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EXHIBIT "B"
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND REIZ&c;E 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
recorded in Book i , Page , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF PROPERTY1
Summerfield - lot 3
Is recorded in Book 32, Page 50, Plat ftarords ,,l
Washington County, Oregon
OWNER: rpt .
BUILDING PERMIT NUMBER: 7/1-19
BUILDING ADDRESS:
I
This is to certify the said structure meets with the require-
ments of the Building Code of the City of Tigard and the above
referenced restriction in hereby released and terminated.
IN WIV(ESS WHEREOF, the undersigned authorized officer of the'
City of Tigard has caused thin certificate and release of restriction
:o be executed this /,, day of /u,,, , 192.�..
Title:
STATE OF OREGON )sa.
County c :rashington )
On this t� day of , 19 7j, peroona.11y
appeared before me the above named 1 yrls i"_, whose
signature appears hereon and who acknowledged to me" hat he executed
the same in his offical capacity on behalf of the City of Tigard.
ry rublid of Oft60971-1—
My Co asioir8gpires:
.d sot..tee.. A P M.
nOGn THON W N,ftw"M W'"809b j,bereea.
j
BOOK J.7n UO ,u-,6c 9n 7J
9 .....,_... .. ......... . b,r„
STATE OF OREGON
County of Woshirpton
and Elects EM ten, Dfrktor of Reco.ds
"Mane" For solid x-Off'No Recorder of Con-
recelved and therheca�r l nb0ocounty k f�eb n ert
Was
No. rft,&
of -_...._.
sold may"""--
Witness my ho-d and sea! nfflxed.
ROGFR THOMSSEN,
Records d Oiredor of
Electlo.y
DepsAy
J�� 7 1231f11 '711
I
Cit of Tigard
Y g d
INSPECTION REQUEST
for
INSPECTION TIME: _ PERMIT NO. :. I
DATE: 3 DATE ISSUED :--/—/ I
OWNERS NAME : --Z-
ADDRESS:/
AME : �- c
ADDRESS:!�c '�,� -:t:
CONTRACTOR : -1-t,7- Yr .?
TEST : Air p, Woter❑ , Visual O Labor I
story p
RESULT: Approved p Disapproved p Pending p
S KETCH: I
C
14
TOR DATE
CN07E: Attach fu001emental test data beretoJ
City of Tigard
INSPECTION REQUEST
for 0
INSPECTION TIME* PERMIT NO. :------
DATE.' -'$
O. :______DATE: 3 b; `E2 DATE ISSUED :__1 Z
OWNERS NAME . T ,0 C. -
ADDRESS:
CONTRACTOR :
I
TEST : Air O, Water[] , Visual [] , Laboratory []
RESULT: Approver! 0 , Disapproved [I Pending L]
SKETCH.
VV.
INSPECTOR DATE
EN07E Attach supplemental test data hereto]
ALL SPACES MUST BE ENDORSED
PRIOR TO APPROVAL
OF TH E PLANS
PURLIC WORKS DEPT, BYE%�-f/C �� DATE'- EJB
PLANNING DEPT. BY___,----- DA'i E ---
BUILDING DEPT, 13)'-
COUNTY
YCOUNTY HEALTH DePT. pY.
-IT'/ ti'2 BY
TIC D l i: 'I. EY G
USA GY
R
N. NATURAL GAS r.Y.
P. G. E. BY.-
T.
YT. R. F. D. 9Y.- I
I
� ',� •+9 ` ,. Ni
CITY OF TIGARD MECHANICAL PERMIT
DATE PERMIT NO. �:�5�/� RECEIPT NO. �_-
BY —.L� " �`c"---_�.ZlFEE 7 A2-------- -•---------
l. Permit shall oe obtained prior to comi,iencement of installation.
2. Permit sr•al.1 be obtained for all appliances which are to become
a fixture to the building.
3. Relocation, replacements, alterations, or changes to burners and
duct work require permits.
4. All work
to be concealed must be inspected before cov(.r up,
New Installati n 1 Replace ❑� Relocation ❑ Addition Alteration U
CONTR. c ��_1�1__._.. �L. �%?..__Y .�- _. OWNER
ADDRESS /1 ;3L�_;�1"/() i/(�-!`• _ WORK ADDRESS �( ' ,��?-ZL (,W/,
APPLICANT --T moi r?t
TELEPHONE NO. T�l� -0;�3 --
FURNACE - MANUFACTURER __ /3� - �' 1.Jt�t TELEPHONE NO
HEAT Input rating (Btu Per Hour) _ c?(`� Vent Size Flue Size
FUEL OIL ❑ GAS�O ELECT ❑ OTHER
TOTAL SO. FT. Top Floor � _ Main Floor —/�?!/� Basement
GENERAL
rte- ITEM NO. FEE ITEM NO. FEF
For Issuance of Permit _ _ _ .00 _ Boilers Ove 50_Hp—�_ �,T
New - Under 1009000 Btu x 4.00 Air_Handling_101000 CFM_
New - Over 1001000 Btu _ _ ,� Air Handl .ng_0_ver .10,000 CFM _
Floor Furnace _ - 4.00 • Evaporative_ Cooler �_ .0
Wall - moor - SuS�JP_l�ded _ Vent 1;'an --____--_ �
Install—Vents _7- Vent_c-r—S,Tem _— —__ 3�0
Repair - Heat & Cool.i_n _— _-T,-.00 _Hood _ _ ______
Boilers Under 3_ H-- 4.00_ r
-�� _ - .i.c Incinerator_ -- 0
Boilers 3-to 15 Hp7. 50 -Domestic
20.0
rs
Boile15-T 30 H ---- _ 10.00 � 6t-F _
er 7-01 Hied
Boilers 50 to -50 HL---"---- 70_.
INSPECTOR 'S COMMENTS
APPROVED BY DATE ISSUED BY DATE
�. YILL
Signature of Applicant
t
City of Tigard
INSPECTION REQUEST
for
r—
INSPECTION TIME: � ' PERMIT NO. :
DATE: DATE ISSUED :--L-Z--
OWNERS
SSUED :--l_1__OWNERS NAME :
A
AME :A D D RES S:
CONTRACTOR :
TEST * Air ❑, Woter❑�' Visual , Laborotory ❑
RESULT' Approved , Disapproved ❑ , Pending ❑
SKETCH:
i
49
I
f
INSPECTOR DATE
LJ?QAttach supplemental test data beret
1
City of Tigard
INSPECTION REQUEST
for
..�
INSPECTION TIME : ��'� PERMIT NO. :
DATE : DATE ISSUED:__1 I
OWNERS NAME .- . 71)C, �___
ADDRESS : . 43
CONTRACTOR
i
TEST: Air ❑, Water ❑ , Visual, Laboratory ❑
RESULT'. Approved, Disapproved ❑ , Pending ❑
SKETCH* Y_zy
' �
INSPECTOR DATE
[NCTE: Attach fupplementol test date Aeret]
I
e
City of Tigard I
INSPECTION REQUEST
for !
INSPECTION TIME: PERMIT NO
DATE / DATE ISSUED :---Z.-.Z--.
OWNERS NAME : ..-_
ADDRESS:
CONTRACTOR :
TEST : Air 0, Wotsr p , Visual p , Laboratory p
RESULT: Approved Disapproved O , Pending p I
SKETCH:
e
e
i
I
1
I PECTOR DATE
NOTE Attach supplemental test data beret !
_ I
i
of Tigard
and
City 9
INSPECTION REQUEST
for
iINSPECTION TIME * .3;C4::� .,,PERMIT NO. :
DATE:3 DATE ISSUED'.
OWNERS NAME * -
iADDRESS : ,<o JY1�lf.P�i�Gy
I CONTRACTOR :=, --
TEST. Air D, Water [1 , \fisunl k, LU borotory ❑
RESULT: Approved*'l Disapproved U Pending []
I
SKETCH:
I
I
I
I
I INSPECTOR DATE
I
]
OTE : Attach supplemental test data heret
I
i
I
� 1 I
C y of Tigard
INSPECTION REQUEST
EST �
Q
for
INSPECTION TIME: PERMIT NO. :
DATE: ---f// /-Z DATE ISSUED :
OWNERS NAME :
A DD R E 3 S:
CONTRACTOR :
TEST . Air ❑, Water�� Visual 0 , Laboratory p I
RESULT. Approved Disapproved 0 t pending p
SKETCH: °
I
e
I
I
I
SPECTOR DATE
C0TV Attach supplamantal test data berets]
I
EXHIBIT "B"
CITY Cr TIGARD
CERTIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hereby certifies that the occupancy of
the following described structure or premiseF with respect to which
a restriction of occupancy 1rta, on Feb. 15. ► 19 7/j,
reccrded in Book 963 , Page 109 , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRI171ON OF PROPERM
Summerfield - lot 3
As recirded in Oook 32, Page 50, Plat 9ecords of
Washington County, Oregon
OWNER: Mr. e Mrs Pnhort 1 Ila+nrmnn
BUILDING PF7111T NUMBER: 74-19
BUILDING ADDRESS: 10045_S.11. e n f,i j r r i i i P
This is to certify the said structure meets with the require-
ments of the Building Code of the City of Tigard and the above
referenced restriction is hereby released and terminated.
IN WITNESS WHEREOF, the undersigned authorized officer of thw'
City of Tigard hee caused this certificate and release of restriction
to be executed this day o. 19_
Title:
STATE OF OREOON )es.
County of Washington )
On this day of , 19_, personally
appeared before me the above named , whose
signature appears hereon and who acknowledged to me that ne executed
the same in his offical capacity on behalf of the City of Tigard.
Notary Public of Oregon
My Conm:ission expires:
EXHIDIT "A"
CITY OF TICARD
Residential Structure Occupcny Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of reoiJonticl
structure (o) on the following described lands prior to the recording
of an occupancy purmit releasing the roatriction. in thn Deed Rocordo
of Washington County, Oregon, is prohibited by the ordinance of
the CiLy of Tigard, Oregon: (Tho City will Janus a esloces
as noon no a "incl inopection doteroinoo that the construction
is antiefactorily completed)
DESCRIPTION OF PROPERTY:
ADDRESS OF PROPERTY: r
NAME OF OLIN ER:
ADDRESS OF OWPtER: o oca g� �.��=
IN WITNESS WHEREOF, the undersigned hoo caused this
restriction to be executed this 4_�`= day of
OWNER;
Na101
APPROVED: ' / Title
C
B y: .�%
uil-ding Offici l
City of Tigard
STATE OF OREGON ,,
County of Washington Co. {' 9 Y
PeFsonal.l;• appeared before mo the above Waned ,.
Tei — and acknowledged the foregoing
instrument to be f�,-y vo} ntary act and dead.
gstory Public' for Oregon
y Commiacion Expires:
awl
1.5039
EXHIBIT ^A"
CITY OF TIGARD
Residential Structure Occupany Roatriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy permit releasing the rentriction. in the Deed Records
of Washington County, Oregon, is prohibited by r3 ordinance of
the City of Tigard. Oregon. (The City will issue a releaso
an auun so a ?incl inspection determines that the construction
is eatiafnctorily comolated)
DESCRIPTION OF PROPERTY:
AODP.ESS OF PROPERTY:
NAME OF OWNER: at r . say-,& Mrd_ 4�.�,�*_�� �. W4.,[ _,n r.o.n
ADDRESS OF OWNER:
IN WITNESS WHEREOF, the undersigned hes caused this
reatrictiun to be executed this eg' day of
OWNER:
APPROVED:
B y:
U�jildirg Offic. s
City of Tigard
STATE OF OREGON
County of Washington 89' a,� , 19 G.-y
Personolly appeared bofore me t kr above name
Y _ sand acknowledged the foregoin
instrument to be _ volunt)ary act and deed.
Notary Public fat Oregon
fly Commiocion Expires;
t74d for racerd.. .t.F.4S10 Zal. ..A M.PM_
1NOM°SLN,Mrae+nr a1��..7aj/,ado b Efanion�
N[ �. T1wC i1y
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Jog
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CITY OF TIGARD
12420 5. W. Maln Slreef
TIGARD, OREGON 97223
APPLICATION FOR BUILDING PERMIT
flew Construction ® Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING_n n DATE ISSUED BJILDING PERMIT 5
DATL RECEIVED BUILDING FEE $ (%/. , i No.
PLAN CHECK $ �.l l _ '7 y ^ f
BY '".fVALUATION $ 3 5-06
— OTHER $ ([
-TOTAL $ c& �x slim RECEIPT No. _
TWO SETS OF PLANS AND PLOP PLANS MUST BE FURNISHED WITH APPLICATION
LOT # :3 MAP A CENSUS TRACT JOB A ��003 _
Architect or EnginneEV���iL-L
Address �('�O S_L.�• _��(p*L. �' .r�, _Phone &30)
Ownery„�
Address ____A Phone_
Builde, Sc- C, _ ----
Address Phone
BUILDING USE Single Ree. a Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUPr No. of Stories_ Total Height, Area of Lot
Type of Construction I II III IV CV) Floor Area B 1 /�/(�G> 2
Set Backs: Front!(', Bacft�_ L.Side_._q- _ R.Side_q__
Private Sewer Pipe Size � Sewer h rilr Septic Tank
Water Se:.vice Pipe Size Storm Sewer [Er Ditch ❑ Drywell❑
Street and Curb Requirements
IS
Driveway Width $� _No. of Parking Spaces_3
SEPARATE PERMITS REQUIRED FOR SEVIER AND PLUMBING
SPECIAL INFORMATIOJ
ADDRESS ASSIGNED /vim;y" -i' cc/ !�r,�%=Y ow 1*raie- —
FIELD CHECK BY `_DATE
PERMIT APPROVED BY
work w conform with a licable Godes and ordinances
It is understood that all or ill pp
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 App1 ant