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2292
EXHIBIT "B"
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hereby certifies that the occupancy of
the following descrited structure or premi3es with respect to which
a restriction of occupancy was, on July 17 , 19 74_,
recorded in Bork 584 , Page 299 , Deod Record of Washington
County, Oregon, Is hereby authorized and approved.
DESCRIPTION OF PROPERTY:
Lot 3, Burnham Park, Tax Map 2S1 208
OWNER: Roger Grahn
BUILDING PERMYT NUMBER: 0018
BUILDING ADDRESS: 13120 S. W. Ash Avenue
This is to certify the said structure meets with the require—
ments of the Buildino Code of the City of Tigard and the above
referenced restriction is hereby released and terminated.
IN ,JITNESS WHEREOF, the undersigned authorized officer of the
City of Tigard has caused this certificate and release of restriction
to be executed this ;3th day of _ Februa;, .---_. _, 19—ULr.
Title: Cid Reco r
STATE OF OREGON Be.
County of Washington ;
On .his 19th day of _�ebruary , 19 76 �, personally
appeared before me the above named Doris Harti9 , whose
signature appears hereon and who acknowledged to me tlat he executed
the same in h1le official capacity on behalf of the City of Tigard.
Notaq Public or Oregon
My Commission expires:
/:ikl�� 11/6/78 _--
tA
F r 2
'• ...,.,,r• jai.d be e�.,md_.�" �.n7...lA��a nt.......J1.K.�1.
p,-.r.,LR THCrrIRRt.NrD�+afoof MomA■6 ENatlee�
�on�1069 714
L Cal
Ci
� yo� ,.._
Sona ui•
..._ n.:!
c 6.5 n f1 �
J b W q,
Id .. :.P
O � K
u n c •g � �
m' is 0 3n � 04
t7
LA. $
W v
N nfj�> Zp 2
I
I
t � of Ti q urd
�. Y
INSPECTION REOUEST
for
INSPECTION TIME : PERMIT NO :�—
DATE: DATE ISSUED:...,.
OWNERS NAME : rtZeG�rrZ. ��.t�aM�
ADDRESS : Z-2/-2-0
I CONTF..`.CTOR :
TEST' Air 0, `Nater ❑ , Visual El , Ltaboratory ❑
RESULT: Approved Q , Disapproved , Pending [3
I :
KETCH ( / ✓Frr� �.'.+n L �. ,.
I S f a I tU Oec�K. a
IV ��� pbefi (irVr2r7� �h u NG.
,r
I
i
INSPECTOR DATE
COTE. Alta.^.h supplemental test data herelo1
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: � PERMIT NJ. :.M
DATE : DATE ISSUED
OWNERS NAME
ADDRESS: - �3/ _ t''
CONTRACTOR :
TEST : Air ❑, Wnter[1 , Visuul bo , Laboratory ❑
ed ❑ DisapprovedA-1—P
ending
RESULT. Approved PP
M
SKETCH:
INSPEC70R DATE
COTE . Attach supp:ementai test data hereto]
i
t
City of Tigard
I i°! ECTI O N REQUEST
fol4 '
-- a�
IOPE'CTICN TIME: PERMIT N0. . .
DATE: DATE ISSUED :---../
i OWNERS NAME : 'r'� ���-•._ ______---- _-_--
ADDRESS: S t✓
CONTRACTOR
'TES'T : Air [], Water(] , Visual �, Laboratory (]
RESULT: Approvedy Disapproved Pending (s
S KETCH:
,qL &5 J
, I
60
, ,?
INSPECTOR DATE �
COTE: Attach suppls•mental test data bereta�
f Y/��-� ��c:� /� ;_ T— f t��t��i�v t�E' '/`'�,f f �""rti'h'-C. ��c.%S/=-r�-•:���=✓v
0�1
V.
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: �' f�' POE RMIT N0. :_
DATE: LL-'L?J'� DATE ISSUED :—
OWNERS
SSUED :_OWNERS NAME : '
AME : '— -----
ADDRESS: __f 3! S rr .lf��l�
CONTRACTOR : —_- 6�r-Cis --- _---- _—
TEST : Air ❑, Woter D , Visual w, Laboratory []
RESULT. Approved ❑ , Disapproved , Pending
SKETCH. 6 �` 7� T=X-'j �'yr✓UiL� '�vh� J
INSPECTOR DATE
[NOTE: A,tach supplemental teat data 6st►et1
�P14rx)s-k: 1,)67- ,fit l-"PXencc 77Y6 r-`11tjA& )41.5 f e ; �r v
S . 44)7_14
77'146- �.S'7- -'� j' /,"" PC- PN%A F D s
City of Tigard
INSPECTION REQUEST
for
du�41
INSPECTION TIME : PERMIT NO. :
DAT ' � S L-L ./7DATE ISSUED'.__.._,
OWNERS NAME : -
A D D R E S S : Z-26A
CONTRACTOR :----
TES
ONTRACTOR :-T--TES r . Air ❑, Water r] , Visual* , Laboratory r]
RESULT'. Approved ❑ , Disapproved, Fending [j-
SKETCH'
jSKETCH'
X11 C T /9 CL' '�'C
CLQ 2 e
i
I SPFCTOR DA`fE I
I �
CNd7E . Attach supplemental t*et data hu-et]
75- Jl d 7
n
ADDRESS /j/J ,,a.(;_�✓�
PERMIT
PERMIT CHARGE none �-----
O— C
TYPE OFONVECTION FEE =�
OWNER
PAID 6Y
BUILDING '2
��i�J: �1
DATE CONNECTED '2
SERVICE RATE � ,_. .�
INSPECTION FEES 20
CONTRACTOR 1 62
PAID BY __ DATE
ASSESSMENT _ PAID _
SiLE OF CONNECTION T'�
City of Tigard
INSPECTION REQUEST
for
INSPF,:�TICN TIME: PERMIT NO. ;
DATE: _ 41-11�L� DATE ISSUED :._._L_L_
OWNERS NAME : —
ADDRESS:
AME :ADDRESS:
CONTRACTOR '.
r
TEST : Air Q, Woterk(, Visual, Laboratory p
RESULT: Approved Disapproved 0 , Pending C7
S"`ETCH:
i
75
p
INSPECTOR DATE
COTE : Attach ju r'rtmantcl tes' wJota n,ret]
I
' i
I
it
I �
I
i
City it of Tigard
INSPECTIOIV
REOUEST
I for
I !NSPECTION TIME ; PERMIT NO : --
DATE:
O . --DATE: ' _ DATE ISSUED•. L L
OWNERS NAME :
OADDRESS : /3
rONTRACTOR :- - ----
TEST. Air ❑, ►vote: ❑ , Visual , Laboratory ❑
Disapproved , p
RESULT: Approved� , PProved C1 Pending
SKETCH: S
N
I
I INSPECTOR DATE
OTEAttach supplemental te.t dote hereto-1
1
I
1
i
14088
E%HItUT "A" +�
1TY OF TICARD
Hesidential structure Occupancy Re2triction
KNOW ALL MEM A" THLSE PRESENT. that occupancy of residential 1
structure (s) on the roll•iuing described lands prior to the rt;cord-
ing of an occupancy permit releasing the te5triction in the Deed �
Records of Washington Co,inty, Oreqon, is prohibited by the ordinance
of the City of Tigard, 'I a t ui11 issue a release as
. r gonz (The Fiy s
soon as a final inspec'.ton dnterminw� that thot construction is
s �tisfacturi; y comple',.nd)
DESLRIPTION OF PROPERTY:
Lot 3, Burnham Perk, Tax Flap 291 2013
ADDRESS OF PROPERTY: 13120 a.'d. At! Aya. �
N NAME nF OWNER aoogr Grafin
--'� �GRESS OF OWNER: 9fjCL5-jJ j.6ML9",,,, bAVarton. Qragon
ss
IN WITNESS WHERLOF, the undersigned ^as r..aused t.hi3 re3trietion f
Vf
w to tie executed this day of , c L. , 19�.
D, OWNERl'�
rLeLL. Title
i
APPROVEjI 9y
U-1 din Official�—'y' n�.��m.« p +
•. w y .,r ni lMer so ti rM-��
IIGwftJ1,tHUNAdCN,t '•
City of Tigard
STATE OF OREGON q�.'... ..
tin I ,
County of Washington
•„_ '.. 7 Y , ,,,.�� 19...x.... f
personally t ppeared before me the Above named��
and acknowledged the foregoing ifiLcrutAent
to bn /_,. voluntary act and dood.
NoLary Put�lic or r'.'gun
6Q1K iJC7i! FJI{�Eili! My Co^mi=.,ion Expires:___,_„
f
14088
EXHIBIT "AI'
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MEN BY THESE PRESENT, that occupancy of residential
structure (s) on the following described lands prior to the record-
ing 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 the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY:
Lot 39 Burnham Park, Tax Map 2S1 2D8
ADDRESS OF PROPER T Y , _•312 0- S.W• ,Aa h
NAME OF OWNER :
ADDRESS OF OWNER : C.�(.R� derto,n� 0reyon
IN WITNESS WHEREOF , the undersig.ied has caused this restriction
to be executed this day of Ju Lys , 1921-.
OWNE_R�J
Name
Title
APPROVE ?y
-,__
By : - --� r� .....I97ia' 1
Official.1 C 1 a Fi1wA Irn rwcetQ, .(.......... ....
u l d i l�g ROor*THUMBttM Dttw.ttt» of B1wrt1r,M
City of Tigard ;;';�
.. ._....................
D�puly
STATE OF OREGON
County of Washington ss p��17
Personally appeared before me the above named
and acknowledged the Foregoing instrument
to bl? voluntary act and deed.
Notary pubic for Or gon
y:
MCommission Expires:
T'• Q 500K 984 WAGE y
Com"
STATE Of OREGOj1�
h as
County of Washingf�n
v r I, Roger Thomssen, Direatpr of Records
and Elections and Ex-Officio t:�cerder of Con-
veyances for suid county, do i:ereby certify
,hot the within instrvnw M of witting was
received and racordsd n bbak of rrccrds
of sold Cordy
Witness my hand and seal affixed.
ROGER TN(MASSEN, Director of
Retards 3 Electkir s
Do"
JUL 17 12 24 FIR '711
'� t PT
r....�.,r-.,.,,..'.t„y�,?"-cw..R,�(,w.n�tsl�`•M'�'a. •'^M.1�rl�'r ,.•..^iMuw..^...,.�.,..�.sw�-r,,,r,D�A•ay„R�,�yyy,,�'�1,».��..,.w..,..K_.....„p,.,,.rr�.-. ..�,.w
BUILDING PERMIT APPLICATION TIGA D DATE-� N° 0 018
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE _
Q NER 7 A Crohn ADDRESS �^��+��� �*�• �ffirl BUILDER PHONE —
i71. ner ENGINEER
BUILDER ARCHITECT DESIGNER —
STRUCTURE ONEW ❑REMODEL CADDITION CREPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
Q RESIDENCE CCOMM CEDUCATIONAL ❑GOV'1__CRELIGIOUSQPATIO ❑CAH PORT' ❑GARAGE_ ❑STORAGE CISI_AB ❑FENCE
OBOND ❑MOVING OrONDITIGNAL -ISE ❑DESIGN REVIEW LICOUNCIL APPROVED ❑SIGNS—
OCCUPANCY._--__LAND USE ZONE BLDG. TYPE. _FIRE ZONE_. - PLAN CHECK BY___— HEAT_._,
i H.A J •r7 A l'U pM 16C+7TF FOR
1�� f
QAC, LOAD.- FLOOR LOAD --HEIGHT NO.STORIES
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE 'TIGHT SIDE
Permit - ----- -------- ---- ---- — -- -- ----
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check a l (1 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
,, + WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDICES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITU BUSINESS
1%State • LICENSE. SEPARATE PERMITS REQUIRED OR SEWER P MBINGIAND HEATING.
Total
BY A ---- - —--_
—�--- APPLIC NT OR ENT
Approved Receipt No.
ADDRESS PPIoNE—�
r
PLUMBING DATE
DATE INSP. 'TYPE INSPECTION REMARKS
ontractor
;,? ,�-7 U I�t�T• � ���.., ✓fin
Permit No. 12
Rough-in _
Fixture
Final
Lv"LaZ 62 C— ----- — HE ATI N G
�T T c.v� gtid
contractor
-- �6 �,Lrn �CICN � J Z••oo DNs Sf�j�On/( Permit No.
- /J F•I'�Y� �j,'LG S T'GPC'wJG► V i �J't3 Gas or Oil
C -
wt:� ✓a��P.�r�Ty�T�r F/0�`��L!'tJC>/ Rou h•in
Final _ --
�•�/2/��_
SEWER
�•_��!�•--`tea`--•--- —
--"` .,.� , � Final 6'3
D L�" DRIVEWAY
Final
— ���• Storm Draina e
Rain Drain Final _•
-- ,QpY b111`
-- _ Sidewalk V
--- — Curb &Street Final
ug 44)
_ A roach
BLDG.DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final —
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
i
UNIFIED SEWERAGE AGENCY NO. ____4995 --__-___-___
WASHINGTON COUNTY DATE _3U1y_1,._1974
CITY OF - — Ti-pard - - -- ---- — -----
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Ro ik—P. Crahn _.
OWNER'S ADDRESS: 9655--S,W.--91#AXAXY Crprea8 —
STRrE
Beaverton __---__ - Oregon 97005
G1Y STATE ZIP
BUILDING SITE: LOT 3 BLOCK - _- ADDITION -_
TAX LOT NO. _ TYPE OF OCCUPANCY residence
ADDRESS __--____--1.3120-_ sh__ ua. -
DWELLING UNITS -__�,—_^___ _ FIXTURE UNITS
SURCHARGE IF APPLICABLE
CPERMIT FEE 525 INSPECTION FEE 25 _ TOTAL DEPOSITED 550 --
\ _
(hEW) 1 (EXISTING) BUILDING SEWER SYSTEM Tigard- ____._
The Applicant agrees to comply with all rules and regi! ations Of e U 'ified Sewerage Agency.
APPLICANT
SEWER PERMIT
THIS PERMIT AU AORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE Eft/ - -- INSTALLER
c
RECEIVED BY V1 L'Gs. lt�?_ - ----- ---� - -��--
IAKCY bR ITS AGE
V
COMMENTS:
This Application and permit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
CITY OF TIGARD
12420 S. W. M.In Stm,
TIGARD, OREGON 97223
APPLICATION FOR BUTI,[)ING PI'.RMIT
New Construction Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING DATE ISSUED BUILDING PERMIT
KATE RECEIVED y BUILDING FEE $-_ � No.
,iy PLAN CHECK
_ OTHER $ b G� VALUATION
TOTAL $ 'Y -' �luY-���RECEIPT No.�'�G�
C
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
t'OT # 3 MAP A _ CENSUS TRACT
_____-------.— JOB A
Architect or rngineer� = -5 -11
f4fn�
�E[?�J h '
Ph ��1 TS -feD 3
one 6Q•(��t�
Address_ _ `--~------�
Phone
Builder, l� -�--
Add resa -
_ Phone_
BUILDING IiSE Single Rea. V Multi Res. ❑ `Comm. l__1 industrial❑
OCCUPANCY GROUP No. of Stories_ Total Height`-/� Area of Lot 10001
Type of Construction I ),I III IV A(V Floor Area B`—� l�s'o-pIs.2
Set Backst Front Back— J L.Side _ R.Side__((_����
Private Sewer Pipe size` _ Sewer Septic Tank �J
water Service Pipe SizeMV
Storm SewerlA.l Ditch ❑ Drywell ❑
Street and Curb Re-quirementg_ -�_
nriv%wny Width III I � -�---�---------�_-- --
No. of Parking Spaces Z _
SL:PAPATE PERMITS REQUIRED FOR SEWER AND PLUMBING �_ `
SPECIAL INFORMATION
ADURES£ ASSIGttt 0
FIELD CHECK DY
PERMIT APPROVED
It ihe s un�leretood that all work will conform with applicable codes and ordinances
of the St"tolof of a
notnand th+ City of T=gar , Oregon, and that the building will
Tigard buil.liny fn.. Uc Certificate of Occ has bee issued by the city of
L ctor. rlcy - �— -- —
�gnbtuet�f App scant `