T 0 f-t, REAR. . :0 ft
STORIES. . . . . . . : 1 THIRD. . . . -0 Sf RIEQU I
HE I CIF-II.. . . . . . . . .I.. . . . . . . . . la ft TOTAL- - , 1704 5 f SMOKE' DETECTORS. :Y
FLOOR LOAD. . . :40 psf VALUE— — $: 87078 PARKING SPACES. . :O
Re mat,P,s :
PLUMBING
-
SINKS. . . . . . . , . .. : 1 FLOOR DRAINS. . . . -:0 BACKFLOW PREVNTRS. . :O
I..PVATORIES. . . . . ..i WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . .0
TUB/(111OWFRS. . , . : .a LAUNDRY T'RAY9. . . - 1. CATCH BASINS. . . . . . . :0
WATEt, CLOSETS. . :2 SEWER LINE ( Ft ) . :0 GREASE' TRAPS. . . . . . . ..0
DISHWASHERS, . . . - I WATER LINE ( ft ) . : 100 OTHER FIXT'URE'S. . . . . .0
GARBAGE D1SP. . . : I RAIN DRAIN (ft ) . :@
WASHING MACE{. . . : 1 SF RAIN DRAINS. , : 1
MECHANICAL FEES
UNIT 1,4 T PC;. 0 type amount by date V,1,C p
/GAS/ VENTS . . . . . :0 PAYM $ 100. 00 JLH 10/19/90
IvIOX INPUT:0 BTU VEN'r FAN'.). . -4 BPPT il, 39 7. V10 Y
. . 31 HOODS. . . . . . : I BPLC $ 258. 05
- URN I 000 . . :0 WOODSTOVES. :0 FA5pc $ 11. 85
FLOOR FURN. . . . '0 CLO DRYERS. : I S TD C $ 600. 00
0011. "I'mr, 31-1p:0 OTHER UNIT y:0 SSDC $ 75. 00
GAS OUTLETS: 1 PARK $
MPR T % 39. 00
NIO'.':')TALGIC HOMES MPLC $ 9. 75
PO BOX 2016 M 5 r'-'C, 4 1.. 95)
PPRT $ 140. 00
1.0KE GPOVF_ OR 97035 F,5wf- $ 7. 00
Phone #: 5036205666 PAYM $ 1997. 60 JLH 02/04/91
f.-o n i;r a r t o r * ----— - - ---—-- ------ - -4— ---
t'1(.)STALC3lC HOMES
I 'll SPX 2016
L.PKL GROVE OP 9703.5
1-11-lone 5036i-*105666
r?pq # 5563,3
$ 21097. 60 TOTAL_.
-his persit is issued sublect to the regulations contained in the REDUIRED INSPECTTONS
Ticard Municipal Code, State of Ort. Specialty Codes and &H other Foot/foitnd Inro Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/beam Strl.ict (--jac; Line Insr)
plans. This pergit Will expire if work is not started within 180 Post/peam me0lan Insi.tlation Insp
days of issuance, or if vmr4 is suspeof9or corp tha 180 day PlM/Undslab Insp Gyp ",ard Insp
/ 1-1-M/Urid Pr f I a or Rain :stn Insp
r"Prmitt..-e Clirir r,t r q-, Merha-,iical Insn Wat to ine Insp
F'1LimbTop Of.(t Appr/Sdwlk Insp
i s(;1.iPd By Framitiq Insp Mecl-i.-Anical F= inal
Call for irisnet,tion -- 639-4175
SEWER CONNECTION
CITY dF T'GA RD F.')E RM T 7'
OERMIT #. . . . . . . .. SWR9004._19
r Ai��
MYOFTWARD
COMMUNITY DEVELOPMENT DEPARTMENT nTE ISSUED: 02/04/91.
13125 SW Hall Blvd. P.O.Sm 233Q7,7ipartl,Orepo�97293(SM)63"J76
''JI.)R _t». . . 5W LHkLE:,lL)L llFt PARCEL: 2S111CA-11400
I ON. LAKES I DE PLACE ZONING: R- 7
. . . . . . . .
LOT. . . . . . . . . . . . .
;Ij. . . . . . . . . . ..43167 FIXTURE UNITS. . . i
1"= WORK. . . :NEW DWEL-L.I NG UN I TS. . : I
I LJ SE. . . . . :5F NO. OF BUILDINGS.- t
1 TYPE. BUGWR IMPERV SURFACE. S f
------------ FEES ----------_--__
1111 G.I C HOMES type amol-1.1t by date recpt
NX L'016 PPMT $ 1500. 00
INSP $ 35. 00
Il'i (IROVE OP 97035 PAYM $ 15,715. 001 JI-J-1 02/04/91
;-W- TOP NOT ON FILE
$ 1535. 00 Tom-
REQUIRED INSPECTIONS
Nvpti:arit iqrre5 to -onaly with all the roes and regulations Sewer Inspection
1rp drif,pol 5,-,qagp Agency. The permit expires 120 days from
F ipd. The total amount paid will be forfeited if tne
The Agency does rat guarantee the accuracy of the
.Kpr. laterais. If the sewer is not located at the measurement
the installer shall orosuect 3 feet in all directions from
..stance aiv7n. If not so located, the installer shall vurda
,
ar and Siet Sewer' Permit and the dwe? will inst 11 a la -al. ^u^ -_ ��~T
Call for inspection 639--4175
CITY or' 'iOARD RECEIPT OF PAYMENT RECEIPT NO. s 1)1—20934.5
CHECK AMOUNT .3782.60
NOSTALOIC HOMES CASH AMOUNT » 0. 00
"DURESS t PAYMEN7 DATE e 02/04/Sl
SUBDIVISION
9521 SW L.AKESIDF' DR
PUR1710SE OF PAYMENT AMOU1,41, PAID PURPOSE OF PAYMENT AMOUNT PA I D
397. 00 VILUMBING, PERM ___ ..__140. 00
HAI'lICAL PE 39. 0411 clJ. BUILD PER J18. 80
!:\I CHECK FE 16'7. 80 SEWER USA 1500. 00
j **.R INSPECT 35. 00 SsTREFT 9I)c 600. 00
ll :s SDC 501A. 0Q, 53TORM DRAIN SDG 3 7 5,, 00
rrr 4
(IMOUN-r t,-)(IID 3782. 60
CITY OF TIGARD --- RECZIPT' nF PAYMENT IRE(-.,'1'71PT NO. 90 -1206004
CHLCk* AMOUNT
t!(imE t NOSTALGIC HONES DEV. CO3
N-QDRESS : P.O. BOX 206 1CASH AMOUNT 0:cJc)"')
PAYMENT DATE lo/19/90
LAKE GROVE, OR 97C.)75- SUBDIVISION
I IRPOSE OF PAYMENT AMOUN r PA I D
PURPOSE Or PAYMENT AMOUN T r I I)
aN CWH,�. FE I 0---56PN 00. oc)
`;UMMERF I EL D. LOT 5
TOIAL AMOUNT FAID 100. CIO
CITY OF TIGARD RECEIPT OF: PAYMENT RECEIPT NO. -.90-206083
CHECK' AMOUNT s 100.()o
NAME a NOSTALGIC HOMES Drz-k/,, CO. CASH AMOUNT 0.00
iADDRESS a P.O. BOX 2016 PAYMENT DATE e to/19/90
SUBDIVISION
LAk,E GROVE, OR 97(1*!.r,---
:V'103E OF PAYMENT AMOUNT fnA 11") PURPOSE of- PAYMLN fAMOUNT PA 117
an! CilECK FE 10-0,35R
J111MEF.-VIELD, L.0-f 4
r(ITAL AMOUNT PAID 1(10.OQ
CITY OF T1BARD RECEip-r OF PAYMENT F-WCEIPT NO. r ch)--206085
CHECV. AMOUNT r 100.00
NAME a NOSTALGIC HOMES DEV. CO. CASH AMOUNT e 4'.).00
ADDRESS p P.O. BOX 2016 PAYMENT DATE r J,,'.',/ 117/90
LAKE OPOVE, -IF-( SUBT)I V T 8 1 ON
IWOSE OF PAYMENT AMOUNT PAID PURF'(13E OF PAYMENT AMOUNT PAID
37P
4N CHE0-:' FE to-5 100.00
:A.JMMERFTEI_D, LOT 6
TOTAL AMOUNT PAID
October 19th, 1990
City Of Tigard
13126 S .W. Hall Blvd.
Tigard, Oregon 97223
To Whom this may concern:
Development : Summerfield
Lot # #4
Plan #1671
Square Ft . 1671
Exactly one foot will be taken from total width of 42 ' per plan.
The revised width will be 41 ' . The areas affected by this
revision are the entry way and great room.
Thank you.
S i n re
To Kenyon Pres ' nt for:
Nostalgic Home Devel . Co.