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EXHIBIT "Bu
CITY OF TIGARD 4065
CERTIFICATE OF OCCUPANCY AND RELEASE OF RFZTRICPION
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 6_7 , ly 74,
recorded ir. Book 978 , Page 690 , Deed Record of Wnahington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF ERCP;-!;,.TY:
Summerfield lot 196
As recorded in Book 34, Page 5, Plat
Records of Washington County, Oregon
OWNER: Mr. 6 Mro. R. E. Turner
BUILDING PERMIT NUMBER: 74-83
BUILDING ADDRESS: 10165 S.W. Highland Drive
This is to certify the said structure meets with the require-
ments of the Building Code of the City of Turd and the above
referenced restriction is hereby released and terminated.
IN WITNMS 1,111MOF, the undersigned authorized officer of the'
City of Tigard has caused this certificate and release of restriction
to be executed this clay of 19
Title:.l11Y-RECOM _
STATE OF OMGON
County of Washington )as.
On this day of 19 "M personally
appeared before me the above named _ ,�j/ , , whose
signature appears hereon and who acknowledged to me that he executed
the same in his offical capacity on behalf of the City of Tigard.
i4 terry Publil__ regon
My C ss expires:
"Id la Mmd. is I-N."..`7y. A M r M
Roots TMOMMM a odu tl%M"a 91"he"
BOOK 994 PACE65v
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City Of Tigard
INSPECTION REQUEST
for
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INSPECTION TIME : PERMIT NO.:
DATE: .21/7/7¢ DATE ISSUED:_.LL
OWNERS NAME :
I ADDRESS : - _
CONTRACTOR :
TE 4T* Air ❑, Water O , Victual ❑ , Laboratory O
RESULT. Approvedo�_ ,Disapproved p , Pending 0
SKETCF: `
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SPECTOR DATE
ICOTE : Attach supplemental toot data hereto
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XLL SPACES MUST BE ENDORSED PRIOR TO
ISSUANCE OF BUILDING PERMIT
PLANNING DEPT.
PULL I C WORKS DEPT. ��-�'�7��^ Dat a _
BUILDING DEPT. D '.`�
y L ...e
TUAT ATTN RURAL
FIRE DEPT. I3y ���. . -Date---------
APPROVr-D rC;
CITY 0 '
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BY --- -- --- TITLE DATE
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City of Tigard
I
INSPECTION REQUEST
for
wof _UU
INSPECTION TIME: _ _ PERMIT NO. :_-. I
DATE: 7 _ ,-*'0 /- DATE ISSJED : Z I
OWNERS NAME : 7. 10- C ,
ADDRESS:
CONTRACTOR :
TEST : Air ❑, Water❑ , Visual ❑ , Laboratory p I
RESULT. Appraved4 , Disapproved ❑ , Pending [j
SKETCH;
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INSPECTOR DATE
NOTEAttach supplemental test data beret] I
T I
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO.:
DATE: / / DATE ISSUED:_.1_L_.
OWNERS NAME: --Z: '• C -
ADDRESS: 4%;�/ 196
CONTRACTOR :
TEST.Air❑, Water L1 , Visual [3 , Laboratory ❑
RESULT: Approve44 , Disapproved ❑ , Pending ❑
SKETCH:
1
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I PECTOR DATE
supplemwal test date Aerotc]
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1 City of Tigard
I
INSPECTION REQUEST
for
IINSPECTION TIME : PERMIT NO.: ._..
I DATE: 6, 2YIXY DATE ISSUED:__L_L.._
OWNERS NAME : — H n r• ss-1''-�
ADDRESS : _ _L4 !"i 2 >G
CONTRACTOR :
I
ITEST:Air❑, Water ❑ , Visual 0 , Laboratory ❑
RESULr. Approve Disapproved ❑ Pending ❑
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I SKETCH:
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INSPECTOR DATE
IOTE: Attach supplemental t*st data hereto,
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City of Tigard
INSPECTION TION REO U E ST
for
INSPECTION TIME : PERMIT NO.: .r .
DATE: / / DATE ISSUED:_..LL.
OWNERS NAME : -
ADDRESS : -
CONTRACTOR : -
TEST:Air ❑, Water (] , Visual ❑ , Laboratory ❑
RESULT: Approved ❑ , Disapproved, Pending ❑
I SKETCH:
z
IN PECTOR DATE
COTE: Attach •upplementol toot date Wet
PLUMBING PERMIT APPLICATION
Jurisdiction of -
No. Type of Fixture Fee Permit No. 2!Lzi/L
Permit fee tis1° L .
Water Closets ('Toilets SCO Permit Issue—
Bath Tubs _ d` Approved by
Lavatory Wash Basin _ � Building Perm
r9p
Shower Receipt No. o
in s is was ing
SinksKitchen _
Sinks Ordinary Location of Building
� —
Sinks i Bar--
Sinks Slop
Automatic Dishwasher
Laundry Trays Name & Address of Owner sc_�LA N
Drains, Floor ` / _ _
Drains Area .� � n(-j l7'' --
Drains, Refrigeratorr
Rain Drains
Automatic Washer Name & Address gf Plumber _
_ Fountains, DrinkIn / N'%�/�•P�''riy��/���
Fountains, SodaU --�1 � -
Hot Water Tank
Water Service Size) ! _
Urinals B Old or�ew (Alter, Repair or
Catch-Basins - ark _ _ _ d-S-Til -
S - --
Lawn Sprinkler stem_y—
Swimming Pool__ __ Other _--
S rinkler system___ —This permit becomes null and void if work or construction authorized is not
commenced within 60 days, or if construction or work is suspended or abandoned
for a period of 120 days at any time after work is commenced.
All plumbing firms must be licensed by the City of Tigard and post a $1,000 bond
I hereby certify that I have read and• examined this application and know the san
to be true and correct. All provisions of laws and ordinances governing this ty
of work will be complied with whether specified herein or not, the granting of a
permit does not presume to give authority to violate or cancel the provisions
of any other state or Local law regulating construction or the performance of
construction.
301 v� Signature of Applicant
CITY OF TIGARD
12420 S. W. Main Street
TIGARD, OREGON 97227
APPLICATION FOR BUILDING PERMIT
New Construction Demolish ❑ Addition ❑ Remodel ❑ Move❑
ZONING DATE ISSUED S'�1w _ — BUILDING PERMIT
F>I c
DATE RECEIVED f - )'1 Y BVILn�r, .F < No j
PLAN 66�l CK $ _ _
BY - VALUATION
-- -- OTHER/T-1, /') $ _ RECEIPT No.
TOTAL
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LUT Nf��, MAP $_ ___ CENSUS TRACT _1 _ JOB N
Architect or Engineer-, ,,Jn- •-;n 1 s-- VC -r-�---
Address
Owner
+1� Phone
Address -
Builder-=71-1)_ -___----__ ___ --- - ---------.___
--------Phone _----
[3UILDING USE Single Res. D Multi Res. ❑ Comm. U Industrial
OCCUPANCY GROUP,1 No. of Stories-- (__•_, Total Height -_ Area of Lot__
Type of Construction I II III IVC-V:-., Floor Area B`
I
Set Backs: FrontI_D1 Backe L.Sa_de R.Side -Lo1�
Private Sewer Pipe Size__!)--____^ SewE.rJSiu�� Septic Tank
Water Service Pipe Size_3 Storm Sewer X Ditch ❑ Drywell❑
Street and Curb ---------------
Driveway Width sf2r- _ No. of Parking Spaces_
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
rY% ---
ADDRESS ASSIGNED., 1- -
- 9YG ---- ----- - DATE ,� /•�
FIELD CHECK BY _--_—---- _-�-�-._-- ______ -___�_ ___�
PERMIT APPROVED
It is understood that all work will conform with applicable codes and ordinance
of the State of Oregon and the City of Tigard, Oregon, and that the building wi
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector.
op z
S gnature of ApplicahE
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MCN 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 Deet. Records
of Wachington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY':
34
t�tcr�rC�S 6� V��uS��ll�c���r, Ca�l��y Q�-c��cal1
ADDRESS OF PROPERTY:
NAME OF OWNER s
ADDRESS OF OWNER: �—
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be executed this ►y T day of
OWNER: i
�i Name
APPROVED: By:
Title
By: i'!�•�: I �j�
Gilding Official —�
City of Tigard
STATE OF OREGON ) so.
County of Waohington ) J
\ , , 197".
PeHsonally appeared before me the above name+d
and acknowledged the forugoing instruuwn tobe
/I— voluntary act and dead.,.
Notary Public f Oregon
MY Commission Expires:
LA
EXHIBIT "B" t .
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND RELEASE OF RPSTRIC.TION
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 6-7 , 19 74,
recorded in Book978 page _ 690_ Deed Record of Wn!:hington
County, Oregon, is hereby authorized and approved.
DH::;CRII-TIOff OF PROPERTY!
Summerfield lot 196
As recorded in Book 34, Page 5, plat
Records of Washington County, Oregon
OWNER: Mr. h Mrs. R. E. Turner
AUILDING PERMIT NUMBERS 4-83
II9UILDING ADDRESS: 10165 S.W. Highland Drive
This is to certify the said structure meets with the require-
tr,orts of the Building Code of the City of Tigard and the above
tef,renced restriction is'hereby released and terminated.
IN WITNFOS WHERF,OF, the undersigned authorized officer of the'
City of Tigard has caused this certificate and release of restriction
to be executed this , day of 19_,.•_•
Titles_ ~�
:;TA'L'E OF ORWON
as.
County of Washington
On this __ __ day of _ 19., personally
nhpoKred before me the above ruined +^� whose
signature appears hereon and who acknowledged to we that he executed
the r;nme in his offical capacity on behalf of the City of Tigard.
Notary public of Oregon ^�
My Commission expires:
9865
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MCN BY THESE PRESENTS, That occupancy of residential
structure (s) on the following described lends prior to the recording
of an occupancy permit releasing the restriction in the Dee6 Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY:
34. i t�cu�e. � � a�c.k-
CA Vllushi��c'} ��. Con%-1 C7reGjoll
ADDRESS OF PROPERTY:
NAM OF OWNER f'\s. F Ae s \�.E=:: 4 i c,in e► �,
ADDRESS of owNER: til
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be executed this k•.k day of p-1c,L, 19Zf
OWNER: j
APPROVED: Byt
Tule
By: 41•1c � ..
ilding Official
City of Tigard
STATE OF OREGON ) on.
County of Washington 19Z.L.
--)�ersonai.ly appeared before me the above named __ l
-- ►-r-��=�-_� and acknowledged the foregoing instrument to be
volwaary act and deed. - )
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1-1 TA THOSMgLN. MramN of Mo.,nu b :'Iw.gnnr My Commimsion E)Wirse:
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STM E OF OREGON
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County of Washlrtpton
I Roper 1Momssen Dlrectp of Records
and EFecttons and Ex-Of,
lclo Recorder of Con-
veyonces for Said county, do hereby certify
that the *thin Instrument of wtluN was
received and recordW In book of records
No. _...,...__..,_
of said County
Wltneu my hand and seof affixed.
ROGER THOMSSEN, Director of
Records 6 Elections