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�► CITY OF TIGARD MECHANICAL PERMIT
DATE PERMIT N0. -_) RECEIPT NO. 916V
BY FEE _
1. Permit shall be obtained prior to commencement of installation.
2. Permit shall be obtained for all appiiances which are to become
a- fixture to the building.
3. Relocauion, replacements, alterations, or changes to burners and
duct work require permits.
4. All work to be concealed must be inspected before cover up.
New Installation Rf Ylace- Relocation Addition,0 Alteration U
CONTR. OWNER °�:"►c t j<'/ C-
ADDRESS %:;Lr2(07 zS �./ { //�' WORK ADDRESS � "
APPLICANT _ e ZZ,
,, TELEPHONE NO. -w- %•c" - � 3/
FURNACE - MAPS JFACTURER __- ���(r fii/Cx TELEPHONE NO.
HEAT Input rating (Btu Pc:r ;?nUr.IF__1_, t'ri_jlVent Size cl _ Flue Size
FUEL OIL ❑ GAS N ELECT OTHER _
TOTAL SO- FT. Top Floor --7"- - Main Floor / / Basement - •
GENERAL
ITEM NO. FEE ITEM NO. FEE
For Issuanco of Permit _ _ _ 300 ' Boilers Over
New - Under 100,000 Btu _ . - ng0---H0
—
4_00 Air -Hand]_ing-lOtC►00_CFM
�� �
New - Over 100,000 Btu _ � Afr Hauling_Over 10,000 CFFMM_
FloorTurnace — Evaporative Cooler p
Wall - Floor-- jjMgnde— Vent_Fan —- --- ---" -
Instal Vents ?° Veni Syyss em-�__-` 0
Repair Heat do Coolin _.00 Hoodw �
Bci ers�er�A _ _ - - - °
4 00 Dames�ic-lncinera£or 0
Boi erS-3-1015-H _ 7.j0 omm:`incinerator�-___ 20.0
Boilers-15tBoilers- 15 to 30 HP 10.00 erOR Lisp;(?a-
Boilers 30 to 0p -'� ---------------- °
INSPECTOR'S COMMENTS
APPROVED BY _ DATE ISSUED BY DATE
Signature O—Applicant
EY lBIT "B"
CITY OF TIGARD M02
C:U.TIFICATE OF OCCUPANCY AND RELEASE 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 August 1'3 ! �, 19_,
recorded in Book _';'i , page 58 , Decd Record of Washington
County] Oregon, is hereby authorized and approved.
DESCRIWION OF PROPERTYC
Summerf Lp.1d - Lot u4`y
OWE: Tualatin Devel.opment Company
BUILD'NG PERMIT NUMBER: 3-1`
6 LDLNG ADDRE.99: 10'70 S.W. enturJ Oak Drive, Tigard, Oregon
1rhis 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.
LN WITNESS WHEREOF, the undersigned authorized officer of the'
City of Tigard has caused this certificate ani release of restriction
to be executed this day of fi,a W 7 -
Title:
STATE OF ORM014 )gs�
County of Washington )
On this .�7 day of-- 97 2 personally
appeared before me the above nameli _�� whose
sign-. a appears hereon and who acknowledged to me that a executed
the same in his offical capacity -)n behalf of the City, f Tigard.
Notary Mblic of Oregon
My Commission expires:
RUQF.R THUMSRCN.Eatt.e».r W R..erl.8 El.e�y,e.
_..........................
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City of Tigard
INSPECTION REQUEST k
for
i
INSPECTION TIME: _. J PERMIT NO. :
DATE: DATE ISSUED :--L- Z
i
OWNERS NAME .
ADDRESS". - e(-
CONTRACTOR .' -
TEST :
ONTRACTOR :TEST : Air n, Wats. ❑ , Visual [1 , Laboratory p
R-'SULT: App-ave d/e , Disapproved ❑ Pendinp �`
SKETCH.
INSPECTOR BATE
COTV Attach supplemental test data hereto
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : . IERMIT NO.:
i
DATE: -.// DATE ISSUED:
I OWNERS NAME : _T h L.,
I ADDRESS : _
I CONT-RA(;TOR :_ ¢� (W6T�r✓
TEST'. A r L7, Water p , visual , La" ,ratory [7
RESULT. Approved , Disapproved , Pending p
I SKETCH:
I
I
I INSPECTOR DATE
I [NOTE Attach supplemental tort daft novel]
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City of ' i Bard
INSPECTION REQUEST
for
INSPECTION TIME : __-_ PERMIT NO. : .__-___-_
DATE: DATE ISSUED -
OWNFRS NAME : 7702, l�--- --
A D D R E f�S :
CONT'RACT(0R :—s_7ZccCGc -- _
TEST'. A r 0, Muter 0 , \visual 0 , Lo' ,rotary [t
RESULT: Approve&J21", Disapproved _l Pending 0
SKETCH:
I
I
I
NDATE
If, )TE Altoch supplemental test data heret:01
1 '
-.� rrrrrnr
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of Tigard
INSPEM ION REQUEST
for
64944off—
!NSPECTION TIME . PERMIT NC
DATE: 10/ z Z DATE ISSUED . —_._L_
OWNERS NAME : -—c—
ADDRESS: 7v Sew c&„��er
: EST - , h-terQ „
RESUt_•" - p.-roved ;..tlppro.ed G
SKETCH:
L :T.�r3
INSPECTOR DATE
NOTE: Attacn sup pi emeota test uata herFto
f
EEL
i ty of Tigard
INSPECTION REQUEST i
for
NtiPECTION TIME. --Z_ V_o PERMIT NC. .
DATEX2"72* DATE ISSUED .—,-/ I
OWNERS NAME . T t7, c-
ADDRESS: _—L�_. 7_0 3cG't' Q�c►K pct, I
r;nNTRAr,Tr) R --- --��
EST ' . v tet �� '.abc►et.�r,, r7j
RESUL ' P.-roved, �.:upprored G vidi,iq Lj
SKETCH:
I
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NSPECTOR DATE i
50TE: Attars, nupmemental test uuta beret] I
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type f Fi xt,,rP FP" Permit No. �.;.
Permit fee
_ P �rmit Issu
od
bathTir_r_- Approved by
avhrBuilding Per-
at m?-_ r
Receipt No.
L(,ca on of Pu I.Id i.rag
:S 1 n l _;� -- ---
Name A Addr r Ow --
_T7 _
A m _ ---- _ Pdame 1 Andre:-,
�• __�._.. __'_._._____ ___.�` '`'"� Au1l.alrr l l'` 1 ( Nit:)?T• Re a.tz r��
v 0 .1 f wr)rk r;r c,;r,, 70?d 1 - rr t
-
V, e!" 7 '•a: `t;. . if _ r Gtrur+.a r. y it itar.d-ned
. .; 1 env +j me of tc-r w-.�rI< ;ntn
;,1:1 p-i0tmbing fzr b- licensed by the City of T, Fr,_ end post. a $1 ,000 bored
I hereby uf:rtz.f U. : t 1 navw --ad dnd examined this and know the sam
by true and All pro-i isl ons ,: .' I ,iws ,,-i 1 :.,rn:.ng this ty
work ti.i : l bF: 1 : wt Ltr whet}rer specz f ted her-ein ( r r ,t, granting :,f a
t. ,rtnit. d ' c give authority to vic lat.., , r , anC C I t;,, prr.V IsI-ins
i :any : -1 law ret-ulating sonstruct.lon c ; the I, -rformance - f
S+gnatue o f Ane
i
of Tigard
INSPECTION REQUEST
_ for
INSPECTION TIME . PERMIT NC.
DATE . < , DATE ISSUED
OWNERS NAME
ADDRESS: ---_
cnN rRAr'YnF. : '
EST h, ter[] , '.ab-rC't,)r -
PESUL_.. . ruvedW Upp, ,,.d G ��idi.�:; L
SKETCH. ~
INSPECTOR DATE
[NOTE: Attach aupplementa' teat uate herrt01 I
CITY OF TIGARD
12420 S. W. Main IN
TIGARD, ORROON 77237
APPLICATION FOR BUILDING PERMIT
New Construction it Demolish ❑ Addition u Remodel ❑ Move
ZONING F-d _ DATE ISSUED 8.$.7_3 BUILDING PERMIT
DATE RECEIVED BUILDING FEE $ W No. 73
BY PLAN CHECK $� 31►.m,_ 17,43k
OTHER $_
VALUATION $
TOTAL $ �U2,fY1 RECEIPT No. kt;,; _
--.
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TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT M 49 MAP A 281 11C CENSUS TRACT w-8 JOB N
Architect or Engineer +` T.D.C.
Address 153DO e.w. u6tb Ave_., iLud, ore®oa _— Phone
Owner _
Address _ ---Phone
Builder `Y_
Address __Phone
BUILDING USE Single Res. ❑ Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROUP_ No. of Stories 1 _ Total Height____— Area of Lot
Type of Construction 01 V Floor Area H 11178__ 2
Set Backs: Front- 7 Back_ 88 L.Side ]__ R.Side 6
Private Sewer Pipe Size 4" Sewer Kine aLv Septic Tank ❑
Water Service Pipe Size` 3/4" Storm Sewer ® Ditch ❑ Drywe11❑
Street and Curb Requirements --existog
Driveway Width 181 No. of Parking Spaces Z
SEPARATE PERMITS REQUIRED POR SEWrR AND PLUMBING
SPECIAL INFORMATION
FDC RESS ASSIGNED 1037o A.Y.
FIELD CHECK BY ZVC DATE 8-7.73
PERMIT APPROVED BY / 41 .
It is understood that all work will conform with applicable codes and ordinances
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.
qna ure Applicant
i4g82 �:
EXHIBIT "A"
CITY OF TIGARD
Her;identlal Structure Occupancy Restriction
KNOW ALL IC;II BY THESE PRESENTS, That occupancy of residential
tructure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Dee" Recoi 's
of Washington Cuunty, Oregon, is prohibited by the ordinance of the
City of Tijird, Oregon:
UEaC11IPTIUN OF PROPERTY:
..�y rcf��•..-�i�r/ i./r /-i'C4 -T.?j
�.�� .l.•r t^re.Is C1 N��s`l.rs�J�nH C:•r�.'r*' � �'�i�90H.
kUDI+Z; OF I'HUI'ERTY: Q V V -
NAME 01' OWNER:
ADWU.k; OF uWUR. t4
IN WITNE53 WHEREOF, the undersigned has caused this restriction
�.o ue executed this, day of
1
OqNER: Tualatin Development Co. , Inc.
F'me
API'RUVEU: By: /CL
Title
By: (��L/i �_(!` �ry2 aoctit'7HOMIIBLN,0110AW N ROOM&S 810mare
building off icle
City of Tigard ry_....................• ... ...................Deputy
STATE OF OREGON ) ss.
Cuunty of Washington ) August 7 , 1973 .
I'ersonallL appeared before me the above named Roy Brown, Vice President
i I nalalin Development Co., Inc. and acknowledged the foregoing instrument to be
hie_ volul:4ary act and deed.
Note Public for Oregon
t-V Comm'.pion Expiree:January 16, 1975
F:Jt 939 FAI968
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71
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MR
EXHIM "A"
MY OF TIGARD
Residential Structure Occupanr_y Restriction
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 restriction in the Dee,. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY:
SV <r T M t 94-A
X13 �'l'Cc,C1ti0 �w•` 1�bCll ;al �ACiE 5�`�
Y11\C '6'ci rk:._ C�� \�. 4v,�,��'filt•brt'r,r,� ; y'
ADDRESS OF PROPERTY:
,rAML OF OWNER _ —X� y .�sa�S
ADDRESS OF OWNER: �g�_�c. vv �� '�` -4� ,a
IN WITNESS WHEREJF, the undersigned has caused this restriction
1.o be executed this; ��= day of L ly
OWNER: Tualatin Development Co., Inc.
---� -" � Name
APPROVED: hY: �� �
By:
building off 1.
City of Tigard
STATE OF OREGON )
ss.
County of Washington
Personally appeared before we the above named I&gygrawn. Vice 1're:4ideng
of 'I'uelatin Dwelop at_�o.T t.- and a�kncvledged the foregoing; insN:rume A. to bu
Voliu.Lary act and deed.
N()taey Public for Oregon
H;i Commission Expires: famur� ice. 197!