10200 SW CENTURY OAK DRIVE-1 bi
'�Ha & H
IL
L0
cz
-79
rrl
Z
10200 SW CENTURY OAK DRIVE >e
;JA IK mvo xwlN3D MS 0070T
z
Liw
a
a
J
w
� I r
z -
�U X x
H
J
Q -
F- H�
C3
A
w
` 0 (r)
0 w 0 R "
0
rr91� Cti C`] .'.� V1 fly F*i Cir
m
_ w
Cil C7 r1 ? Q
CJ z P4 rl
U ' F 1 0000
T � O F I
y ^�
EA41
INA
�+
0-1
o �
N
o
EXHIBIT "B"
1� 3 CITY OF TICARD
C:1RTIFICATE OF OCCUPAIICY AND RELF.AFE OF RESTRICTION
The City of Tigard hereby cer*.'Cies that the ocrupaney of
the following described struc`.ure or premises with respect to W'lieu
a restriction of occupoacy vas, on — 4-� 190
recorded in Bcak _jy- , Page 76(v , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRZFTION OF 1011ERTY1
�e)
OWNER: 7tf,07Z 2'
IIBUILP-NMM
ER:PERMIT MER: 73--o2"7
I?f U LDLNO ADDRESS- /0.;2-00 c�.�. C'��l STI�/ (94& 0'e'lle
This is to certify the said structure meets with the require-
ments of the Building Code of the City of Tigard and the above
F
referenced restriction is hereby released and terminated.
IN WITNESS WHEREOF, the undersigned authorized officer of the'
City of Tigard has caused this certificate and release of restriction
to be executed thir /fir day of / lar- < 19�.
Title: 3 1 ^_
STATE OF OREGON +�lvd fa soad... ».'..1�_.._..l• Yoe/0 AM
88. G soon THON11ef3N,DI g
of wold&6 ElwM�onr
County of Washington ) p � !
♦� MR...... .y[�U!«>tLt/...................I.......... Dor,.-c
on this / _ day of -7�/cefi�IL 19)y, personally
appeared before me the above named �� a,c G�. whose
signature appears hereon and who acknowledged in me that hr; executed
the same in his offical capacity on behalf of the City of Tigard.
Z; C!e (--c
Notary Public of Oregon "
My Commission expires:
Poop 965
0
o f
6 2
ver,, ISL'
/ CITY OF TIGARD MECHANICAL PERMIT
i
DATE.- PERMIN0. _ RECEIPT NO.
BY � [i !1!' t(= _ FEE
1. Per-mit shall be obtained prior to commencement of installation.
2. Pe,mit shall be obtained for all appliances which are to become
a fixture to the building.
3. Relo-,ation, replacements, alterations, or changes to burner,- and
duct work require permits.
4. All work to be concealed must be inspected before cover up.
New Installatiop Replace L_)/ Relocation ❑ Addition ❑ Alteration ❑
CONTR. 'T i/F �i�+ //�:✓F:/ _�,• OWNER �.�1��F:
ADDRESS /�.3 rr :� <t / /Y,�e. WORK ADDRESS .,S•!C,
6 ADDLICANT
TELEPHONE NO.
FURNACE - MANUFACTURER TELEPHONE NO. : .--
HEAT Input rating (Btu Per Hour) Vent Size . 0<i Flue Size
FUEL OIL ❑ GAS" ELECT ❑ OTHER
TOTAL SQ. FT. Top Floor `-` Main Floor Basement
GENERAL
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permit 3.00 Boilers Over__5_0 H
New - Under 100 000 Btu 4.00 Air Handling 10,000 CF 00 CFM
Flo er u Air Handling Over I
—ova orativve Cooleror Furnace
a - oor - Suspended Ventan
Install Vents en a em
e a r - Heat & Cooling4 00 00
o ers n er H Domestic nc nera or
Boilers o ommInncinera• or l0
70=era o 0to Other o sUec
0=1 o
INSPECTOR'S COMMENTS
APPROVED BY _ ,jATE ISSUED BY. DATE
Signature of ApplicantC7 �,
r
I
I .
City of Tigard
I REQUEST
INSPECTION
I for
I INSPECTION TIME : PERMIT
I DATE: . Z/� DAT
'E ISSUED' __L—L—
OWNERS NAME .
ADDRESS :._
I CONTRACTOR :____
TEST: A r J , Water Ll , Visral 0 , La" ,rotary [J
RESULT. Approved L , Disapproved 1 , Pending J
SKETCH:
I
INSPECTOR DATE
[J )TE Attach supplemental test data heret]
City of Tigard
INSPECTION REQUEST
for
SPECTION TIME: PERMiT NO. :
—
DATE . _L_ DATE I S S U E D :_1_L
iNERS NAME '
ADCRESS :
)NTRACTOR -
=ST : Air u, WaterO , Visua��,, L-boratory ❑
c.SULT: AporovedX, Disapproved O , Pending O
(ETCH:
1
i
INSPECTOR DATE
TE: Attach supplemental test do%a beret0J
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. :
DATE : DATE ISSUED: L
OWNERS NAME .-
ADDRESS :
AME :4DDRESS :
C0N*rRACT0R :.___ � ✓ 1 _
TEST'. A r J, Watei_a'• ,ratory El
i RESULT. Approved Disapproved 1 , Pending [j
I —
SKETCH:
I
i
I
'INSPECTOR — DATE
IOTE : Attach supplemental test data heret]
1
i
City of Tigard
INSPECTION REQUEST
for
"PECTION TIME :. J-l3o PERMIT NO. . _
i
DATE. Ze ,A ' 3 'SATE I SSU ED- -.
OWNERS NAME : -'.r2- F -
ADDRESS ' _
I C•)N'I RACTOR
1'F.S 1 Jllm@r j , Ln
IRESULT is ppr�ti
SKETCH:
I
I
I
i
I
I INSPECTOR DATE
[OTE: Attach supplemental test veret]
1
i
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME. PERMIT"
DATE: IZ3 DATE ISSUED :—/
OWNERS NAME : �- � --- ----- —
ADDRESS: � �' � �CONTRACTOR '. —
TEST :Air G, Watery , Visual Laboratory p
I
RESULT: Apnroved Disapproved O Pending p
SKETCH.'
I
I
INSPECTOR DATE
NOTE: Atto;h supplemental test data beret I
1
f��
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Perrr,it No. �
Permit fee c�J-`'�-
.� Water Closets Toilets '.oc' Permit Issues ? 7 7
�l Bath Tubs Approved by
LavatQry WastiBasin .� Building Perm.
3h ,wer Receipt No
Sin s Lti�.;}�wa- .,>hin•-_ ` 41r'
Sinks, Kitchen _ t'
Sin ks,�C,rdl.nar_--- Locatio of Buildin,,
Sink:, dr
Sinks S c
Aut(im,t1G_is wi-�-SF er
Laundry_Tray:---.- Name Addre. , i Owr; r �ai
D:a iris , F,rc•r � ' '
D1 a:n Air c.a
Di :�:i_. Ke?r ��Grator
R.3_r_Dr ain;
/ Aut _ mat; c Washer ��^ountalnName-)& Address
s, rLri lr.__ s1 _
Fnuntains, Scdea Z
777-7—iter Tatik
"rria"IsBuil n 01d T rw �H � er Repair, or
=—ns
—__*__. r
_f�rri► k i Sy `em
=w -
f pr
----•-
�_I. rF,.e r S -._in
This 1,ermi + roc c•: : i i --nd vc iri if work (,r const rugLA', }. : ,.zed is ri r
�n'rten^ed wi '.h:r. ! i , ; _: 12 _')nstruc } . cn or, w3rk r 3ban d:,r.: d
' . . a per . .jd of ., ' , . at -Any time of t"r work irs
All plumbing firms must be licensed by the City of T1g.i.d and post a $19000 bon
I hereby certify that I have read and examined this application and knew the s
to be true and c-)rrec+ . All provisions of law- and .rdlnan,_P>> vvr-rning this t
of work w i .Ll be comps . -gid with whether speci.f leci herein nc t, t..hc- granting of
permit does not pre,um., to give authority to yr ;late or cancel '.h,! provisi.ns
of Any ether state -,r Local law regulating construction cr the ierformance of
construction.
S1gnaTure 0I Applisant
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : hERMIT NO. .' .-
DATE' DATE ISSUED'.__.L__L_
OWNERS NAME : --
I ADDRESS : (C -0 ---
CUNTRACTO R :--
ITEST .a r J, Water �] , %fisc-ol 0, Lc'- ,ratorl r1
RESULT. Appiovedo , Disrapproved 1 PNnding D
SKETCH:
I
I
i
rAINSPECTOR DATE
CNOTE' Attach supplemental test data heret]
1
181' G
EXHIBIT "A"
CITY OF TIGARD
Re,idential Structure Occupancy Restriction
KNO'4 ALL MLN BY IMSE PRESENTS, That occupancy of resid , tial
structure (a) on the following described lands prior to the recording
of an occupescy permit releasing the restriction in the Deet. Records
of Washington Cuur.ty, OreEon, is prohibited by the ordinance of the
City of Turd, Oregon:
DESCRIPTION OF PROPERTY:
1�'s [moi�....\...G.�- t'1 W C� �t� �-�J J U\� �� , P Cl.C'�►,� ��,
ADDRESS OF
NAME OF OWNER:
ADDRESS OF OWNER:
v -\t.. A.
IN WITNE.So WHEREOF, the undersigned has caused this restriction
to be executed this day of
OWNER:
/U/��.�;•��lJ �.JE EGO 7'
Nam
APPROVED:
/ v le
By: �.
Building Official nI dIanaKd..y..: PM
City of Tigard noctR TMOM9881q. ,DjA�* �r el Itecerde b EI#H+nn'
STATE OF OREGON ) ss.
County of Washington ) September 6 __, 19_U.
Personal-i� appeared before me the above named R91 Brown.
Vice FrMAM nom_ and acxnowledged the foregoing instrument to be
voluntary act and deed. .p
Notary Public for Oregon
My Commission Expires: j&AM&�Y 16. 1975
ao�� 945 f,,6[788
�
, of f§
%
C-i
A f2-5 k
Z
}
/
!
\ L) } .
c�
. �
CITY OF TIGARD �
11410 f. W. Main Nrg*
TIGARD, 0111"114M ff111
APPLICATION FOR BUILDING PERMIT
New Construction Demolish LJ Addition ❑ Remodel ❑ Move❑
ZONING DATE ISSUED BUILDING PERMIT
BUILDING FEES$7
No.
DATE RECEIVED '73�/�+��
PLAN CHECK $ _ 1�7 j° VALUATION $ �__
d Y 12, sTrTt I—,T°f
+`— OTHERq,K,&& c[oao1L�!
TOTAL $ RECEIPT No.—
TWO SETS OF PIANS AND PLOT 'LANS MUST BE FURNISHED WITH APPLICATION
LOT M_ A�Q_ MAP N �� t - / _ _ CENSUS TRACT 11SL � JOB 1� _
Architect or Engineer
Address Phone
Owner
Address Phone_.__—�
B u i l d e r _--�—�-- --- ----- — — --
Address— _ Phone___—_
icUILDING USE Single Res. ® Multi fees. ❑� Comm. ❑ Industri.alC�
oCCUPANCY GROUP L- No. of Stories__ Total Height /!5t _ Area of Lot-2160
Type of Construction I 11 III IV (VFloor Area B_____ 1 /4/Z 2
Set Backs: Front�Qdack�Q_J L.Side �� R.Side
Private Sewer Pipe Size__ —_ SewerklLyf, QY Septic Tank ❑
Water Service Pipe Size Storm Sewer Ditch ❑ Drywell❑
Street and Curb Requirements__.__.
Driveway Width____LS— — ^_-____—No, of Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBIN;
SPECIAL INFORMATION
ADDRESS ASSIGNED��'nZb[j
FIELD CHECK BYvw ,— DATF.��—�_
PERMIT APPROVED B**
!e is :understood that all work will conform with applicable codes and .)ruinances
of the State of Oregon and the City of Tigard, Oregon, and that the building wil
not be occupied until a Certificate of Occupancy has been issued by the City cf
Tigard Building Inspector.
S gi nature of�. _ licant
r�