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EXHIBIT °s" 16. :;0
CITY OF TIGARD
C,oi TIF'ICA`E OF OCCIPANCY AND RELEASE OF RFSTRICI'ION
,The City of Titard hereby certifies that the occ,pr.acy of
the following described :structure or premises with respect to which
a restriction of occupancy was, )n _____,2 7 2�i 19—,
recorded in Book 949 , Page 570 , Deed Record of Washington
County. Oregon, is hereby authorized and approved.
DESCRIPTION OF YFOYEHTY:
oris!�l/r!G`1�d4A* f:,
OWNER: LA/ /-w_1//L' eta�GC�/F/�c�r
BUILDING PERMIT NUMBER:
7"N�r
BUILDING ;cUDIta3S./OjiS- ,SW� COCA% e)4 K- Jl7r2/ye-
This is to certify the said structure meets with the require,
ments of the Building Code of the City of TiEard and the above
referenced restriction is hereby released nod terminated.
IN WITNESS WHEREOF. the undersigned authorized officer of the'
t.
City of Tigard has caused this certificate and release of restriction
to be executed this 27 day of Icb. , 19 74.
Title: C14Y Recon
STATE OF OR@XION
Count; of Washington )ss.
On this _27 GBy Qi Feb. , 19_2jL, personally
appua_ed before me the above ngmed Doris Hartia , whose
siEna Lure nppears hereon and who a,:knowledged to me that he executed
the same in his offical capacity on behalf of the City of Tigard.
Notary Pu�ic of Oregon 0
My Commission expir,:s:
1U-d!a Mnftd..,K.:..�. . 19UU
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City of Tigard
INSPECTION BEQUEST
for
TIO 11R;E PERMIT NO : ._
INS PEC N
DATE: //9i 75' DATE ISSUED' / -
OWNERS NAM
ADDRESS . '
CONTRACTOR !____-- - ------
TEST . A r 0, Water Fiscal [I , La' ,rotary [-1
RESULT: Approved , Disapproved _1 , Pending
SKETCH.
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9 INSPECTOR DATE
ICt7Tt Attach supp!emento! test data hereto]
r
ve, CITY OF TIGARD HEATING FERMIT
7
GATE FE MIT NO. ��o/ S� RELEIFT NO.
BY -- 1 C 61614f /1 C� FEE
1. Permi sha 1 be ely a ned prior to .ommence:ment of inst&llation.
2. Permit shall be obtained for all appliances which are to become a fixture
to the building.
3. Relocation, replacements c changes to bui hers and d•act wor
require pe.mits.
4. All work t Le concealed must be before cover up. ❑
New on Installati {LI Replace ❑ Peloca�tion ❑ Addition
�r ,/-+ ?� Q_ Alteration
CONTR. ���L11i�LGC�_1CL-'1_S.�z.�--- --- ---- - OWNER
ADDRESS _Lr _(C � ��/� YA WOPK ADDRESS /O.S/�,tS:L'QJC��.r AV, Q!;
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APPLICANT
99 T.EI.EPHO NE NO.
FURNACE - MANUFACTURER �,l.p_ l��cliilc5'�� TELEFHCNE-NO. �___�•�
HEAT !, put =atlr,g (Btu Per Hour7r6'tic. Vent Size Flut- Si,aa _
FUEL GTL GAS I ELECT ❑ OTHER
TOTAL SO. FI'_ Top Flc,,or Main Floor — /-;�'y� Basement
GENERAL
ITEM NO, FEE AWT ITEM NO. FEE AM''
For Issuance of Permit 3`0 _ Boilers over 50 Hp ; 5.00
New - Under 100,000 Btu 4-,001 X Air Hand1ing_10, J10 CFM 3.0_0 _
New - Cver 100,000 Btu 500 Air_Handlling Over 1.0,0_00 CFM _ 5.00
Floor Furnace! 4A EvaDorative Cooler 3000
wall - Floor - Supended 4.0 �_ Vent tan 2000
Install Vents 200 _ Vent System r 3.00 _
R-rair - Heat & Coolin 4.00l Hood
Bailers Under 3 Hp 4`0 _ Domes tic__1;zciner_ator S.OU
Boilers 3 +-a 15 Hp _ 7. 5( Conan.,, IInc.rerator 20000
Boilere 15 to 30 Hp 0.0 _ Other Not Listed 300 y
Boilers 30 to 50 Hp 500 _.�
INSPECTOR' S COMMENTS
APPROVED BY DATE _ ISSUED BY y DATA;
S1 rate's of A 1..>�ar�t
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City of Tigard
`
INSPECTION REQUEST
for
SPECTION TIME: ` *c - PERMIT NO. ;
DATE: _ � DATE ISSUED
/HERS NAME
ADDRESS: -jr
)NTRACTOR : _------------
=ST : Air L`1, Water[I Visual p , Laboratory p
-SULT: AporovedDisapproved ❑ Pendia® p
CETCH:
INSPECTOR OA E��
TE: Attach supplemental teat data b•-ret]
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City of Tigard
INSPECTiON REQUEST
�
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for
SPECTION TIME : PERMIT
DATE: /1 / j7?3 DAVE ISSUED :_
I
INERS NAME :
ADDRESS: k� ,ru tick,("co,
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)NTRACTOR :
ST . A,r -1, Water [] , visual,/j, Laboratory []
=SUET . Approved' , Disapproved ❑ Pending (]
(ETCH:
INSPECTOR DATE
rE Attoch supplemental test data hereto]
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City cif Tigard
i
INSPECTION REQUEST
for
IINS', 1 wN TIME :9:'go PERMIT NO.
I DATE: LOZ3� DATE ISSUED:—.LL
OWNERS NAME : 774D,<--
ADDRESS : 4D,GADDRESS :
CONTRACTOR :—
TEST .
ONTRACTOR :TEST. A r J, Water ❑ , /isca^ La" ,rotary [l
RESULT. Approved pl�, Disapproved _I , Pending ;]
I SKETCH:
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INSPECTOR LATE
ICOTE : Attach supplemental test data hereto
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PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No. ,
Permit fee -2
`? Water Closets (Tr;� lets - Permit Issue�c
Adt.h Tubs Approved by
Lavator __ Was_ Bas�rl Building Perml
:3hower -- Receipt No.
itl D..shwashing_---
Sinks Ki tcht,n ewe
SirXs Crdinaa_ Lo�.atiorL of Build�rr
Sinks,�i� _� — ._ ---
La_r:dr�Tr _ Name & Address t' 0wr�-t
�_ n-•a r,'s Ari:,_, __—_ .'S=iLy ._:...t�...__� -,� _ �_._
Nanw. & Addrr.:;:
- —
t. Builr Idr' A`ter�ReDai.r �.r
Ins
�--- --.ars: r..�r`1 __,__-- -- ----•- ��F?;.—__�� __.___..._______. __.
Thi:; t .1 ' _ 7rv, v(, r] i.f work cr cons'.r,. ized 1s n r
cmmPn r: •.�: if constructirtl 11 w is ; n lod abar:d:,ned
f ,;d , , !ay.-, it -any time after work 1...; ,
A1]. p-J ,.imning firms r;us-t he Licensed by the City of Tiga:d and post 9 $1,000 bcn
I hereby rertity t')at !lave read and examined this app , al,,.. n and knew the sac
to be true, and cr,rrFc ' . All provisions of :Laws 6nt3 g^vF rning thjs t)
of work will be w1tn whether specified her(-Ln r riot, the granting of e
pemiit '. , :, n;it presumes t give authority to violate. , r the
of any c,11 • r st:tte or 1_".;al law regulating construe• t i ur► r t.hp perf, rmance of.
rd Signature o Apps 17ant. ------ ___-----
y
CITY OF TIGARD
Ism a W. m9b ltiwr
TIGARD, ORROON "M
APPLICATION FOR BUILDING PERMIT
New Construction ❑ Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING p-n DATE ISSUED_10-11-73 BUILDING PERMIT
DATE RECEIVED BUILDING FEE 'S +4.00 No. 73 . 239
PLAN CHECK $�,1Q�II
BY — OTHER $ S 4.00 recording
f 'UATTON $ __
TOTAL $---14 1% State RECEIPT No.
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TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT #-15 MAP ! 9ai Igg CENSUS TRACT , W-t JOB
Architect or Engineer T ,e Atin nagalonmant Co.
Address , Phone_
Owner
Address _ Phone
Builder --- --
Address Phone
BUILDING USE Single Res. Multi Res. ❑ Comm. 1:1Industrial
t�c-J ❑.
OCCUPANCY GROUP L No. of Stories`_ Tota), Height_ Area of Lot
Type of ConstructionHM WNW( Floor Area B 1_-�,1�2
Set Backs: Front_�� Backe L.Side41 R.Side_ ((''�"��
Private Sewer Pipe Size ave Sewer Septic lank 1_J
Water Service Pipe Size____j/4j, _ Storm Sewer-M Ditch ❑ Drywell❑
Street and Curb Requirements as required by Subdivision ordinance
Driveway Width 1.91No. of Perking Spaces
SEPARATE PE^.MITS REQUIRED FOR SEWER AND PLUMBING r
SPECIAI, INFORMATION
ADDRESS ASSIGNED 10315 S.W. Century Oak Drive
FIELD CHECK BY EWC —^—DAT£_.Uic in-ii-7A 74
PERMIT APPROVED BY�I
It is understood that all work will conform with applies cod �r(d ordinances
of the State of Oregon and the City of Tigard, Oregon, and that he building will
not be occuried until a Certificate of Occupancy has been ssued by the City of
Tigard Buileing Inspector.
I
<fature pp scant
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
structure (a) on the following descrihsd ]ands prior to the recording
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 011 issue a release
as soon as a final inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
Pte-. P..`c.c>.-a%-�� `
P\ea�c P,tc�o' �.� o! W e•►!.',.r. , �^, C a V, O r t111T-
40DRESS OF PROPERTY; �S,��s �w c._..�r� _ ��.�Oe•'�v�
NAME OF OWNERS
ADDRESS OF OWNERS
nl-\Tz)
IN WITNESS WH:REOF, hhe undsrs+fined has caused this
rietriction to be executed this \�~ day of v-� 19_-"af
OWNER:
Name op
APPROVED: Tit e
By:
Building Official
City of Tigard
STATE OF OREGON
County of Washington ; se' October 11 19
Personally appeared before me the a ove named
llor Brow and acknowledged the foregoing
instrument to be ha. voluntary act and dead.
At 4
No a�c For Oregon _
My Commission Expi:ss: 1/14/75
4541
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupan• Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
structure (s) on tris following described lands prior to the recording
of an occupancy permit releasing the restriction in the Dead Records
of Washington County, Oregon, is prohibited by the ordinance of
the City of igard, Oregon: (The City will issue a release
as soon ae 6 final inspection determines that the construction
is satisfactorily completed)
DESCRIPTION`` 01 PROPERTY:
Opt o�
ADDRESS OF-PROPERTY:
NAME OF OWNERS
ADDRESS OF OWNER: NLA ea e. .- _P\
IN WITNESS WHEREOF, the undersigned has caused this
restriction to be executed this \\72-'' day of
OWNER:
)1PPRbVED: �— Title
By:
Building c e
City of Tigard
STATE OF OREGON
County of Washington Be. October 11 , 19 73
Personally appeared before me the above named
Roy Brown and acknowledged the foregoing
instrument to be his voluntary act and deed.
�c _L
Notary Public for Oregon
My Commission Expires: 1/16/75
S�
ra•d for �e
, oed.. /7._ 10.�.. A M.PO
W)GEA THOMRBE rNnAet �•6 Et MtNnN
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Ba'K 949 ,,.L:570
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